1

Eating Habits, Lifestyle, and Genetics on the Incidence of Cardiovascular Disease

Yiasmene Chirgott, Marauka Santucci, Michaela Watkins

Centofanti School of Nursing, Youngstown State University

NURS 3749 Nursing Research

Ms. Randi Heasley MSN, RN, CNE

20 June 2021

Abstract
 2
The purpose of this paper is to answer the following research question: How do eating habits,

lifestyle, and genetics contribute to cardiovascular disease (CVD) and what nursing interventions

can mitigate these factors? To do this, we provide a comprehensive overview of the effects that a

sedentary lifestyle and unhealthy eating choices, obesity, and genetics have on contributing to

cardiovascular disease. Research has been gathered from various scholarly databases including

CINAHL, PubMed, and EBSCO. We find that cardiovascular disease can be extremely

preventable with the right eating habits and lifestyle choices. We also provide recommendations

for nursing practice that will aid in the reduction of mortality from cardiovascular diseases

among populations.

Keywords: Cardiovascular Disease, Obesity, Physical Activity, Eating Habits, Dietary Habits,

Genetics

Eating Habits, Lifestyle, and Genetics on the Incidence of Cardiovascular Disease

 3
The purpose of this research paper is to explore how eating habits, physical activity, and

genetics can increase or decrease the risk of developing cardiovascular disease. We ask the

following research question: How do eating habits, lifestyle, and genetics contribute to CVD and

what nursing interventions can mitigate these factors? The Centers for Disease Control and

Prevention (CDC) states that CVD is the leading cause of death for men and women in the

United States, with some of the highest incidents occurring in certain racial and ethnic groups

(2020). Eating habits, physical activity, and weight are factors that can be controlled, and it is

important for an individual to make healthy lifestyle choices to decrease their chance of

developing CVD. While an individual's genetics are not within one’s control, genetics still play a

substantial role in how likely one is for developing the disease. According to the World Health

Organization (WHO), CVD takes an estimated 17.9 million lives each year topping the charts as

the number one cause of death globally (2021). Due to the prevalence of CVD, educating people

on what increases their chance of developing the disease can help save the lives of millions. The

significance of nursing lies in what we can do to support and educate patients regarding CVD,

their current condition, and recommended changes they can make in order to improve or control

the disease.

Search Strategy Narrative

To gather the information to write this research paper, 3 main databases were used: CINAHL,

PubMed, and EBSCO. Using keywords such as “Cardiovascular Disease”, “Obesity and CVD”,

“Eating habits in relation to CVD”, and “Genetics and CVD”, we identified a total of 386

articles. To further narrow down the articles, we used specific filters such as publication date by

year (2006 to 2021), articles in full text, and peer reviewed articles. After further review, 8

articles were chosen in relevance to the topic of cardiovascular disease to include in this paper.
 4
Eating Habits

According to Donald C. Thompson II, cardiovascular disease is characterized by “a

number of heart and blood vessel diseases”, some of which being hypertension, coronary heart

disease, congestive heart failure, atrial fibrillation, myocardial infarction, and strokes (Thompson

II, 2020, p.1). Cardiovascular disease is an extremely common health issue, not only among

Americans, but also throughout the world. One of the biggest contributing factors of CVD is an

individual’s eating habits, which can either increase or decrease a person’s risk of developing it.

One of the most common diets recommended to reduce the risk of CVD is a low fat, low

sodium diet, with an abundance of fruits and vegetables. More recently, doctors and

professionals are suggesting the use of the Mediterranean Diet to help reduce the risk of CVD,

and mortality related to CVD. When following the Mediterranean Diet, an abundance of fruits,

vegetables, nuts, legumes, and unprocessed cereals are consumed. Furthermore, a small amount

of meat, meat products, and dairy are consumed. Additional characteristics of this diet allow for

up to 40% of the calories consumed to come from extra virgin olive oil, wine with meals, and

high fiber foods. Fiber is proven to have many benefits on the cardiovascular system. For

example, fiber helps to reduce inflammation associated with CVD. Fiber also protects the cells

throughout the entire body from becoming insulin resistant, which decreases the risk of CVD.

