Cardiovascular risk reduction - quality prescribing guidance 2026-2029: consultation

8. Healthier Lifestyle

8.1 Background

Adopting a healthier lifestyle can reduce an individual's risk of cardiovascular disease. Scotland's Population Health Framework published in 2025 has a renewed and long-term focus on prevention across all the areas that affect health. Its aim is two-fold – to improve Scottish life expectancy whilst reducing the life expectancy gap between the most deprived 20% of local areas and the national average by 2035.

The choices we make about our health are shaped, and often limited by, the environments and systems around us. Enabling healthier lives centres on improved nutrition and physical activity to promote healthy weight and prevent cardiovascular disease, cancer, type 2 diabetes (T2D) and other chronic conditions (non-communicable diseases).

The population health framework builds on existing policies including:

• Good Food Nation Plan which represents a fresh approach to food policy and embeds long-term strategic transformation into decision making at both the national and local levels
• Physical activity for health: framework which advises on action to improve levels of physical activity at both national and local level which is firmly founded on evidence-based international guidance
• Tobacco and Vaping Framework: Roadmap to 2034 which has an initial focus on improving smoking cessation services and routes for support and a marketing campaign to deter youth vaping by highlighting the risks and dangers of vapes

The social determinants of health are the social, cultural, political, economic and environmental conditions in which people are born, grow up, live, work and age, and their access to power, decision-making, money and resources that give rise to these conditions of daily life. The social determinants of health influence a person’s opportunity to be healthy, their risk of illness, health behaviours and healthy life expectancy.^[15]

These differences between different population groups can lead to health inequalities which include:^[16]

• Health-related risks: some people may find it harder to access healthy foods than others
• Healthcare: some people may find it harder to access healthcare services than others
• Health status: some people may have a shorter life expectancy than others

When supporting individuals through lifestyle changes it is important to assess the social determinants of health and use a shared decision-making model to better guide them to the most appropriate resources.

8.2 Modifiable Lifestyle Risk Factors

8.2.1 Diet

Individuals are encouraged to follow the advice in NHS inform Eat Well Guide which helps support individuals to make healthier food choices. ^[17]

A healthy diet rich in fruits, vegetables, whole grains and low-fat dairy can help to reduce the risk of heart disease by maintaining blood pressure and cholesterol levels.

Excessive intake of sodium is directly linked to high blood pressure, and it has been shown that the higher the daily salt intake, the higher the systolic blood pressure. ^[18] More information is available in the hypertension chapter.

The high levels of omega-3 fatty acids in oily fish are good for heart health.^[19] Eating a portion of oily fish – such as salmon and trout – each week can also help to lower the risk of developing heart disease.

NHS inform has information for citizens on healthy diets and weight loss. It highlights the barriers individuals may face when trying to eat well and stay active and challenges the idea that maintaining a healthy weight is just about will power and personal choices.

Barriers to eating well and staying active include:

• lack of amenities – it can be hard to make healthy choices if there aren’t shops nearby
• employment – it can be hard to make healthy choices if your breaks at work are short and rushed
• advertising – less healthy food is often more heavily promoted
• cost – less healthy food is often cheaper than healthier options
• opportunities for activity – it’s hard to be active if there aren’t safe, affordable, and welcoming places to walk, cycle, wheel, or be active
• biology and genetics – our bodies and family history can influence weight, appetite and how easily we gain or lose weight

Individuals should be supported to make small, realistic changes which can have a big impact over time.

8.2.2 Alcohol

Even light to moderate alcohol consumption may increase cardiovascular risk and individuals should be advised to reduce alcohol consumption.17

Individuals should be advised that to reduce health risks, on any single drinking occasion they should:

• limit how much they drink
• drink more slowly
• drink with food
• alternate alcoholic drinks with water or non-alcoholic drinks
• have several drink-free days each week

Individuals concerned about their drinking can be signposted to NHS inform and to their GP.

Drinking more than the levels outlined in the low-risk drinking guidelines on a regular basis increases the risk of serious health conditions including heart disease.

The Chief Medical Officers’ guideline has advice on low risk drinking for both men and women.

Other citizen resources include:

• Alcohol - BHF
• Alcohol and your health | Alcohol Focus Scotland
• SHAAP (Scottish Health Action on Alcohol) Advice for heavy drinkers who are thinking about cutting back or stopping drinking alcohol

8.2.3 Physical Activity

In general, the more time spent being active, the greater the health benefits. Even a small increase in physical activity can improve health and quality of life.

A recent meta-analysis found that increasing daily steps by 1,000 steps correlated with a reduction of all-cause mortality of 15%, and a 500-step increment correlated with a reduced risk of CV mortality by 7%.^[20] It also found that as few as 2,337 steps a day started to lessen the risk of dying from heart and circulatory diseases, while at least 3,867 steps reduced the risk of dying from any cause.

People who do regular physical activity have lower risk of T2D and heart disease. Physical activity also improves sleep, helps maintain a healthy weight, manages stress and can improve quality of life.

Further information on physical activity guidelines including for children, adults, adults with a disability, older adults and during pregnancy is available via NHS inform.

8.2.4 Stress

Stress can be defined as an individual's feeling of inability to cope with overwhelming demands. The effect of a stressful situation and the response to it, vary between individuals. Stressful situations can be acute and short-lived or accumulate over time and become chronic.^[21]

Psychosocial stress, which includes stress symptoms as well as direct stressors such as loneliness and critical life events, is associated with the development and progression of heart disease. Stress has direct biological effects but is also highly correlated with socioeconomic and behavioural risk factors like smoking.12

NHS inform has information on handling stress including an online course SilverCloud - Space from Stress designed to help individuals learn new skills to cope with stress, boost their self-esteem and improve their resilience. It uses interactive exercises, diaries and calendars and SMART (specific, measurable, assignable, realistic, and time-bound) goals to help individuals plan ahead and deal with stressful situations and events.

8.2.5 Tobacco Smoking ^[22]

In recent decades progress has been made to reduce the harms associated with tobacco smoking including public health policies such as the banning of smoking in public places and the Tobacco and Vaping Roadmap to 2034.

Cessation of tobacco smoking reduces the risk of cardiovascular disease. Individuals should be asked at every opportunity if they smoke or have recently stopped smoking. Support should be offered and available for individuals to commence their individual stop smoking attempt. See risk factor chapter on smoking for more detailed information.