Lifestyle Medicine and Dyslipidemia in Viet Nam: Dietary Patterns, Cardiovascular Risk, and Lipid-Lowering Therapy

Lifestyle Medicine and Dyslipidemia in Viet Nam: Dietary Patterns, Cardiovascular Risk, and Lipid-Lowering Therapy

Primary category: Evidence & Clinical Practice

Secondary category: Lifestyle Medicine in Viet Nam

Article type: VLMA Perspective

Last reviewed: October 30, 2026

Two people may receive similar cholesterol results but face very different cardiovascular risks.

One may have mildly elevated cholesterol, no established cardiovascular disease, and several dietary habits that could reasonably be improved. Another may exercise regularly, maintain a healthy body weight, and eat well, yet have markedly elevated low-density lipoprotein cholesterol and a family history of heart attacks at unusually young ages.

Both deserve appropriate assessment, but they may need very different approaches to care. For the first person, dietary changes and other lifestyle interventions may provide an important opportunity to improve cardiovascular health. For the second, an inherited lipid disorder may be contributing to lifelong exposure to atherogenic lipoproteins, making medication and family assessment important even when lifestyle habits are already healthy.

This distinction is central to evidence-based Lifestyle Medicine. Nutrition, physical activity, tobacco cessation, and other healthy behaviors can improve lipid profiles and cardiovascular health. However, not all lipid abnormalities respond equally to these interventions, and an improved laboratory result does not necessarily mean that cardiovascular risk has been adequately addressed.

For healthcare professionals in Viet Nam, the challenge is to connect lifestyle-related interventions with appropriate lipid assessment, cardiovascular risk evaluation, and evidence-based treatment while recognizing that some important risk factors are not primarily determined by individual behavior.

The publication of a new American dyslipidemia guideline in March 2026, following a focused European update in August 2025, provides a timely opportunity to reconsider how these principles can be applied responsibly.

For the Vietnam Lifestyle Medicine Alliance (VLMA), the important question is not whether lifestyle changes or medication should always come first. It is how each can contribute appropriately to preventing cardiovascular disease.

Dyslipidemia Is More Than High Cholesterol

Dyslipidemia refers to abnormalities in blood lipids or lipoproteins. These may include elevated low-density lipoprotein cholesterol, elevated triglycerides, abnormal concentrations of other atherogenic particles, or combinations of these findings.

Different lipid abnormalities have different clinical implications.

Low-density lipoprotein cholesterol is a major causal factor in atherosclerotic cardiovascular disease. Prolonged exposure to elevated concentrations contributes to cholesterol accumulation within arterial walls and the development of atherosclerotic plaques.

Over time, atherosclerosis can affect coronary, cerebral, and peripheral arteries, increasing the risk of myocardial infarction, ischemic stroke, and peripheral artery disease.

Triglyceride-rich lipoproteins and their remnant particles also contribute to atherosclerotic risk. At very high triglyceride concentrations, acute pancreatitis becomes an additional and potentially serious concern.

High-density lipoprotein cholesterol is often described as good cholesterol, but this simplified description can be misleading. A higher concentration does not automatically neutralize the risk associated with elevated atherogenic lipoproteins. Furthermore, treatments that increase high-density lipoprotein cholesterol have not consistently demonstrated cardiovascular benefit simply by raising that laboratory value.

A lipid profile therefore needs to be interpreted within the person's broader clinical circumstances.

Someone who has experienced a myocardial infarction may require intensive lipid-lowering treatment even when their current cholesterol concentration appears only moderately elevated.

A younger adult with markedly elevated low-density lipoprotein cholesterol and a strong family history of premature cardiovascular disease may also require early assessment and treatment despite having no symptoms.

The clinical objective is not simply to produce normal laboratory results. It is to reduce the likelihood of preventable cardiovascular events over time.

What Changed in the 2026 American Dyslipidemia Guideline?

On March 13, 2026, the American College of Cardiology, American Heart Association, and collaborating professional organizations published an updated guideline on the management of dyslipidemia.

The document replaces the 2018 American guideline on blood cholesterol and reflects a broader understanding of cardiovascular risk associated with atherogenic lipoproteins.

The guideline was subsequently subject to published corrections in June and September 2026. Its recommendations should therefore be interpreted using the current corrected version.

One of its central themes is the cumulative effect of exposure to elevated atherogenic lipoproteins across the lifespan.

Cardiovascular risk does not begin only when a person reaches middle age or develops symptoms. A younger individual with persistently high low-density lipoprotein cholesterol may accumulate substantial risk over several decades.

The guideline also adopts the American Heart Association's PREVENT equations to guide cardiovascular risk assessment and primary-prevention treatment discussions in relevant United States populations.

Another important development is the recommendation to measure lipoprotein(a) at least once in adulthood to identify an inherited risk-enhancing factor.

The guideline also supports selective measurement of apolipoprotein B when conventional lipid results may not adequately represent the number of atherogenic particles.

A further change is the return of explicit treatment goals for low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol, with more intensive targets for patients at higher cardiovascular risk.

For example, patients with established atherosclerotic cardiovascular disease who are at very high risk of further events have a recommended low-density lipoprotein cholesterol goal below 55 mg/dL, approximately 1.4 mmol/L.

