Efficacy of Structured Lifestyle Interventions in Post-Acute Coronary Syndrome Care: A Systematic Review
Abstract
Background: Structured lifestyle interventions are a cornerstone of preventing recurrence after Acute Coronary Syndrome (ACS), yet evidence on their effectiveness across diverse outcomes and delivery models requires synthesis. This study evaluated whether structured, multi-component lifestyle intervention programs reduce major adverse cardiovascular events (MACE) and improve cardiovascular risk factors and quality of life compared to usual care in post-ACS patients. