Most US cardiologists fail to practice what they preach, reporting inconsistent personal compliance to critical pillars of lifestyle medicine, particularly dietary and physical activity recommendations, according to a recent study in the Journal of the American College of Cardiology.

Previous research showed Americans could significantly reduce the risk for heart disease and mortality if they cut back on or eliminated cholesterol, saturated fat, sodium, sugar, refined grains, and fried food in favor of beans, grains, nuts, seeds, fruits, vegetables, and mushrooms.

Were physicians achieving that goal? "Not so much," said Kim A. Williams, Sr, MD, professor at the University of Louisville School of Medicine in Louisville, Kentucky, and co-author of the latest study.

“We did a survey of academic physicians and trainees 3 years ago that showed that 0.3% of them were aware of and following a whole-food plant-based diet,” Williams told Medscape Medical News. “So we planned this study to focus on cardiologists since heart disease remains the leading killer of Americans, as it has been since 1918.”

Falling Short on Diet

Williams and colleagues invited 525 members of the American College of Cardiology (ACC)’s CardioSurve panel to participate in the survey between June 14 and July 11, 2024. Of those, 166 participants completed the survey, which included questions about training in lifestyle medicine, personal dietary habits, physical activity, and sleep. The researchers also asked about the use of alcohol and tobacco, lifestyle recommendations for patients, and stress management and social well-being.

The vast majority of cardiologists who responded (87%) said they had received no formal training in lifestyle medicine during their medical education. Even so, 41% of survey respondents frequently recommended a whole-food, plant-based diet for prevention of cardiovascular disease. However, only 8% said they personally complied with this diet.

“There are many barriers to adoption of the healthiest form of diet, ranging from habit and taste to familiarity and marketing,” Williams said. “Physicians are not immune to these influences despite their conflict with published science.”

Respondents also reported barriers to recommending a whole-food plant-based diet to their patients, including concerns about protein adequacy (28%), social and cultural challenges to adherence (40%), and patient compliance (63%).

Focusing on Lifestyle Factors

Most respondents (91%) said they integrated counseling about physical activity into patient care, and 69% said they met physical activity guidelines themselves, engaging in at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise weekly. About half (49%) said they also participated in strength training at least twice weekly.

On average, cardiologists reported sleeping 6.8 hours per night. However, 35% indicated dissatisfaction with their sleep patterns. The researchers also found that half of respondents performed stress resiliency exercises, but few said they had participated in formal stress management programs.

Although the overwhelming majority of respondents (92%) said they abstained from tobacco use, 69% reported drinking, and 34% said they did so on a weekly basis.

Most cardiologists (84%) valued social connections, but more than two third (69%) found it challenging to maintain them due to professional demands.

“There are growing concerns about the future shortage of cardiologists, driven by burnout, administrative burdens, and the rising demand from an aging population, with more cardiologists retiring every year than fellows training to replace them,” Williams said. “The best thing we could do for the field, and in fact for our nation, would be to preserve our own health. If plant-based dieting and exercise can lead not only to a decade longer of life but also a healthier and more energetic senior physician career stage, why wouldn’t we all do it?”

‘A Call to Action’

Ezim Ajufo, BM, BCh, an electrophysiology fellow at Mass General Brigham in Boston, said she found the data involving alcohol consumption and difficulties with social connection to be the most concerning.

“Cardiologists enjoy uniquely rewarding careers but can lead exceptionally stressful, busy, and potentially highly sedentary lives,” Ajufo said. “The medical profession at large requires a certain degree of selflessness, which can evolve into self-neglect if left unchecked.”

Ajufo called the study’s findings “a call to action for individual cardiologists, employers, and the institutions that represent us. We must learn to practice what we preach about the importance of a healthy lifestyle for ourselves, our families, and for the good of our patients.”

Williams and Ajufo reported having no financial conflicts of interest relevant to this study.

Brian Ellis is a freelance writer and editor who lives in Southwest Virginia.