Patients with established disease who are not classified as being at very high risk may have different treatment goals.

These are risk-specific recommendations, not universal cholesterol targets for everyone with dyslipidemia.

European guidance has also evolved. In August 2025, the European Society of Cardiology and European Atherosclerosis Society published a focused update to their 2019 dyslipidemia guidelines.

The update incorporates newer evidence concerning lipid-lowering treatments, cardiovascular risk assessment, lipoprotein(a), hypertriglyceridemia, and selected clinical circumstances.

Importantly, it does not replace the entire 2019 guideline. Recommendations that were not changed remain part of the European framework.

Although the American and European approaches differ in some details, both emphasize that lipid management should reflect cardiovascular risk rather than rely on a single cholesterol threshold.

Understanding Lipid Measurements Before Making Treatment Decisions

A standard lipid profile generally includes total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides.

Non-high-density lipoprotein cholesterol can be calculated by subtracting high-density lipoprotein cholesterol from total cholesterol. It reflects cholesterol carried by several classes of atherogenic lipoproteins.

For many individuals, a standard lipid profile provides sufficient information for initial assessment and treatment monitoring.

However, the conditions under which a sample is collected and the laboratory methods used can influence interpretation.

The 2026 American guideline recognizes that fasting is unnecessary for many routine lipid measurements. Nonfasting samples can provide useful cardiovascular risk information and may make testing more convenient.

Fasting testing becomes particularly relevant when triglycerides are substantially elevated, a disorder of triglyceride metabolism is suspected, or an initial result requires clarification.

For example, when a nonfasting lipid profile shows triglycerides of 400 mg/dL or higher, approximately 4.5 mmol/L, the guideline recommends obtaining a fasting lipid profile to improve interpretation, particularly the estimation of low-density lipoprotein cholesterol.

Low-density lipoprotein cholesterol is frequently calculated rather than measured directly. Some calculation methods become less reliable when triglycerides are elevated or when cholesterol concentrations are very low.

The 2026 guideline favors newer estimation methods, including the Martin/Hopkins and Sampson equations, over the traditional Friedewald equation because they provide greater accuracy across a wider range of lipid values.

These technical considerations matter when treatment decisions depend on measurements close to clinically important thresholds.

Before attributing an abnormal lipid profile to dietary habits or physical inactivity, clinicians should also consider secondary causes.

Hypothyroidism, poorly controlled diabetes, chronic kidney disease, certain medications, and inherited conditions can affect lipid concentrations.

Someone with substantially elevated triglycerides associated with uncontrolled diabetes, for example, needs appropriate diabetes assessment and treatment alongside nutritional counseling.

Similarly, markedly elevated low-density lipoprotein cholesterol may warrant investigation for familial hypercholesterolemia rather than repeated general advice to reduce dietary fat.

A useful lipid assessment establishes not only what is abnormal, but also what the findings mean for the person's cardiovascular and metabolic health.

Cardiovascular Risk Matters More Than a Single Cholesterol Value

The clinical importance of dyslipidemia depends substantially on the person's overall cardiovascular risk.

A central distinction is between primary and secondary prevention.

Primary prevention concerns people without established atherosclerotic cardiovascular disease. Treatment decisions consider age, cholesterol concentrations, blood pressure, diabetes, kidney disease, tobacco exposure, family history, and other relevant factors.

Secondary prevention concerns people with established atherosclerotic cardiovascular disease, including previous myocardial infarction, certain ischemic strokes, and symptomatic peripheral artery disease.

These patients generally have a higher baseline risk of recurrent cardiovascular events and often benefit from more intensive lipid-lowering treatment.

The 2026 American guideline also emphasizes the importance of risk across the lifespan.

A younger person may have a relatively low estimated ten-year risk because age contributes strongly to conventional cardiovascular risk models.

However, prolonged exposure to markedly elevated low-density lipoprotein cholesterol can create substantial cumulative risk even when the individual remains asymptomatic.

This is especially relevant to inherited lipid disorders, where elevated cholesterol concentrations may be present from childhood.

A cardiovascular risk score can support clinical discussions, but it cannot replace professional judgment or account perfectly for every relevant characteristic.

Previous cardiovascular events, cumulative lipid exposure, family history, associated conditions, and individual circumstances all influence the assessment.

International Risk Calculators Require Careful Interpretation in Viet Nam

The PREVENT equations represent an important development in the 2026 American guideline.

They were developed using United States population data and incorporate cardiovascular, kidney, and metabolic risk information.

Within the American guideline, the equations are used to estimate ten-year and longer-term cardiovascular risk for relevant adults aged 30–79 years and support decisions about primary-prevention lipid-lowering treatment.

However, their application in Viet Nam requires caution.

Background cardiovascular event rates, population characteristics, risk factor distributions, and healthcare access may differ between the United States and Viet Nam.

A model that performs well in its development population may overestimate or underestimate cardiovascular risk when applied to another population.

Consequently, the American guideline's risk thresholds should not automatically be presented as independently validated treatment thresholds for Vietnamese patients.

The same considerations apply to European tools such as SCORE2 and SCORE2-Older Persons.

Their calibration, intended populations, and limitations need to be understood before considering local clinical use.