Once the resistance begins to wear away, the risk of developing CVD increases, yet most

individuals only consume about half of the recommended intake of fiber. Thompson II states in

his article that “increased fiber intake is associated with a 15-30% decrease in all-cause and

cardiovascular related mortality when comparing people who eat the highest amount of fiber to

those who eat the least” (Thompson II, 2020, p.2).

 5
Diets that consist of a large consumption of animal protein, specifically red meat,

saturated fat, sweets, sodium, and food additives are shown to increase inflammation, thus

increasing the risk of CVD (Thompson II, 2020, p.2). Evidence has shown that animal protein

has a large amount of sulfur amino acids, and this is thought to be why consuming large amounts

of it can lead to CVD, while protein that comes from plants is said to help reduce the risk of

CVD (Naghshi, Sadeghi, Willett, and Esmailzadeh, 2020, p.3). The article, “Dietary intake of

total, animal, and plant proteins and the risk of all cause, cardiovascular, and cancer mortality:

Systematic review and dose-response meta-analysis of prospective cohort studies” states that the

“intake of plant protein was associated with a lower risk of mortality from all causes and

cardiovascular diseases, which is consistent with its beneficial effects on cardiometabolic risk

factors, including blood lipid and lipoprotein profiles, blood pressure, and glycemic regulation”

(Naghshi et al., 2020, p.2). This is thought to be because plant proteins have bioactive peptides,

which are very beneficial to the human body.

Overall, an individual’s eating habits can contribute to their risk of developing CVD

(Thompson II, 2020, p.4). In Thompson’s article, the results show that “eating patterns have been

established that tremendously affect risks in all areas of CVD” (Thompson II, 2020, p.5). For

example, in Naghshi, Sadeghi, Willett, and Esmailzadeh’s article, the results showed that “intake

of plant protein was associated with a lower risk of all cause and cardiovascular disease

mortality” (Naghshi et al., 2020, p.2). Beyond eating habits, physical activity and obesity are two

critical factors research has linked to CVD.

Lifestyle: Physical Activity and Obesity

 6
Obesity is highly related to an increased risk of cardiovascular mortality. The purpose of

the article, “Effects of body fatness and physical activity on cardiovascular risk: Risk prediction

using the bioelectrical impedance method” was to look at the effect of body fat percentage (BF

%) on the occurrence of and mortality from cardiovascular diseases, and to study the effect

physical activity has on BF%. (Calling, Hedblad, Engstrom, Berglund, Janzon, 2006).

Researchers believe that physical activity is beneficial for overweight and obese individuals to

reduce their cardiovascular risk. Therefore, the study aims to answer the question of whether

there is a lower risk of having a cardiovascular event (CE), or cardiovascular disease, in men and

women who are physically active versus those who have low levels of physical activity.

The study included 26,942 men and women between the ages of 45 and 73. The

participants without a history of CVD were followed up for the incidence of coronary events,

strokes, and death from CVD over a seven-year timespan. Furthermore, BF% was evaluated in

relation to the cardioprotective effects of leisure time physical activity. Other lifestyle factors

that contribute to CVD include one’s medical history, medications, and lifestyle risk factors such

as smoking, alcohol consumption and diabetes mellitus. According to the classifications set by

the World Health Organization, “5,111 of the men and 5,501 of the women were overweight

with a BMI between 25.0-29.9 km/m2. In addition, 1,299 of the men and 2,221 of the women

were obese with a BMI greater than 30 kg/m2” (Calling et al. 2006). The results show that

during the seven-year follow-up, 1,315 participants suffered from either a CE or ischemic stroke,

while 425 participants died from CVD. The researchers found that there were positive

correlations between BF% and BMI, as well as BF% and waist circumference, that were

associated with increased risks of CVD. Overall, results state:

 7
Physically active individuals with high BF% had a reduced cardiovascular morbidity and

mortality compared with subjects with low activity, with the exception of no significantly

reduced CVD mortality among women with high BF%. Other studies have similarly

shown that physical activity is cardio-protective in overweight and obese individuals

(Calling et al., 2006, p. 573).

