Lifestyle Medicine and Cardiovascular Disease in Viet Nam: From Risk Reduction to Secondary Prevention and Recovery

Lifestyle Medicine and Cardiovascular Disease in Viet Nam: From Risk Reduction to Secondary Prevention and Recovery

Last reviewed: 23 September 2026

Cardiovascular disease is one of the clearest areas where Lifestyle Medicine can contribute to health, but it is also one of the areas where its role needs to be described most carefully. Unhealthy diet, tobacco use, physical inactivity, harmful alcohol use, excess adiposity, high blood pressure, abnormal blood lipids and diabetes all contribute to cardiovascular risk. Yet cardiovascular disease is not one condition, and it is not simply the result of “poor lifestyle choices”. It includes coronary heart disease, stroke, heart failure, peripheral arterial disease, rheumatic and other valvular heart disease, arrhythmias, cardiomyopathies and congenital heart disease, many of which have causes and treatment requirements that extend far beyond lifestyle. [1]

This distinction matters in Viet Nam. Noncommunicable diseases, including cardiovascular disease, cancer, chronic respiratory disease and diabetes, account for about 80% of deaths nationally. Viet Nam's 2021 national STEPS survey found that 26.2% of adults aged 18–69 had raised blood pressure or were taking antihypertensive medication, 22.2% did not meet World Health Organization physical-activity recommendations and 19.5% had a body mass index of at least 25 kg/m². Average salt consumption was 8.1 grams per day. Among people aged 15 years and older, 20.8% were current smokers, including 41.1% of men. [2,3]

Stroke alone illustrates the scale of the cardiovascular burden. An analysis using Global Burden of Disease 2021 estimates attributed approximately 166,954 deaths in Viet Nam to stroke in 2021, while age-standardized stroke mortality had declined over the preceding three decades. These are modelled estimates rather than national death-registry counts, but they illustrate an important point: age-standardized outcomes can improve while the absolute burden remains very large as populations grow and age. [4]

For Lifestyle Medicine, the question is therefore not whether lifestyle matters to cardiovascular disease. It clearly does. The more useful question is where lifestyle interventions fit across the cardiovascular journey, what they can realistically achieve, and what other care must occur alongside them.

Cardiovascular prevention begins with total risk, not one lifestyle factor

Cardiovascular events rarely result from a single risk factor. A person may smoke, have elevated blood pressure and low-density lipoprotein cholesterol, live with diabetes and chronic kidney disease, and have a family history of premature cardiovascular disease. Another person may exercise regularly and eat reasonably well but still have substantial cardiovascular risk because of age, genetics or established atherosclerosis.

Contemporary cardiovascular prevention therefore combines validated risk estimation, where appropriate, with established clinical conditions and risk modifiers such as blood pressure, lipids, diabetes, kidney disease, smoking, adiposity, family history and other relevant factors. The exact tools and thresholds vary across guidelines and populations. This is relevant to Viet Nam because a risk model developed in one population should not automatically be assumed to perform identically in another. Social and environmental circumstances also matter because they can influence both cardiovascular risk and the feasibility of changing health behaviors. [5]

This is where Lifestyle Medicine and preventive cardiology naturally meet. Lifestyle Medicine contributes structured attention to nutrition, physical activity, sleep, risky substances, stress and social connection, together with behavior-change skills. Cardiovascular medicine contributes disease-specific risk assessment, diagnosis, investigation and evidence-based pharmacological, interventional and surgical treatment. The current international definition describes Lifestyle Medicine as a medical discipline that uses evidence-based lifestyle interventions to treat, reverse and prevent noncommunicable disease. [6] That definition does not mean that every cardiovascular condition can be reversed through lifestyle change, nor does it imply that evidence-based cardiovascular medicines or procedures become unnecessary when lifestyle improves.

