Evidence mapPaperPMID 31408370Full record

ReviewEuropean journal of preventive cardiology2020

Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors.

Katharina Lechner, Clemens von Schacky, Amy L McKenzie, Nicolai Worm, Uwe Nixdorff, Benjamin Lechner, Nicolle Kränkel, Martin Halle, Ronald M Krauss, Johannes Scherr

Open access · bronzeAbstract readReview
In one paragraph

Review in European journal of preventive cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 195 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
195citing papers in PubMed, 4 pooled it
16.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

195 citing papers in PubMed, 4 syntheses or guidelines pooled it, 352 citations in OpenAlex.

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  19. Frontiers in pharmacology · 2026
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135 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 2 countries.

Katharina LechnerTechnical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany.
Clemens von SchackyPreventive Cardiology, Ludwig-Maximilians University, Munich, Germany.
Amy L McKenzieVirta Health, San Francisco, USA.
Nicolai WormGerman University for Prevention and Health Care Management, Saarbrücken, Germany.
Uwe NixdorffEuropean Prevention Centre, Medical Centre Düsseldorf (Grand Arc), Germany.
Benjamin LechnerDepartment of Internal Medicine IV, Ludwig-Maximilians University, Munich, Germany.
Nicolle KränkelCharité - Universitätsmedizin Berlin, Klinik für Kardiologie, Campus Benjamin Steglitz, Berlin, Germany.
Martin HalleTechnical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany.
Ronald M KraussChildren's Hospital Oakland Research Institute, USA.
Johannes ScherrTechnical University of Munich, School of Medicine, Department of Prevention, Rehabilitation and Sports Medicine, Germany.
Ludwig-Maximilians-Universität München · DECharité - Universitätsmedizin Berlin · DEGerman Centre for Cardiovascular Research · DEInstitute for Sports Medicine · DEUniversitätsklinik Balgrist · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Despite major efforts to reduce atherosclerotic cardiovascular disease (ASCVD) burden with conventional risk factor control, significant residual risk remains. Recent evidence on non-traditional determinants of cardiometabolic health has advanced our understanding of lifestyle-disease interactions. Chronic exposure to environmental stressors like poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation and psychosocial stress affect numerous traditional and non-traditional intermediary pathways related to ASCVD. These include body composition, cardiorespiratory fitness, muscle strength and functionality and the intestinal microbiome, which are increasingly recognized as major determinants of cardiovascular health. Evidence points to partially overlapping mechanisms, including effects on inflammatory and nutrient sensing pathways, endocrine signalling, autonomic function and autophagy. Of particular relevance is the potential of low-risk lifestyle factors to impact on plaque vulnerability through altered adipose tissue and skeletal muscle phenotype and secretome. 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. The ketone body ß-hydroxybutyrate, through inhibition of the NLRP-3 inflammasome, is likely to be an intermediary for many of these observed benefits. Adhering to low-risk lifestyle factors adds to the prognostic value of optimal risk factor management, and benefit occurs even when the impact on conventional risk markers is discouragingly minimal or not present. The aims of this review are (a) to discuss novel lifestyle risk factors and their underlying biochemical principles and (b) to provide new perspectives on potentially more feasible recommendations to improve long-term adherence to low-risk lifestyle factors.

Indexed as

Healthy LifestyleHeart Disease Risk FactorsLife StyleRisk Reduction BehaviorAtherosclerosisHumansProtective FactorsRisk Assessmentadipose tissue phenotypeAtherosclerotic cardiovascular diseaseketone body ß-hydroxybutyraten-3 fatty acidsnovel lifestyle risk factorsplaque phenotype

Identifiers

PMID31408370
PMCPMC7065445
OpenAlexW2968241928

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.