Modifiable Lifestyle Factors in Cardiovascular Disease Prevention: Current Evidence and Future Directions

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide despite substantial advances in pharmacologic and interventional therapies. Modifiable lifestyle behaviors are major determinants of cardiovascular risk and essential targets for primary and secondary prevention. This narrative review summarizes contemporary evidence on smoking cessation, physical activity and exercise, nutrition, alcohol consumption, sleep health, sedentary behavior, and integrated lifestyle strategies. Evidence from randomized trials supports cardiovascular risk-factor and event reduction with selected dietary and exercise interventions (i.e., Mediterranean and Dietary Approaches to Stop Hypertension (DASH)), whereas many estimates for sleep, sedentary behavior, alcohol and composite lifestyle scores derive from observational studies and should be interpreted as associations rather than causal effects. Conversely, unhealthy dietary habits, tobacco use, excessive alcohol consumption, poor sleep quality, and prolonged sedentary behavior contribute to endothelial dysfunction, inflammation, metabolic dysregulation, and accelerated atherosclerosis and subsequent increased risk of CVD. Emerging evidence further underscores the importance of considering lifestyle behaviors collectively rather than individually, as their effects may be synergistic. Comprehensive lifestyle modification remains one of the most effective and cost-effective approaches to reducing cardiovascular risk and should be integrated into routine clinical practice and public health initiatives.