Coronary artery calcium scoring is another investigation that may refine cardiovascular risk in selected patients when uncertainty remains about preventive treatment.

However, it is not a routine requirement for everyone with elevated cholesterol.

A coronary artery calcium score of zero does not eliminate cardiovascular risk, particularly in younger individuals or people with important risk-enhancing conditions.

Additional investigations are most valuable when their results are likely to influence a meaningful clinical decision.

For healthcare professionals in Viet Nam, international risk models and advanced testing methods provide useful scientific references. Their adoption into routine care, however, requires appropriate consideration of local applicability, clinical value, and available resources.

Dietary Patterns Matter More Than Lists of Forbidden Foods

Nutrition is one of the most established lifestyle interventions for dyslipidemia, but its effects depend on the changes made.

Reducing saturated fat intake can lower low-density lipoprotein cholesterol, particularly when saturated fats are replaced with appropriate unsaturated fats.

A 2020 Cochrane systematic review found that sustained reduction in saturated fat intake reduced combined cardiovascular events, although it did not demonstrate a clear reduction in all-cause mortality.

This distinction matters because improvements in cholesterol concentrations and improvements in clinical outcomes are related but not identical measures.

The American Heart Association's dietary guidance emphasizes an overall pattern that includes vegetables, fruits, whole grains, legumes, suitable protein sources, and predominantly unsaturated fats.

Replacing foods rich in saturated fat with appropriate vegetable oils, nuts, fish, and other sources of unsaturated fat can improve dietary fat quality.

Foods containing soluble fiber, including oats, barley, beans, and certain fruits, may also help lower low-density lipoprotein cholesterol.

However, what replaces a food matters.

Reducing saturated fat while increasing refined carbohydrates may produce different metabolic effects from replacing saturated fat with whole grains, legumes, and unsaturated fats.

This becomes particularly relevant when elevated triglycerides coexist with insulin resistance.

Dietary cholesterol, saturated fat, food processing, fiber, total energy intake, and the broader eating pattern are related but distinct considerations.

Evidence-based nutritional care should therefore avoid reducing dyslipidemia management to a single rule, such as eliminating every food containing cholesterol or requiring everyone to follow one specific dietary pattern.

The dietary approach should reflect the lipid abnormality, cardiovascular risk, nutritional needs, and individual circumstances.

Applying Dietary Evidence to Vietnamese Meals

Dietary recommendations in Viet Nam should be practical and compatible with foods people commonly eat.

Rice, noodles, vegetables, fish, tofu, legumes, eggs, fruit, and different meats can form part of a healthy eating pattern.

Their effects on health depend on portion sizes, preparation methods, overall dietary composition, and individual metabolic needs.

For someone with elevated low-density lipoprotein cholesterol, replacing frequently consumed fatty meats with suitable portions of fish, tofu, legumes, or leaner protein sources may improve the dietary fat profile.

Reducing frequent consumption of deep-fried foods may also be helpful, especially when those foods contribute substantially to excess energy, saturated fat, or trans fat intake.

Cooking oils deserve attention as well. Palm oil and coconut fat contain relatively high proportions of saturated fat compared with many vegetable oils rich in unsaturated fats.

These differences can be explained without describing traditional Vietnamese foods as inherently unhealthy.

For someone with elevated triglycerides, other dietary factors may require greater emphasis.

Large amounts of refined carbohydrates, sugar-sweetened beverages, excess energy intake, and alcohol can contribute to triglyceride elevation in susceptible individuals.

The dietary priorities for a person with markedly elevated low-density lipoprotein cholesterol may therefore differ from those for someone with triglyceride elevation associated with insulin resistance.

Food affordability and cultural familiarity also matter.

A dietary program based on imported foods, expensive supplements, or unfamiliar meals may offer no meaningful advantage over an appropriate approach using accessible Vietnamese ingredients.

The most useful dietary plan is not necessarily the most restrictive. It is the one that addresses the person's clinical needs, supports overall health, and can be maintained without unnecessary nutritional or financial burdens.

Severe Hypertriglyceridemia Requires a Different Clinical Response

Triglycerides are often discussed alongside cholesterol, but markedly elevated concentrations introduce a separate clinical concern: acute pancreatitis.

Mild to moderate hypertriglyceridemia is commonly associated with insulin resistance, obesity, diabetes, alcohol consumption, certain medications, and other metabolic conditions.

In these circumstances, improving dietary quality, reducing added sugars and refined carbohydrates, minimizing alcohol, increasing suitable physical activity, and addressing excess body weight may help reduce triglycerides.

However, severe triglyceride elevation can also result from inherited disorders, poorly controlled diabetes, and other medical conditions requiring specific treatment.

The 2026 American guideline identifies fasting triglyceride concentrations of 500 mg/dL or higher, approximately 5.7 mmol/L, as requiring particular attention to pancreatitis risk.

The concern becomes especially important at concentrations of 1,000 mg/dL or higher, approximately 11.3 mmol/L.

A person with such results should not simply receive general advice about diet and exercise with instructions to return several months later.

Appropriate evaluation may involve identifying secondary causes, assessing the possibility of an inherited disorder, reviewing medications, and determining whether triglyceride-lowering treatment is indicated.

