Adherence

Adherence to a combination of healthy lifestyle behaviors (smoking cessation, high physical activity, and healthy diet) is significantly lower in low- and middle-income countries compared to high-income countries among individuals with prior cardiovascular disease.

For patients with heart disease or stroke, simply knowing healthy behaviors are good is not enough; access and cost are major barriers. In lower-income settings, focus on affordable, locally available healthy food options and recognize that occupational activity may not replace the need for structured leisure-time exercise. Smoking cessation programs should be prioritized, especially in lower-income regions where cessation rates are lowest.