Due to the global increase of cardiovascular diseases, there has been a lot of attention

focused on lifestyle choices such as physical activity for those who develop the disease. In

developed countries, cardiovascular diseases and cancers cause approximately 75% of deaths in

individuals older than 65 years (Naseri et al., 2020, p. 2). The Global Burden of Disease study

states that in countries like Europe and Iran, CVDs account for 20-46% of all deaths. In Iran

alone, 46% of overall deaths are because of CVDs. The aim of the study conducted by Naseri,

Amiri, Masihay-Akbar, Jalali-Farahani, Khalili, and Azizi (2020) was to evaluate what effect

physical activity had on the prevalence of CVD in middle-aged men and women over a decade.

This study has been conducted on data from later phases of the Tehran Lipid and Glucose Study

(TLGS). “The TLGS is an ongoing population-based cohort, designed to determine the

prevalence of non-communicable diseases and their risk factors, conducted on a representative

sample of residents of district 13 of Tehran” (Naseri et al., 2020, p. 2). 1,751 men and 2,322

women greater than or equal to 40 years old, and without a history of CVD, were included in the

study. Physical activity, leisure time, and occupational activities were assessed using a validated

version of the Modifiable Activity Questionnaire (MAQ). The questionnaire required

participants to report the frequencies and durations of physical activities for 12 months. People

who were employed were asked to state the hours per week they worked and the physical

activities they participated in at work. The recommended level of physical activity was set at 150
 8
minutes of aerobic physical activity per week. Additionally, measurements of physical activity

were taken at two time periods (baseline and the closest measurement before the cardiac event

took place). From there, categories that showed the extent in which participants followed

guideline recommendations over time were labeled as “Compliers” and “Non-compliers.”

Participants who had low levels of activity were said to have not met the guidelines of being

moderately or highly active. Results show that adherence to physical activity recommendations

increased from 63.5% to 66.6% between the two measurements of baseline and before a cardiac

event throughout the study.

Based on our results, middle-aged men who either constantly adhere to physical activity

guidelines or adapt an active lifestyle over time have lower risk of developing CVD and

CHD. The current study demonstrated that compared to non-compliers, middle-aged men

who maintained recommended levels of physical activity over time had the lowest CVD

and CHD risk (Naseri et al., 2020, p. 5).

Exercise is a lifestyle choice that positively contributes to preventing CVD risk factors

such as hypertension, diabetes, and hyperlipidemia (Naseri et al., 2020, p. 6). However, physical

activity exerts its cardioprotective effects by interfering with the build-up of plaque on artery

walls. For the direct effects to occur, physical activity needs to be maintained over time. In brief,

both starting and continuing the recommended levels of physical activity, in addition to other

lifestyle behavior changes, can have positive effects on reducing BF%, waist circumference,

BMI, and the risk of CVD in both men and women at any age (Naseri et al., 2020, p. 9).

Alongside eating habits and lifestyle factors, genetics is a major contributor to the progression of

cardiovascular disease.
 9
Genetics

Aside from eating habits, physical activity and obesity, the role that genetics plays in

association with cardiovascular disease is gaining a sizable amount of attention due to evidence

showing that CVD has a large genetic factor. In the article, “Mitochondrial DNA copy number is

associated with all-cause mortality and cardiovascular events” the purpose was to investigate

whether the mitochondrial DNA (mtDNA) is associated with peripheral arterial disease (PAD)

and mortality related to cardiovascular events. This was a quantitative PCR-based study with 236

male patients with PAD being compared to 249 controlled males. The baseline characteristics

between the PAD patients and the control patients were compared with descriptive statistics

presented by means and quartiles (Koller et al. 2020, p. 1). Mitochondria is a double membraned

cell organelle which supplies energy by synthesizing adenosine triphosphate through oxidative

phosphorylation. An increase or decrease in the amount of mtDNA is associated with the cause

of many diseases and cancers. This study explains that a low number of mtDNA is a cause of

cardiovascular events.

Individuals in the lower quartile of mtDNA had a twofold increased risk for PAD. Also,

the 25th percentiles and 50th percentiles for mtDNA were lower in patients than in controls, while

the 75th percentile was higher. During the seven-year follow-up, 37 of the 236 patients had died

with 12 being cardiovascular related (Koller et al. 2020, p. 2-4). These findings show that low

mtDNA is associated with CVD and gives patients twice the risk of mortality. The risk for an

incident of cardiovascular events is also doubled for those in the lowest quartile. An explanation

to these findings is still being studied, but some research shows that mitochondrial dysfunction

disrupts cell homeostasis; and this has been hypothesized to be involved in the development and
 10
progression of CVD (Koller et al. 2020, p. 8). Mitochondrial DNA is not the only genetic factor

contributing to CVD, as inflammatory markers play a role as well.

In addition to mtDNA, inflammatory markers are found to have an impact on the risk of

developing CVD. In a study done by Edward Yu, Eric Rimm, Lu Qi, Kathryn Rexrode, Christine

Albert, Qi Sun, Walter Willett, Frank Hu, and JoAnn Manson (2016), the Nurse’s Health Studies

of 2016 were reviewed. It focused on understanding the CVD etiology in women. There was a

link between CVD risk and inflammatory markers such as C-reactive protein and interleukin-6,

which found those to be predictive of CVD events. Also, low levels of HDLs and high levels of

homocysteine and lipoproteins were associated with an elevated risk. On the other hand, higher

levels of plasma n-3 fatty acid chains were associated with a lower risk. Other genes that were

associated with an increased risk of CVD are complement factor H, ABCA1, CETP, NFB1, and

haptoglobin with a HbAc1 higher than 6.5%. Blood type also plays a role, as people with type O

have a lower risk than other groups (Yu et al. 2016, p. 6-7). Another genetic factor involved in

the risk of CVD is race.

Studies on cardiovascular disease over the years have consistently demonstrated higher

rates of CVD among Blacks compared to Whites. In the article, “Black–White Differences in

Cardiovascular Disease Mortality: A Prospective US Study, 2003–2017,” it focuses on

determining the factors that explain the higher Black: White ratio of CVD mortality rate among

United States adults. This study includes 29,054 participants with 41% of them being Black and

54.9% being White. The study conducted participants younger than 65 years and those 65 and

older for 3 reasons: Black adults develop CVD risk factors at an earlier age than Whites,

previous research shows that there is a decrease in the Black to White mortality ratio as age

increased, and age focus allows for different policy implications (Tajue et al. 2020, p. 1-2).
 11
Racial differences associated with increased CVD risk include socioeconomic factors,

psychosocial factors, and blood pressure. As a result of the study, it was concluded that Black

participants were more likely to have a lower education, less annual income, no health insurance,

depressive symptoms, and higher stress. Also, Blacks reported to be more likely to not be living

with a significant other, to smoke cigarettes, to have a longer ambulance response times, and

limitation regarding access to high performing hospitals. It is also clinically known that Blacks

have a higher blood pressure than Whites. All these findings in the Black participants are directly

associated as to why CVD mortality rates are higher in Blacks than in Whites. Implementing

national policies that are aimed at addressing social issues could potentially decrease this Black

to White ratio difference in CVD mortality rates (Tajue et al. 2020, p. 3,7). Genetics has a great

relation to CVD and its mortality rates with key factors being mtDNA, race, and other specific

genes.

Conclusion

In this paper, we answered the following question: How do eating habits, lifestyle, and

genetics contribute to CVD and what nursing interventions can mitigate these factors? We

achieved this by exploring recent research on CVD causes and preventative measures. Overall,

there are many interventions that can help to decrease the risk of cardiovascular disease (CVD).

We highlight the importance of an individual's eating habits, physical activity, and genetics in

CVD prevention. Eating habits that can help to reduce the chance of developing CVD are to

follow the Mediterranean Diet, which means eating many fruits, vegetables, nuts, legumes,

unprocessed cereals, and a small amount of meat, meat products, and dairy products. In addition

to the Mediterranean Diet, increasing one’s fiber intake is proven to tremendously decrease the

risk of CVD. Along with healthy eating habits, physical activity is associated with lower body fat
 12
percentage, BMI, and waist circumference leading to reduced cardiovascular risk. Therefore, if

one includes the recommended 150 minutes of physical activity into their weekly routine, there

is a lesser risk of developing cardiovascular disease. Moreover, what truly contributes to CVD is

controlling risk factors such as hypertension, diabetes, and hyperlipidemia. Some of the major

genetic factors resulting in an increased risk of CVD are mitochondrial DNA (mtDNA), race,

and other specific genes. A low mtDNA is shown to be associated with CVD and gives patients

twice the risk of mortality. Blacks have a higher risk due to socioeconomic and psychosocial

factors. With genetics, there is not much prevention to minimize the risk of CVD, rather, it is

important to understand genetic risk factors and monitor one’s health accordingly. For the race

aspect, addressing social issues could minimize CVD rates in high risk racial groups, such as

Blacks.

