Lifestyle medicine pillars for women's heart health

Lifestyle factors, including physical activity, dietary patterns, sleep, stress response, social connections, and use of risky substances, are increasingly recognized as predictors of cardiovascular disease (CVD) and cardiovascular health, with significant overlap between the American Heart Association's Life's Essential 8 guidelines and the 6 pillars of Lifestyle Medicine (LM). Assessing and addressing lifestyle factors have a foundational role in the prevention and management of cardiovascular disease and improving cardiovascular health. Sex and/or gender related factors can influence access, engagement, and adherence to guidelines around lifestyle and may lead to differential effects on cardiovascular risk and outcomes that are not well understood. This review summarizes the research on sex and gender factors that impact lifestyle medicine for women, including motivations and barriers to adopt LM recommendations, impact on cardiac risk factors and physiology, and interactions among LM pillars that influence women's cardiovascular risk and outcomes. Recognition of the reproductive age and perimenopausal predictors of higher cardiovascular and cardiometabolic risks can provide windows of opportunity to discuss lifestyle and primary prevention across the lifespan. While more research is needed, a deeper understanding of these sex and gender differences related to lifestyle and heart health for women has the potential to support earlier discussions and referrals when indicated to preventive cardiologists and LM certified clinicians, including physicians, dieticians, exercise physiologists, sleep specialists, social workers, behavioral therapists, and coaches. Alignment of LM education with women's symptoms, preferences, and goals may increase adherence to guidelines around physical activity, whole food plant predominant nutrition, sleep quality and quantity, stress management, social connections and avoidance of risky substances, leading to reduced cardiovascular risk and improved cardiovascular health and outcomes.