Blood pressure deserves particular attention in Viet Nam

High blood pressure is one of the most important modifiable cardiovascular risks worldwide and has particular relevance in Viet Nam. The national STEPS survey found that the prevalence of raised blood pressure among adults aged 18–69 increased from 18.9% in 2015 to 26.2% in 2021. Among people with raised blood pressure, the proportion being managed at a health facility increased from 13.6% to 24.7% over the same period. These figures reflected important progress, but also substantial gaps at the time of the survey. [3]

The health system has continued to expand community-based management since then. In September 2026, the World Health Organization reported that a large-scale Ministry of Health initiative supported by the World Health Organization and Resolve to Save Lives was screening around 10 million people for hypertension and diabetes each year and had brought more than two million people into treatment. Among people participating in the program, the proportion with controlled blood pressure increased from 53% in 2022 to 72% in 2025. [7]

Lifestyle interventions are an important part of blood-pressure management. Dietary quality, sodium reduction, physical activity, weight management where appropriate, tobacco cessation and reduction of harmful alcohol use can all contribute. But Lifestyle Medicine should not create the expectation that every person with hypertension can or should manage it without medication. Contemporary hypertension guidance combines lifestyle measures with pharmacological treatment according to blood pressure, cardiovascular risk, comorbidities, tolerance and individual circumstances. [9]

Sodium is particularly relevant in Viet Nam. Average salt consumption of 8.1 grams per day in the 2021 STEPS survey remained substantially above international recommendations. Salt reduction therefore has implications not only for individual counseling, but also for home cooking, sauces and condiments, packaged foods, restaurant meals and population-level food policy. [3]

Cardiovascular nutrition is about dietary patterns, not a single “heart food”

Nutrition advice for cardiovascular health is easily oversimplified. No single food protects the heart, and dividing foods into simplistic lists of “good” and “bad” choices can distract from the person's overall dietary pattern, health status and cultural context.

The current Lifestyle Medicine framework emphasizes a whole-food, plant-predominant eating pattern. Cardiovascular prevention guidance similarly supports healthy dietary patterns rich in plant foods and lower in excess sodium, saturated and trans fats, refined carbohydrates and sugar-sweetened beverages. [5,6,11] For Viet Nam, this needs local interpretation rather than importing a foreign “cardiac diet”. Vietnamese food traditions contain many potentially favorable elements, including vegetables, herbs, legumes, fruit and dishes based on relatively minimally processed ingredients. At the same time, the food environment is changing. In September 2026, World Health Organization representatives in Viet Nam highlighted rising consumption of ultra-processed foods, fast foods and sugary drinks, which are often high in salt, sugar and unhealthy fats. [8]

The practical objective should therefore be to preserve healthy aspects of Vietnamese food culture while addressing excessive sodium, processed meats, highly processed and fried foods, sugary beverages, portion patterns and other exposures relevant to the individual.

Supplements deserve particular caution. In chronic coronary disease, current American Heart Association and American College of Cardiology guidance does not recommend nonprescription or dietary supplements, including fish oil, omega-3 fatty acid supplements or vitamins, for reducing cardiovascular events. The 2025 European Society of Cardiology and European Atherosclerosis Society dyslipidaemia update similarly concludes that evidence does not support routine use of dietary supplements or vitamins for reducing atherosclerotic cardiovascular risk without documented safety and meaningful lipid-lowering efficacy. [10,11] A product marketed for “heart health” should not displace dietary improvement, smoking cessation, blood-pressure control or lipid-lowering treatment with proven cardiovascular benefit.

Physical activity changes meaning across the cardiovascular journey

Physical activity is important across the cardiovascular continuum. In people without established cardiovascular disease, regular movement contributes to lower cardiometabolic risk, better blood-pressure control and improved cardiorespiratory fitness. Once cardiovascular disease is established, physical activity can remain highly beneficial, but the question becomes more clinical. Someone with stable cardiovascular health may need general physical-activity guidance, while someone recovering from myocardial infarction, coronary intervention, cardiac surgery or an episode of decompensated heart failure may require clinical assessment, individualized exercise prescription, monitoring or structured cardiac rehabilitation.

The 2024 European Society of Cardiology guideline on chronic coronary syndromes treats exercise as part of secondary prevention and recommends individualized exercise prescription. Healthy lifestyle behavior remains part of ongoing coronary care after medication or intervention has begun; it is not a preliminary step that becomes irrelevant once the patient receives a stent or prescription. [12] General physical activity therefore does not replace formal cardiac rehabilitation when cardiac rehabilitation is indicated.