The dietary approach also differs according to the degree of elevation.

For triglyceride concentrations between 500 and 999 mg/dL, the 2026 guideline recommends avoiding alcohol, reducing added sugars, refined carbohydrates, and saturated fat, and individualizing total fat intake.

At concentrations of 1,000 mg/dL or higher, a very-low-fat dietary approach may be required under professional supervision, together with elimination of alcohol and added sugars and other clinically indicated treatment.

Some rare inherited disorders, including familial chylomicronemia syndrome, require particularly specialized dietary and medical management.

These approaches should not be treated as interchangeable.

An unsupervised high-fat ketogenic diet may be particularly inappropriate for someone with severe triglyceride elevation or a disorder of triglyceride metabolism.

Severe abdominal pain, persistent vomiting, or other symptoms concerning for acute pancreatitis require urgent medical assessment.

Lifestyle-related interventions remain relevant, but they must not delay necessary medical treatment when severe hypertriglyceridemia presents a significant risk.

Lipoprotein(a): An Inherited Risk That Lifestyle Changes May Not Correct

Lipoprotein(a) is a distinct lipoprotein particle containing apolipoprotein(a) attached to an apolipoprotein B-containing particle.

Elevated lipoprotein(a) is an established causal risk factor for atherosclerotic cardiovascular disease and is associated with calcific aortic valve stenosis.

Its concentration is determined predominantly by genetic factors.

Unlike many other lipid abnormalities, lipoprotein(a) generally changes relatively little in response to ordinary dietary modification, exercise, or weight reduction.

Healthy behaviors remain important because they can reduce other modifiable cardiovascular risks. However, patients should not be led to believe that a healthier diet or increased physical activity will necessarily normalize genetically elevated lipoprotein(a).

The 2026 American guideline recommends measuring lipoprotein(a) at least once in adulthood to identify an additional inherited risk factor.

A concentration of 125 nmol/L or 50 mg/dL or higher is considered a risk-enhancing finding within the American guideline framework.

Higher concentrations are associated with progressively greater cardiovascular risk.

These measurement units should not be treated as exactly interchangeable through one universal conversion formula. The relationship between lipoprotein(a) mass and particle concentration varies according to particle characteristics.

The European guidelines also recognize elevated lipoprotein(a) as an important cardiovascular risk modifier.

For patients with elevated lipoprotein(a), clinicians may consider more intensive management of low-density lipoprotein cholesterol and other cardiovascular risk factors according to the overall clinical picture.

An elevated result does not automatically mean that every patient requires a particular new treatment or repeated lipoprotein(a) testing.

Its interpretation depends on the person's cardiovascular risk, family history, associated conditions, and available treatment options.

This is an important example of why Lifestyle Medicine must recognize inherited biology. Not every cardiovascular risk factor can be substantially corrected through behavior alone.

Apolipoprotein B Can Clarify Risk When Cholesterol Results Are Misleading

Apolipoprotein B is a structural protein found on several types of atherogenic lipoprotein particles.

Because each of these particles generally carries one apolipoprotein B molecule, its concentration provides an indication of the number of circulating atherogenic particles.

This can be clinically useful when the amount of cholesterol carried by those particles does not accurately reflect their number.

People with diabetes, insulin resistance, elevated triglycerides, or certain other metabolic patterns may have substantial atherogenic particle concentrations even when low-density lipoprotein cholesterol appears less concerning.

The 2026 American guideline supports selective apolipoprotein B measurement when it can improve cardiovascular risk assessment or guide treatment.

This may be particularly relevant in patients with elevated triglycerides, diabetes, or low achieved low-density lipoprotein cholesterol concentrations.

For people with hypertriglyceridemia, non-high-density lipoprotein cholesterol or apolipoprotein B may also provide a more informative assessment of atherogenic lipoprotein burden than low-density lipoprotein cholesterol alone.

However, this does not mean that every person with dyslipidemia needs apolipoprotein B testing.

For many patients, a standard lipid profile remains sufficient for initial assessment.

Additional testing is most useful when the result is likely to clarify an important uncertainty or change treatment decisions.

For healthcare settings where advanced lipid testing may be less accessible or create additional costs, this distinction is particularly relevant.

A more sophisticated laboratory measurement does not necessarily provide greater clinical value if it does not influence management.

Familial Hypercholesterolemia Should Not Be Missed

Familial hypercholesterolemia is an inherited condition associated with markedly elevated low-density lipoprotein cholesterol from early life.

Because exposure begins during childhood, affected individuals may accumulate substantial cardiovascular risk long before conventional age-based risk calculators identify them as high risk.

Someone with familial hypercholesterolemia may exercise regularly, maintain a healthy body weight, and follow an appropriate diet while still having very high cholesterol.

This does not indicate poor lifestyle choices or inadequate motivation. It reflects a biological disorder that often requires early and sustained lipid-lowering treatment.

An untreated low-density lipoprotein cholesterol concentration of 190 mg/dL or higher, approximately 4.9 mmol/L, is an important warning sign in adults, particularly when accompanied by a family history of premature cardiovascular disease.

However, that laboratory finding alone does not establish familial hypercholesterolemia.