Significance for Nursing Practice

Cardiovascular disease can be extremely preventable. Therefore, it is very important as a

nurse in practice to reinforce the importance of adopting a healthy lifestyle as well as support,

listen, encourage, advise, and direct patients on how to adjust the modifiable risk factors. They

can encourage patients to address and become aware of what puts them at risk. Nurses should

provide their patients with information on what increases and decreases his or her risk of

cardiovascular disease. Some patients will try to adjust multiple factors all at once, become

discouraged and return to unhealthy habits. Advising patients to make changes slowly by setting

small, realistic, and achievable goals can help them to stay on track. There are numerous nursing

interventions to be done for cardiovascular patients in the clinic including monitoring vital signs,

helping to modify diet/lifestyle habits, and coordinating diagnostic examinations. These

interventions can identify signs of early onset CVD as well as provide resources needed for
 13
prompt treatment. Explaining and sharing diagnostic results can help patients to make informed

decisions regarding their health. Educating patients and providing teach-back are key in nursing

practice specifically related to cardiovascular disease. Ultimately, CVD is a pervasive, while

highly preventable disease that nursing professionals have the opportunity to address in the

routine care of patients.

 14
References

Calling, S., Hedblad, B., Engström, G., Berglund, G., & Janzon, L. (2006). Effects of body

fatness and physical activity on cardiovascular risk: Risk prediction using the

bioelectrical impedance method. Scandinavian Journal of Public Health, 34(6), 568–575.

https://doi.org/10.1080/14034940600595621

Centers for Disease Control and Prevention. (2020, September 8). Heart Disease Facts. Centers

for Disease Control and Prevention. https://www.cdc.gov/heartdisease/facts.htm.

Koller, A., Fazzini, F., Lamina, C., Rantner, B., Kollerits, B., Stadler, M., Klein‐Weigel, P.,

Fraedrich, G., & Kronenberg, F. (2020). Mitochondrial DNA copy number is associated

with all‐cause mortality and cardiovascular events in patients with peripheral arterial

disease. Journal of Internal Medicine, 287(5), 569–579.

https://doi.org/10.1111/joim.13027

Naghshi, S., Sadeghi, O., Willett, W. C., & Esmaillzadeh, A. (2020). Dietary intake of total,

animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality:

systematic review and dose-response meta-analysis of prospective cohort studies. BMJ,

m2412. https://doi.org/10.1136/bmj.m2412

Naseri, P., Amiri, P., Masihay-Akbar, H., Jalali-Farahani, S., Khalili, D., & Azizi, F. (2020).

Long-term incidence of cardiovascular outcomes in the middle-aged and elderly with

different patterns of physical activity: Tehran lipid and glucose study. BMC Public

Health, 20(1), 1–10. https://doi.org/10.1186/s12889-020-09747-6

 15
Tajeu, G. S., Safford, M. M., Howard, G., Howard, V. J., Chen, L., Long, D. L., Tanner, R. M.,

& Muntner, P. (2020). Black–White Differences in Cardiovascular Disease Mortality: A

Prospective US Study, 2003–2017. American Journal of Public Health, 110(5), 696–703.

https://doi.org/10.2105/ajph.2019.305543

Thompson II, D. C. (2020). The Dimensions of Cardiovascular Disease and Nutritional

Therapeutic Management, 43(3).

World Health Organization. (n.d.). Cardiovascular diseases. World Health Organization.

https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1.

Yu, E., Rimm, E., Qi, L., Rexrode, K., Albert, C. M., Sun, Q., Willett, W. C., Hu, F. B., &

Manson, J. A. E. (2016). Diet, Lifestyle, Biomarkers, Genetic Factors, and Risk of

Cardiovascular Disease in the Nurses’ Health Studies. American Journal of Public

Health, 106(9), 1616–1623. https://doi.org/10.2105/ajph.2016.303316