Secondary prevention becomes central once cardiovascular disease is established

Primary prevention aims to prevent cardiovascular disease and a first cardiovascular event in people who do not yet have established atherosclerotic cardiovascular disease. Once disease is established, reducing future cardiovascular risk becomes secondary prevention. A myocardial infarction, ischemic stroke or coronary revascularization makes this distinction obvious, but established disease may also be identified in other ways.

Lifestyle intervention remains important, but it becomes part of a broader secondary-prevention strategy. Depending on the condition, this may include antiplatelet or anticoagulant therapy, lipid-lowering treatment, blood-pressure management, diabetes treatment, heart-failure therapies, revascularization where appropriate and disease-specific follow-up. The 2025 European Society of Cardiology and European Atherosclerosis Society focused update on dyslipidaemia continues to place statins at the center of pharmacological low-density lipoprotein cholesterol lowering and strengthens recommendations for earlier treatment intensification in high-risk settings such as acute coronary syndrome. [10] Lifestyle improvement and lipid-lowering treatment should therefore not be presented as competing options in people with established atherosclerotic cardiovascular disease.

The same principle applies after coronary intervention. A stent can treat a critically narrowed coronary segment, but it does not remove atherosclerosis from the rest of the vascular system or eliminate the factors contributing to future risk. Conversely, lifestyle change cannot make an urgently indicated coronary intervention unnecessary. Good cardiovascular care often requires both evidence-based treatment of established disease and sustained attention to the factors that influence future risk.

Cardiac rehabilitation is much more than supervised exercise

One of the most important cardiovascular developments of 2026 was the publication on 28 August of the first dedicated European Society of Cardiology Guidelines on Cardiac Rehabilitation. Until then, cardiac rehabilitation recommendations had been distributed across disease-specific European Society of Cardiology guidelines. The new guideline provides a unified framework for comprehensive rehabilitation across different cardiac conditions and healthcare settings. [13]

Modern cardiac rehabilitation is not simply a supervised exercise class. It includes comprehensive assessment and risk stratification, self-management and behavior change, patient education and health literacy, optimization of cardiovascular treatment, physical-activity counseling, structured exercise training, nutrition and body-composition management, smoking cessation, psychosocial care, management of frailty and comorbidities, and support for return to work. Center-based care remains important, while telerehabilitation and hybrid approaches can provide alternatives for selected patients. [13]

The guideline covers a broad range of cardiac conditions and circumstances rather than only myocardial infarction. This has an important implication for Lifestyle Medicine because many components commonly associated with Lifestyle Medicine already belong inside high-quality cardiac rehabilitation: physical activity, nutrition, smoking cessation, psychosocial health, patient education and sustainable behavior change. The appropriate response is therefore integration rather than duplication. Lifestyle Medicine should not create a parallel post-heart-attack pathway that competes with cardiac rehabilitation. It can strengthen the lifestyle and behavior-change components of an evidence-based rehabilitation pathway.

Cardiac rehabilitation is available in some Vietnamese healthcare settings, but publicly accessible national data describing program availability, referral, enrollment, completion, geographic access and outcomes remain limited. Establishing that national picture would itself be a useful research and quality-improvement priority.

Recovery is physical, psychological and social

Surviving a cardiovascular event is not the end of the clinical journey. Someone recovering from myocardial infarction, cardiac surgery or another major cardiac event may experience fear of exertion, reduced confidence, anxiety, depression, uncertainty about returning to work or sexual activity, and concern that another event may occur. These issues directly influence physical activity, medication adherence, rehabilitation participation and quality of life.

The 2025 European Society of Cardiology Clinical Consensus Statement on mental health and cardiovascular disease emphasizes the multidirectional relationship between cardiovascular and mental health and argues for more systematic integration of mental-health assessment and appropriate management into person-centered cardiovascular care. [14] Recovery should therefore be understood as more than normalization of an electrocardiogram, successful completion of a procedure or absence of chest pain. It also involves restoration of function, confidence, participation and quality of life. Lifestyle Medicine can contribute through behavior-change skills, sleep assessment, stress management and social connection, but depression, anxiety and other mental disorders require appropriate professional assessment and treatment rather than being reduced to “stress”.

