Nutrition and cardiovascular prevention
There is strong evidence demonstrating the role of nutrition in the prevention of cardiovascular risk . There are numerous studies in this regard, often contradicting each other, so caution is required in interpreting the results of these and how, therefore, a single dietary change can affect cholesterol levels and reduce cardiovascular risk .
Dietary factors and lifestyle in general largely influence the development of cardiovascular problems, directly or through their action on plasma lipid levels, blood glucose, blood pressure and body weight.

Physical activity and cardiovascular risk
A sedentary lifestyle is one of the major independent cardiovascular risk factors. In fact, carrying out regular physical activity involves a decrease in the risk of numerous adverse outcomes in all age groups, with a reduction in mortality from all causes. In addition, it helps in prevention in healthy individuals, in those with risk factors and in patients with heart disease.
In fact, physical activity improves blood pressure levels, cholesterolemia, triglyceridemia, body weight and diabetes compensation with effects in all age groups and in all sexes. The type of physical activity that is recommended is of moderate intensity for more than 30 minutes a day, at least 5 times a week. Or intense physical activity for more than 20 minutes a day, at least 3 times a week.

Lifestyle correction: what we need to do

Reduce the consumption of saturated fatty acids
The 2019 European guidelines for the treatment of dyslipidemia recommend reducing the consumption of saturated fatty acids to reduce cholesterol levels. Their intake should be less than 10% of the daily calorie intake. Furthermore, it is advisable to avoid the intake of foods containing trans fatty acids generally present in margarines and industrial products.
Some studies highlight a neutral role of saturated fat intake on overall cardiovascular risk and that the only fats that actually increase cardiovascular risk are trans fats. However, fat intake should come mainly from sources of unsaturated fatty acids, in particular monounsaturated and polyunsaturated fatty acids of the ω3 and ω6 series, present respectively in extra virgin olive oil and in oils in general, in fish, in nuts.
There are insufficient data available to make a recommendation regarding the optimal ratio of ω3 and ω6 fatty acids. Dietary cholesterol intake should be greater than 300 mg / day, particularly in people with high cholesterol levels. However, significantly reducing dietary cholesterol does not always result in a significant reduction in plasma levels. Both because the intestine absorbs cholesterol from biliary recirculation, and because the human body is equipped with an endogenous cholesterol synthesis system.

Carbohydrates Carbohydrates have a “neutral” effect on cholesterol levelsalthough excessive consumption can still have a negative effect on HDL-C and triglyceride levels. Carbohydrate intake should vary between 45-55% of total daily kcal, since both higher and lower percentages were associated with increased mortality. The intake of simple sugars must not exceed 10% of the total energy. A greater restriction may instead be indicated for overweight subjects, with hypertriglyceridemia, suffering from metabolic syndrome or diabetes mellitus. It is advisable to prefer whole grains, in order to increase the fiber intake and reduce the consumption of refined grains.

Moderateto avoid an excessive intake of simple sugars and should be abolished in those individuals with high triglycerides or overweight. Alcohol intake has a major impact on triglyceride levels. In individuals with excessive weight and / or abdominal fat, calorie intake should be reduced and energy expenditure increased. The reduction in body weight, even if modest (5-10% of body weight), can improve some forms of dyslipidemia and positively affects other cardiovascular risk factors.

Eating dietary fibers that reduce cholesterol levels
Dietary fibers have a cholesterol-lowering effect. The introduction of 40-45 g of fiber per day is recommended, preferably from wholemeal products, fruit and vegetables.

Choosing the right protein sources
From the point of view of protein sources , the guidelines recommend preferring skinless poultry, lean and semi-fat fish and to consume instead, in moderation, beef, lamb, pork, veal, seafood and crustaceans and reduce the possible cold cuts, sausages and processed meat.

Dairy products and eggs
It is recommended to choose dairy products and cheeses derived from skimmed or semi-skimmed milk and limited consumption of eggs is allowed.

Moderate consumption of dried fruit
Furthermore, a moderate consumption of unsalted nuts and various seeds is suggested, avoiding coconut instead due to the high saturated content.
Another significant lifestyle change recommended by the guidelines is the cessation of smoking with a view to global prevention.

Cholesterol and lifestyle correction: where it can go
Lifestyle modifications are effective in reducing overall cardiovascular risk, but sometimes plasma cholesterol levels change little (on average by 5%). With this in mind, it is important to maintain a healthy lifestyle by preferring the most “protective” foods and keeping the body weight within a normal range and to contact a doctor if cholesterol levels remain altered.

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