Clinical assessment may involve previous untreated cholesterol values, family history, physical findings, exclusion of secondary causes, and genetic testing when appropriate and available.

Family-based or cascade screening can help identify relatives who may also have inherited elevated low-density lipoprotein cholesterol.

This can be especially valuable for children and younger adults who have not yet developed cardiovascular complications.

Assessment and treatment in children require age-specific professional guidance rather than automatic application of adult risk calculators or treatment thresholds.

For Viet Nam, recognizing familial hypercholesterolemia offers an important opportunity to prevent unnecessary cumulative exposure to very high cholesterol concentrations.

Lifestyle changes remain beneficial, but they should not become a reason to postpone indicated medical assessment or treatment.

Physical Activity Supports Cardiovascular Health Without Replacing Lipid Treatment

Regular physical activity contributes to cardiovascular health through several mechanisms.

It can improve cardiorespiratory fitness, insulin sensitivity, blood pressure, body composition, and aspects of lipid metabolism.

Exercise may help reduce triglycerides and produce favorable changes in high-density lipoprotein cholesterol in some people.

Its effects on low-density lipoprotein cholesterol, however, are generally more modest and variable.

Someone with severe hypercholesterolemia or established atherosclerotic cardiovascular disease may improve physical fitness substantially without achieving the low-density lipoprotein cholesterol reduction needed for appropriate cardiovascular protection.

This does not mean that the exercise program has failed. It means that different interventions affect different pathways of cardiovascular risk.

Smoking cessation, adequate sleep, appropriate weight management, and reduced harmful alcohol consumption also support cardiovascular health.

Their benefits should be recognized without assuming that they reproduce the lipid changes or clinical outcomes achieved through effective low-density lipoprotein cholesterol-lowering medication.

For patients at high cardiovascular risk, healthy behaviors and pharmacological treatment should generally be considered complementary rather than competing approaches.

When Lipid-Lowering Medication Is Needed

Lipid-lowering medication should be considered according to cardiovascular risk, the pattern and severity of lipid abnormalities, and the expected clinical benefit of treatment.

Statins remain a foundation of pharmacological low-density lipoprotein cholesterol reduction because extensive randomized evidence demonstrates their ability to reduce major atherosclerotic cardiovascular events.

For people with established atherosclerotic cardiovascular disease, appropriate statin treatment is a central component of secondary prevention.

In primary prevention, treatment decisions depend on cardiovascular risk, cholesterol concentrations, relevant medical conditions, family history, age, patient preferences, and the expected balance of benefits and harms.

The 2026 American guideline also emphasizes earlier treatment in selected people with substantial lifelong exposure to atherogenic lipoproteins, including familial hypercholesterolemia and other high-risk conditions.

Some patients require additional medication because statin treatment alone does not achieve an appropriate cholesterol reduction or because the maximum tolerated regimen is insufficient.

Ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, and bempedoic acid are among the non-statin therapies discussed in contemporary international guidelines.

These medicines differ in their lipid-lowering effects, supporting cardiovascular outcomes evidence, route of administration, safety considerations, cost, and availability.

The 2025 European focused update supports the use of selected non-statin treatments with demonstrated cardiovascular benefits, including bempedoic acid in specified circumstances.

Their selection requires individual clinical assessment.

An international recommendation does not independently establish that a medicine is registered, marketed, reimbursed, or appropriate for use in a particular patient in Viet Nam.

The objective of treatment is to reduce avoidable cardiovascular risk, not to achieve medication-free care regardless of clinical consequences.

Statin Safety Requires Assessment, Not Assumptions

Concerns about statin safety are common.

Some patients worry about muscle pain, liver injury, diabetes, or the long-term consequences of taking medication.

These concerns deserve careful discussion rather than automatic dismissal.

Statin-associated muscle symptoms can occur, but not every episode of muscle discomfort during treatment is caused by the medicine.

Clinical assessment may consider symptom timing, severity, recent physical activity, other medical conditions, medication interactions, and alternative explanations.

For some patients, changing to another statin, adjusting the treatment regimen, or adding an appropriate non-statin medicine may help maintain cardiovascular protection.

Severe muscle weakness, dark urine, or other symptoms suggesting serious muscle injury require prompt medical assessment.

Statin treatment can modestly increase the risk of new-onset diabetes in susceptible individuals. However, in patients with a substantial cardiovascular indication, the expected reduction in cardiovascular events generally outweighs this risk.

Stable chronic liver disease is also not automatically a contraindication to statin treatment.

In appropriately selected patients, statins may be used for cardiovascular prevention despite stable chronic liver disease, including metabolic dysfunction-associated steatotic liver disease.

This should not be interpreted as establishing the safety of every lipid-lowering medicine in acute liver failure or decompensated cirrhosis, where additional considerations apply.

Pregnancy and lactation require particular attention. The 2026 American guideline advises discontinuing statins during most pregnancies, although treatment may be considered in exceptional high-risk circumstances under specialist care. Statins should generally be avoided during lactation.

Kidney disease, potential medication interactions, and other individual circumstances may also influence treatment decisions.

The appropriate response to a safety concern is clinical reassessment and an individualized plan, not automatically discontinuing effective preventive medication.

Dietary Supplements Are Not Equivalent to Evidence-Based Treatment

Commercial products promoted for cholesterol control are widely available.