Stroke shares cardiovascular risk, but requires its own rehabilitation pathway

Stroke forms part of the broader cardiovascular disease burden, and many of its modifiable risk factors overlap with coronary disease, including hypertension, tobacco exposure, diabetes, abnormal lipids, physical inactivity, unhealthy diet and excess adiposity. Lifestyle interventions are therefore relevant to both primary and secondary stroke prevention, but stroke also demonstrates why Lifestyle Medicine cannot be treated as a universal clinical pathway.

A person recovering from stroke may experience weakness, spasticity, impaired balance, swallowing difficulties, aphasia, cognitive impairment or substantial disability. These needs can require stroke-specific medical care and multidisciplinary rehabilitation involving neurology, rehabilitation medicine, physiotherapy, occupational therapy, speech and language therapy, clinical nutrition, nursing and psychological support. Lifestyle Medicine can complement this pathway by addressing ongoing cardiovascular risk and supporting sustainable health behaviors, but it should not be presented as a replacement for stroke rehabilitation.

Secondary prevention after ischemic stroke may also require antiplatelet or anticoagulant treatment, lipid-lowering therapy, blood-pressure management and other disease-specific interventions depending on the mechanism of the stroke. These decisions require appropriate clinical assessment and must remain within the relevant professional scope of practice.

Improving lifestyle does not mean stopping cardiovascular treatment

One of the most important messages for patients and professionals is that improving lifestyle does not automatically mean stopping medication. Blood pressure may improve after sodium reduction, increased physical activity or weight loss. Glucose levels may fall after changes in diet and activity. Fitness may improve with rehabilitation. When clinically significant changes occur, treatment may sometimes need adjustment, but those adjustments should be based on clinical monitoring rather than on the assumption that a healthier lifestyle makes medicine unnecessary.

This is especially important after myocardial infarction, ischemic stroke or coronary intervention, in heart failure and in people with established atherosclerotic cardiovascular disease, where evidence-based pharmacological treatment can substantially reduce future risk. The same principle applies to procedures and emergency care. Lifestyle change cannot reopen an acutely occluded coronary artery or replace reperfusion treatment for acute myocardial infarction. Someone with new severe chest pain, signs suggestive of stroke, acute breathlessness, syncope or another possible cardiovascular emergency needs urgent medical assessment, not a lifestyle consultation.

Lifestyle Medicine should therefore improve the broader context in which evidence-based cardiovascular treatment operates, support sustainable behavior change and potentially reduce residual risk. It should never encourage unsupervised discontinuation of cardiovascular medication or delay urgent care.

Behavior change matters because information alone is rarely enough

People recovering from a cardiovascular event often receive a long list of instructions at discharge: stop smoking, change diet, exercise, take several medicines, monitor blood pressure, lose weight, attend follow-up and perhaps join rehabilitation. Each recommendation may be reasonable, but together they can become overwhelming. Sustainable secondary prevention therefore requires more than information transfer. It means understanding what matters to the patient, agreeing on priorities, setting realistic goals, supporting self-efficacy, identifying barriers and following progress over time.

The person's environment matters too. Changing diet may require changes across an entire household. Outdoor exercise may be limited by heat, air pollution or unsafe streets. Medication adherence may be affected by cost, availability or health literacy. Rehabilitation may be inaccessible to someone who lives far from a specialist center or cannot leave work or caregiving responsibilities. Lifestyle Medicine can contribute particular strength in this part of cardiovascular care, provided it does not turn structural barriers into judgments about individual motivation.

Viet Nam now has a stronger framework for prevention and long-term care

The policy context in Viet Nam has changed substantially. The Law on Disease Prevention No. 114/2025/QH15, effective from 1 July 2026, explicitly covers prevention and control of noncommunicable diseases alongside communicable diseases, mental health and nutrition in disease prevention. For noncommunicable diseases, the Law identifies risk factors related to unhealthy behaviors and lifestyles, metabolic disorders and environmental pollution. It also provides for risk-factor prevention, early detection and preventive care, and management of noncommunicable diseases in the community. [15]

This direction aligns closely with the ongoing expansion of hypertension and diabetes management at commune and ward health stations. The World Health Organization describes a two-way referral model in which people who need more specialized care are referred to hospitals and clinically stable patients can return to local health stations for continued monitoring and long-term management. [7]

For cardiovascular care, this suggests a continuum rather than a collection of isolated programs: risk identification → risk-factor management → acute cardiovascular care when needed → secondary prevention → rehabilitation → long-term follow-up. Lifestyle Medicine can contribute throughout this continuum, but its role changes at each stage.

