Some risk factors for heart disease cannot be modified, such as age and family history. Others can be changed by appropriate interventions. The major modifiable risk factors for developing heart disease known to date are smoking, high blood cholesterol, hypertension, abdominal obesity (especially in men and postmenopausal women), high intakes of saturated and total fat and low physical activity levels. Hypertension and high blood cholesterol may be controlled by making lifestyle changes (eg eating more fruit and vegetables and using salt and fat in the diet sparingly), losing weight, being more active, taking medication if prescribed and limiting alcohol intake.

Numerous expert advisory committees have concluded that there is no relationship between the consumption of sugars and heart disease. A recent FAO/WHO report on Carbohydrates in Human Nutrition concludes, "There is no evidence for a causal role of sucrose in the etiology of coronary heart disease. The cornerstone of dietary advice aimed at reducing coronary heart disease risk is to increase the intake of carbohydrate-rich foods, especially cereals, vegetables and fruits rich in non-starch polysaccharide, at the expense of fat." This advice is supported by an Expert Committee for WHO (2003) and an IOM Report (2002). A meta-analysis of 37 dietary interventions on cardiovascular risk factors showed that a reduction in total fat and saturated fat (replaced with carbohydrate) could improve blood fat (lipid) profile and reduce risk of coronary heart disease in free-living subjects. The review also showed that exercise and weight loss provided further beneficial effects on cardiovascular disease risk factors following the dietary intervention. The findings of this review are supported by a more recent randomised controlled trial in which replacing fat either with sugar or starches in the diet of overweight subjects had no deleterious effect on blood lipid levels. Sugar intakes typical of those seen in a western diet do not have an adverse effect on blood fats.

 There is good evidence that moderately low-fat, high-carbohydrate diets, rich in fruit and vegetables, reduce the risk of coronary heart disease and further benefits are attained by increasing physical activity levels. Sugar can make a low-fat diet more palatable.

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