These may include herbal preparations, vitamins, antioxidants, fish oil products, red yeast rice, and other dietary supplements.

Their effects vary, and claims should be evaluated according to the evidence for the specific product and the clinical outcome being claimed.

The 2025 European focused update recommends against using dietary supplements or vitamins without documented safety and significant low-density lipoprotein cholesterol-lowering efficacy for the purpose of reducing atherosclerotic cardiovascular risk.

A product that produces a modest change in a laboratory result has not necessarily been shown to prevent myocardial infarction or stroke.

Some supplements may contain pharmacologically active substances or interact with prescription medicines.

Red yeast rice products, for example, may contain variable amounts of monacolin K, a compound chemically identical to lovastatin.

Product variability creates concerns about dose consistency, adverse effects, medication interactions, and quality.

Products marketed as natural should not automatically be assumed to be safer.

Omega-3 products also require careful distinction.

Prescription icosapent ethyl has demonstrated cardiovascular benefit in selected high-risk patients with elevated triglycerides who were receiving appropriate background treatment.

The 2026 American guideline recognizes a role for this treatment in defined clinical circumstances, but it should not be regarded as a routine treatment for everyone with elevated triglycerides.

The evidence cannot be generalized to all omega-3 formulations or ordinary over-the-counter fish oil supplements.

Similarly, foods containing soluble fiber or plant sterols may modestly reduce low-density lipoprotein cholesterol, but their effects should not be equated with the demonstrated cardiovascular outcome benefits of particular prescription medicines.

For VLMA, scientific independence requires distinguishing dietary measures, supplements, and regulated pharmaceutical treatments without endorsing commercial cholesterol-lowering products.

Follow-Up Should Evaluate Response, Safety, and Treatment Continuity

Beginning a dietary intervention or prescribing lipid-lowering medication is only the start of dyslipidemia management.

Follow-up helps determine whether treatment has produced a meaningful response, whether adverse effects are occurring, and whether the plan remains appropriate.

Lipid measurements may be repeated at suitable intervals to evaluate biological response, adherence, and the need for treatment adjustment.

Interpretation should consider the baseline result, cardiovascular risk, intended treatment goal, and possible laboratory or biological variability.

A substantial reduction in low-density lipoprotein cholesterol may still leave a high-risk patient above the recommended treatment goal.

Conversely, a lower-risk individual may not require the same treatment intensity.

Follow-up should also address medication access, tolerability, dietary feasibility, and the patient's understanding of treatment.

If someone cannot obtain prescribed medication or finds a dietary recommendation difficult to maintain, repeating the same instruction may not resolve the problem.

A useful clinical review connects changes in lipid results with the patient's circumstances, treatment safety, and the intended cardiovascular benefits.

The Professional Context for Dyslipidemia Care in Viet Nam

Viet Nam has its own professional recommendations addressing dyslipidemia management.

The Vietnam National Heart Association published its 2024 Recommendations for the Management of Dyslipidemia, covering cardiovascular risk assessment, lipid measurement, lifestyle interventions, pharmacological treatment, inherited lipid disorders, and follow-up.

These recommendations provide an important Vietnamese professional reference.

In March 2026, the Association also published a professional review discussing the updated American dyslipidemia guideline and its implications for clinical practice.

This demonstrates that contemporary international developments are being examined within the Vietnamese cardiovascular professional community.

However, a professional review of an international guideline should not be confused with the formal issuance of a new Vietnamese national clinical guideline.

Similarly, recommendations issued by a professional association should be distinguished from legally binding instruments issued by competent state authorities.

The 2026 American guideline and the 2025 European focused update provide important evidence that Vietnamese healthcare professionals may consider when reviewing clinical practice.

Their recommendations nevertheless need to be interpreted with attention to local population characteristics, medication availability, healthcare resources, professional requirements, and individual patient circumstances.

Lipoprotein(a) and apolipoprotein B testing may provide useful information in selected patients, but availability and costs can differ between healthcare facilities.

The same applies to coronary artery calcium scoring and other advanced investigations.

In some settings, improving access to standard lipid testing, appropriate risk assessment, treatment initiation, and reliable follow-up may provide greater practical value than expanding sophisticated investigations without a clear clinical purpose.

For Viet Nam, the opportunity is to translate international evidence into accessible and appropriate cardiovascular prevention rather than simply reproduce another country's treatment pathway.

Shared Decision-Making Supports Long-Term Prevention

Many people with dyslipidemia do not experience symptoms directly attributable to their abnormal lipid concentrations.

This can make long-term preventive treatment difficult to understand.

Someone who feels healthy may wonder why medication is necessary for a problem that might not cause a cardiovascular event for many years.

Another person may believe that taking a statin means their efforts to improve diet and physical activity have failed.

Healthcare professionals can address these concerns by explaining cardiovascular risk, the expected benefits of treatment, and the limitations of relying exclusively on lifestyle interventions.

The discussion should distinguish preventing a future cardiovascular event from treating a symptom the patient currently experiences.

For someone with a previous myocardial infarction, lipid-lowering therapy may provide important protection against recurrent events.

For another person with modest lipid abnormalities and low estimated cardiovascular risk, the balance of expected benefits, treatment options, and follow-up may differ.