What should healthcare organizations in Viet Nam do differently?

In primary care and community settings, the priority is systematic identification and sustained management of cardiovascular risk. Blood pressure, smoking, diabetes, lipid disorders, obesity and other relevant clinical risks need to be considered alongside lifestyle behaviors. Lifestyle counseling should be linked to follow-up and measurable goals rather than delivered as a one-time piece of advice.

For hospitals treating acute cardiovascular disease, secondary prevention should begin before discharge rather than months later. Medication optimization, risk-factor assessment, smoking-cessation support, patient education, rehabilitation referral and a clear follow-up plan should form part of the transition from acute treatment to longer-term care. For rehabilitation services, the 2026 European Society of Cardiology guideline provides a useful contemporary international benchmark: comprehensive cardiac rehabilitation combines clinical assessment, exercise training, risk-factor management, nutrition, smoking cessation, psychosocial care, education, self-management and behavior change. [13]

Continuity between levels of care is equally important. A person whose blood pressure is well controlled at hospital discharge but uncontrolled six months later has not achieved durable secondary prevention. Appropriate shared care, home blood-pressure monitoring, community follow-up and digital support may help close this gap where feasible. Clear referral pathways are also necessary. Cardiology, primary care, rehabilitation, clinical nutrition, nursing, pharmacy, clinical psychology and other professions can all contribute, but responsibilities should be explicitly defined rather than assumed.

Measurement should extend beyond attendance

A cardiovascular Lifestyle Medicine or rehabilitation program should not be judged simply by the number of people who attended a class or received lifestyle advice. Depending on the population, meaningful clinical outcomes may include blood-pressure control, lipid management, glycemic status, smoking cessation, functional capacity, recurrent cardiovascular events, hospitalizations and mortality. Behavioral outcomes may include physical activity, dietary quality, medication adherence and participation in rehabilitation, while patient-reported outcomes can include symptoms, quality of life, confidence, psychological well-being and ability to return to work or other valued activities.

Process measures matter as well. Healthcare organizations may need to know what proportion of eligible patients are referred to cardiac rehabilitation, how many enroll, how many complete the program and how many remain connected to long-term follow-up. The 2026 European Society of Cardiology guideline gives increased prominence to functioning, health-related quality of life and patient-reported outcomes, reflecting a broader understanding of recovery than freedom from recurrent cardiovascular events alone. [13]

For Viet Nam, developing a practical minimum dataset for cardiac rehabilitation and cardiovascular secondary prevention could help healthcare organizations identify gaps, compare their own performance over time and generate locally relevant implementation evidence.

Professional and regulatory boundaries remain essential

Cardiovascular disease is an area where professional boundaries are especially important because errors can have immediate consequences. Under Viet Nam's current Law on Medical Examination and Treatment, reflected in Consolidated Document No. 26/VBHN-VPQH dated 26 February 2026, professional practice is linked to a valid practice licence, registered practice and the permitted scope of practice. The licence itself records the practitioner's professional title and scope, and practitioners are entitled to diagnose and provide treatment within that permitted scope. [16]

Activities that constitute medical examination or treatment must therefore be carried out within the qualifications, licensing and scope-of-practice requirements applicable to the practitioner and healthcare facility. Lifestyle Medicine education or an international certification does not, by itself, create a Vietnamese practice licence, professional title or expanded scope of practice.

This does not reduce the importance of interdisciplinary care. It makes interdisciplinary care safer. Physicians, nurses, rehabilitation professionals, clinical nutrition practitioners, pharmacists, clinical psychologists and other professionals can contribute different competencies, but they should not be treated as interchangeable. International guidelines from organizations such as the European Society of Cardiology are valuable scientific references; they do not automatically become Vietnamese legal or regulatory standards unless incorporated into applicable Vietnamese requirements or guidance.

