Mixed
Adherence to low-risk lifestyle factors (whole food/Mediterranean diet, physical activity, stress management, sleep) shifts tissue cross-talk from a proinflammatory to an anti-atherogenic milieu, reducing cardiovascular risk independently of conventional risk factor changes.
Focus on eating whole, unprocessed foods (like the Mediterranean pattern with olive oil/nuts) and staying active, rather than obsessing over calorie counts or fat grams. This approach improves your body's internal environment (reducing inflammation) and protects your heart, even if your weight or cholesterol numbers don't change drastically.
Collectively, low-risk lifestyle factors cause a set of phenotypic adaptations shifting tissue cross-talk from a proinflammatory milieu conducive for high-risk atherosclerosis to an anti-atherogenic milieu.
Why this rating
Based on a review of RCTs (PREDIMED, CENTRAL-MRI) and mechanistic studies, though it is a review paper rather than a single primary trial.
Source
Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors
Katharina Lechner et al. · European Journal of Preventive Cardiology · 2019
DOI 10.1177/2047487319869400
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