Medication costs, adverse-effect concerns, treatment burden, and access to care are also relevant.

Shared decision-making should help people understand their clinical risks and participate in choices that reflect both the evidence and their circumstances.

It should not be used to promote medication avoidance as an achievement or to persuade everyone to follow the same treatment pathway.

Measuring Better Dyslipidemia Care

Healthcare organizations may report how many patients receive lipid screening or are prescribed statins.

These figures provide information about service activity, but they do not fully describe the quality of cardiovascular prevention.

For patients with established indications for lipid-lowering treatment, relevant measures may include whether appropriate therapy was offered, whether cardiovascular risk was assessed, and whether follow-up occurred.

For those receiving treatment, the achieved reduction in low-density lipoprotein cholesterol and progress toward the appropriate treatment goal provide important information about response.

However, these remain intermediate outcomes.

The ultimate objective of lipid management is to reduce myocardial infarction, ischemic stroke, and other atherosclerotic cardiovascular events.

Such outcomes require careful interpretation because they are influenced by multiple factors and may develop over many years.

For patients with severe hypertriglyceridemia, preventing acute pancreatitis may also be an important treatment goal.

Healthcare organizations may examine whether suspected familial hypercholesterolemia is recognized, whether appropriate family screening is considered, and whether high-risk patients remain connected to necessary treatment.

Lifestyle-related programs should also be evaluated according to what they actually demonstrate.

A program reporting increased vegetable consumption has measured dietary behavior change. It has not necessarily demonstrated fewer cardiovascular events.

Similarly, a program reporting lower cholesterol has measured a biological response. Whether that reduction is sufficient depends on the patient's underlying risk and clinical goals.

Responsible evaluation should distinguish service activities, behavioral changes, laboratory responses, treatment safety, and meaningful patient outcomes.

Professional and Legal Responsibilities in Viet Nam

Lifestyle Medicine can contribute to dyslipidemia care through evidence-based education, appropriate nutritional support, physical activity, tobacco cessation, and attention to behavioral and social factors affecting cardiovascular health.

However, diagnosing lipid disorders, determining eligibility for pharmacological treatment, prescribing medication, interpreting investigations for individualized clinical decisions, and managing adverse effects are regulated healthcare activities.

In Viet Nam, these responsibilities are governed by the Law on Medical Examination and Treatment No. 15/2023/QH15, as amended, and applicable implementing regulations.

Consolidated Document No. 26/VBHN-VPQH dated February 26, 2026, provides an updated consolidated reference to this law.

The Law on Disease Prevention No. 114/2025/QH15, effective July 1, 2026, provides a broader legal framework for disease prevention and health promotion.

These laws should not be interpreted as creating an independent clinical scope of practice through Lifestyle Medicine education, professional membership, or international certification.

Healthcare professionals must act within their qualifications, competence, and legally authorized scopes of practice.

International professional recommendations also do not automatically establish the approval, reimbursement status, or clinical suitability of a medicine, investigation, risk calculator, or treatment threshold in Viet Nam.

Personal health information requires appropriate protection.

Lipid measurements, medication records, family histories, and cardiovascular risk assessments may contain identifiable and sensitive personal health data.

The Law on Personal Data Protection No. 91/2025/QH15 and Government Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, establish relevant requirements concerning personal data processing and protection.

Healthcare organizations and educational activities using identifiable patient information must consider applicable legal bases, confidentiality obligations, security safeguards, retention requirements, and necessary permissions.

For VLMA, the appropriate contribution is professional education, critical interpretation of evidence, and scientific knowledge exchange rather than providing individualized diagnosis or medical treatment.

Implications for the Vietnam Lifestyle Medicine Alliance

Dyslipidemia demonstrates why evidence-based Lifestyle Medicine should be integrated into established cardiovascular prevention rather than presented as a separate alternative.

Dietary patterns, physical activity, tobacco cessation, and other healthy behaviors can improve cardiovascular health and contribute to lipid management.

For some people, these changes may produce meaningful improvements alongside appropriate clinical monitoring.

For others, inherited lipid abnormalities, substantially elevated atherogenic lipoproteins, established cardiovascular disease, or other high-risk circumstances make medication an important component of effective prevention.

For VLMA, the opportunity lies in helping healthcare professionals understand these differences.

Educational resources could examine the interpretation of lipid measurements, dietary interventions specific to lipid abnormalities, familial hypercholesterolemia, lipoprotein(a), severe hypertriglyceridemia, and the relationship between lifestyle support and pharmacological treatment.

Professional discussions could also explore the limitations of applying international cardiovascular risk calculators to the Vietnamese population and how healthcare organizations can evaluate the quality of long-term lipid management.

Such activities would benefit from collaboration with appropriately qualified specialists in cardiology, internal medicine, endocrinology, clinical nutrition, and related fields.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. Its activities focus on evidence-based professional education, capability development, scientific knowledge exchange, and collaboration.

VLMA does not independently diagnose dyslipidemia, prescribe or adjust lipid-lowering medicines, undertake individualized cardiovascular risk assessments for treatment decisions, or provide specialized clinical services.