From preventing the first event to preventing the next one

Lifestyle Medicine has its clearest cardiovascular role when understood as part of a continuum. Before cardiovascular disease develops, it can contribute to risk reduction by addressing tobacco, diet, physical inactivity, sleep, stress, social connection, excess adiposity and related metabolic risks. Once cardiovascular disease is established, those same domains remain important but become part of secondary prevention alongside evidence-based medication, procedures and clinical monitoring. After an acute event, the focus expands further to rehabilitation, functional recovery, psychological health, participation in everyday life and sustained long-term prevention.

The message for Viet Nam is therefore not that cardiovascular disease can be solved through lifestyle alone. It is that cardiovascular care is incomplete when lifestyle, behavior and recovery are treated as optional additions after the “real treatment” has finished.

A coronary intervention can save a life. Medication can reduce the risk of another event. Rehabilitation can restore physical and psychological function. Lifestyle interventions can reduce risk and support long-term health. These are not competing approaches. They are different parts of the same cardiovascular care pathway, and the opportunity for Viet Nam is to connect them better.

References and further reading

1. World Health Organization. Cardiovascular diseases. World Health Organization.

2. World Health Organization Viet Nam. Viet Nam unites to tackle top causes of disease and death. 15 December 2025.

3. Ministry of Health of Viet Nam and World Health Organization. National Survey on the Risk Factors of Noncommunicable Diseases in Viet Nam, 2021.

4. Truyen TTT, Vo NLY, Vo QP, et al. Burden and risk factors of stroke in Vietnam from 1990 to 2021: a systematic analysis from Global Burden Disease 2021. Journal of Stroke and Cerebrovascular Diseases. 2025;34(3):108241. doi:10.1016/j.jstrokecerebrovasdis.2025.108241.

5. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. 2021;42(34):3227–3337. doi:10.1093/eurheartj/ehab484.

6. Rea BL, Cheema S, Lanza S, Makinde MT, Matthews S, Palma M, Kadosh MA, Lapsa-Lešinske A, Karlsen MC. Governance and Update Process for Lifestyle Medicine Core Competencies and Definitions. American Journal of Lifestyle Medicine. 2026;20(7):1116–1123. doi:10.1177/15598276261424740.

7. World Health Organization Viet Nam. Strengthened grassroots health care brings noncommunicable disease services to 10 million people in Viet Nam. 8 September 2026.

8. World Health Organization Viet Nam. Speech of Dr Angela Pratt at KOL Workshop on Nutrition and NCDs. 15 September 2026.

9. McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European Heart Journal. 2024;45(38):3912–4018. doi:10.1093/eurheartj/ehae178.

10. Mach F, Koskinas KC, Roeters van Lennep JE, et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal. 2025;46(42):4359–4378. doi:10.1093/eurheartj/ehaf190.

11. Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease. Circulation. 2023. doi:10.1161/CIR.0000000000001168.

12. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. European Heart Journal. 2024;45(36):3415–3537. doi:10.1093/eurheartj/ehae177.

13. Bäck M, Wilhelm M, Marcin T, et al. 2026 ESC Guidelines on cardiac rehabilitation. European Heart Journal. Published online 28 August 2026. doi:10.1093/eurheartj/ehag099.

14. Bueno H, Deaton C, Farrero M, et al. 2025 ESC Clinical Consensus Statement on mental health and cardiovascular disease: developed under the auspices of the ESC Clinical Practice Guidelines Committee. European Heart Journal. 2025;46(41):4156–4225. doi:10.1093/eurheartj/ehaf191.

15. National Assembly of Viet Nam. Law on Disease Prevention No. 114/2025/QH15. Adopted 10 December 2025; effective 1 July 2026.

16. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH dated 26 February 2026, Law on Medical Examination and Treatment.

Clinical and regulatory note: This article is intended for professional education and discussion. It does not provide individual cardiovascular advice, establish a treatment protocol, replace emergency or specialist cardiovascular care, or define a Vietnamese professional scope of practice. Cardiovascular risk assessment, diagnosis, medication management, exercise prescription after cardiovascular events and rehabilitation may require individualized clinical assessment and appropriately qualified professionals. Lifestyle interventions should be integrated with, not substituted for, evidence-based cardiovascular treatment when indicated.

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