The Personalization of Lifestyle Modification of Acute Coronary Syndrome: A Scoping Review*

Abstract

Acute coronary syndrome (ACS) remains a major public health challenge and a leading cause of mortality worldwide. Cardiovascular diseases account for approximately 17.9 million deaths annually, representing nearly one quarter of global mortality. In Thailand, ACS-related mortality remains substantial, with reported rates of 31.8, 31.0, and 32.62 per 100,000 population in 2020, 2021, and 2022, respectively. ACS is influenced by non-modifiable factors,including age, sex, genetic predisposition, and family history, as well as modifiable behavioral and metabolic risks such as hypertension, diabetes mellitus, dyslipidemia, obesity, smoking,alcohol consumption, physical inactivity, unhealthy dietary patterns, poor sleep quality,psychosocial stress, and limited social support. These modifiable risks highlight the need for sustained health promotion, secondary prevention, and individualized behavioral support.

Lifestyle modification is increasingly recognized as a core component of ACS prevention, treatment, recovery, and secondary prevention. Although pharmacological therapy,coronary revascularization, and clinical monitoring remain essential, long-term cardiovascular outcomes depend substantially on patients’ ability to adopt and maintain healthy behaviors in daily life. Existing evidence often focuses on isolated behaviors, including diet, exercise, smoking cessation, or medication adherence, rather than conceptualizing lifestyle modification as an integrated, person-centered process. Evidence synthesis is also limited regarding how personalized lifestyle modification can be implemented among ACS patients through a holistic framework that integrates individual motivation, family involvement, healthcare counseling, digital health technologies, and environmental support. This scoping review therefore aimed to synthesize current evidence on personalized lifestyle modification among ACS patients within the broader
context of non-communicable disease care.

The objective of this study was to synthesize current evidence on personalized lifestyle modification among patients with acute coronary syndrome, focusing on five domains: diet,physical activity, sleep, social interaction, and stress management. It also examined smoking,alcohol consumption, obesity, body mass index, and factors supporting sustainable behavioral change. Guided by the Personalization of Lifestyle Model of NCD Patients, the review explored relationships among lifestyle behaviors, risk factors, health outcomes, and self-care.

A scoping review methodology was employed in accordance with the PRISMA-ScR framework. Literature searches were conducted in PubMed, Scopus, and ScienceDirect for studies published between 2014 and 2024. Search terms included “Acute Coronary Syndrome,”“Lifestyle Modification,” “Lifestyle Management,” and “Lifestyle Change.” Eligibility criteria included randomized controlled trials (RCTs), systematic reviews and meta-analyses, clinical practice guidelines, rapid reviews, observational studies, and cohort studies involving adult patients with ACS or other coronary artery disease–related conditions that evaluated or addressed lifestyle modification, behavioral change, cardiovascular risk reduction, cardiac rehabilitation,or secondary prevention of recurrent cardiovascular events. Only English-language full-text studies were included. Two independent reviewers screened and assessed the studies, and a third expert reviewer resolved disagreements. Data were analyzed using content analysis and descriptive synthesis.

The initial search identified 10,229 records. After screening titles, abstracts,duplicates, relevance, and methodological quality, 13 studies met the inclusion criteria and were included in the final synthesis. The included studies comprised randomized controlled trials,systematic reviews and meta-analyses, clinical practice guidelines, rapid reviews, observational studies, and cohort studies. Thematic synthesis identified six domains related to lifestyle and behavioral modification in ACS patients: diet, physical activity, smoking and alcohol consumption,sleep, stress management, and social interaction. Diet and physical activity were the most frequently emphasized domains.

Dietary behaviors, physical activity, sleep, stress management, social support,smoking, alcohol use, and obesity emerged as key modifiable factors influencing ACS risk,recovery, and recurrence. High consumption of carbohydrates, saturated fat, and energy-dense foods, combined with inadequate intake of protein, vegetables, fruits, and dietary fiber, was associated with increased cardiovascular risk. In contrast, healthy dietary patterns, particularly the Mediterranean diet, were linked to lower saturated fat intake, greater fiber consumption,improved metabolic profiles, and reduced recurrent cardiovascular events. Regular aerobic exercise, resistance training, and reduced sedentary behavior contributed to improved endothelial function, weight control, reduced inflammation, improved metabolic regulation, and lower recurrence risk. Sleep disturbance, obstructive sleep apnea, insufficient sleep, and poor sleep quality may aggravate hypertension, sympathetic activation, metabolic dysfunction, and recurrent cardiovascular events. Sleep assessment, continuous positive airway pressure therapy, cognitive behavioral therapy for insomnia, and digital sleep monitoring may improve outcomes. Chronic stress, anxiety, depression, and psychological distress were associated with elevated blood pressure, inflammation, and poorer prognosis, whereas mindfulness-based, relaxation, counseling,and psycho-behavioral interventions may reduce distress. Family-centered care, peer support,community engagement, healthcare counseling, smoking cessation, alcohol reduction, and weight control are essential for sustained lifestyle modification.

This demonstrates that personalized lifestyle modification is crucial for reducing ACS risk, preventing recurrence, promoting recovery, and enhancing quality of life. Effective interventions should integrate dietary counseling, structured physical activity, sleep management,stress reduction, smoking cessation, alcohol reduction, weight control, family support, healthcare provider counseling, and digital health technologies. Nurses play a vital role across the ACS care continuum, from prevention and acute treatment to rehabilitation and long-term follow-up.Future research should develop and test culturally relevant, context-specific, technology-supported lifestyle modification programs for ACS patients, particularly in Asian populations and real-world clinical settings.

Keywords: Acute coronary syndrome, Lifestyle modification, Non-communicable diseases,Personalized care, Scoping review

Author contribution:
PW: Conceptualization, Data curation, Investigation, Methodology, Project administration,Writing–original draft, Writing–review and editing
NP: Conceptualization, Data curation, Investigation, Methodology, Project administration,Writing–review and editing, Supervision, Funding acquisition, Corresponding with the editor-in-chief