Its intended contribution is to strengthen professional understanding and support the responsible application of scientific evidence within authorized healthcare services.

Healthy Living and Lipid-Lowering Treatment Belong Together

Dyslipidemia illustrates why cardiovascular prevention cannot be reduced to a choice between healthier habits and medication.

Someone may make substantial improvements to their diet and physical activity while still needing lipid-lowering treatment because of inherited risk or established cardiovascular disease.

Another person may benefit considerably from dietary changes and sustained lifestyle support without requiring the same treatment intensity.

The appropriate approach depends on the pattern of lipid abnormalities, cardiovascular risk, associated medical conditions, treatment response, and individual circumstances.

The 2026 American guideline and 2025 European focused update reinforce the importance of managing atherogenic lipoproteins according to clinical risk and cumulative exposure.

They also highlight why one cholesterol value may not fully describe cardiovascular risk, why inherited factors deserve attention, and why severe triglyceride elevation requires a separate safety assessment.

For healthcare professionals in Viet Nam, the opportunity is to connect these advances with accessible testing, thoughtful risk evaluation, culturally relevant dietary support, appropriate medication, and reliable follow-up.

Lifestyle Medicine should neither promise that everyone can normalize their lipids without medication nor present prescription treatment as a substitute for healthier daily habits.

Better dyslipidemia care is not simply about achieving a more favorable cholesterol result. It is about helping people reduce preventable cardiovascular risk through interventions that are clinically appropriate, evidence-based, safe, understandable, and sustainable.

Selected References

1. Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153–e1276. DOI: 10.1161/CIR.0000000000001423. Including published corrections dated June 22 and September 8, 2026.

2. American Heart Association. 2026 Guideline on the Management of Dyslipidemia: Top Things to Know. March 13, 2026.

3. Mach F, Koskinas KC, Roeters van Lennep JE, et al. 2025 Focused Update of the 2019 European Society of Cardiology/European Atherosclerosis Society Guidelines for the Management of Dyslipidaemias. European Heart Journal. 2025;46(42):4359–4378. DOI: 10.1093/eurheartj/ehaf190.

4. Vietnam National Heart Association. Recommendations for the Management of Dyslipidemia, 2024. August 14, 2024.

5. Vietnam National Heart Association. 2026 ACC/AHA Guideline Update on Dyslipidemia Management: Key Changes and Applications in Clinical Practice. Professional review published March 19, 2026.

6. Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2021;144–e487. DOI: 10.1161/CIR.0000000000001031.

7. Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in Saturated Fat Intake for Cardiovascular Disease. Cochrane Database of Systematic Reviews. 2020;8. DOI: 10.1002/14651858.CD011737.pub3.

8. Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in Atherosclerotic Cardiovascular Disease and Aortic Stenosis: A European Atherosclerosis Society Consensus Statement. European Heart Journal. 2022;43:3925–3946. DOI: 10.1093/eurheartj/ehac361.

9. European Atherosclerosis Society. Dietary Supplements: 2025 Focused Update of the European Dyslipidaemia Guidelines. 2025.

10. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. DOI: 10.1177/15598276251379821.

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

12. National Assembly of Viet Nam. Law on Disease Prevention No. 114/2025/QH15. December 10, 2025. Effective July 1, 2026.

13. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. June 26, 2025. Effective January 1, 2026.

14. Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Selected Provisions and Implementation Measures of the Law on Personal Data Protection. December 31, 2025. Effective January 1, 2026.

Editorial and Professional Scope Note

This article presents an educational and professional perspective of the Vietnam Lifestyle Medicine Alliance on the contribution and limitations of evidence-based Lifestyle Medicine in dyslipidemia care, based on information reviewed through October 30, 2026.

It is intended for professional information, education, and scientific knowledge exchange. It does not constitute a clinical practice guideline, individualized medical advice, a diagnostic or treatment protocol, dietary prescription, exercise prescription, cardiovascular risk calculation, medication recommendation, or authoritative interpretation of Vietnamese law.

Vietnam Lifestyle Medicine Alliance (VLMA) is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. VLMA is not a licensed medical examination or treatment facility, cardiovascular treatment provider, medical licensing authority, or healthcare accreditation organization. It does not independently diagnose lipid disorders, prescribe or adjust lipid-lowering medication, interpret clinical investigations for individual treatment decisions, or provide specialized cardiovascular care.

Clinical assessment, diagnosis, prescribing, cardiovascular risk evaluation, medication management, and follow-up must be undertaken by appropriately qualified and authorized healthcare professionals and facilities within their applicable scopes of practice and in accordance with relevant Vietnamese requirements.

Lifestyle-related interventions should not delay or replace clinically indicated lipid-lowering treatment, appropriate cardiovascular risk assessment, specialist evaluation, or emergency care. Severe triglyceride elevation, suspected acute pancreatitis, significant medication-related symptoms, and other concerning findings require appropriate clinical assessment.

International clinical guidelines, research findings, and professional frameworks are cited for educational purposes. Their inclusion does not imply that they automatically have regulatory force in Viet Nam or that VLMA has formally adopted, delivered, validated, endorsed, or certified any dyslipidemia management or treatment program discussed in this article.

The illustrative patient situations are hypothetical and do not describe actual VLMA clinical activities or identifiable patients.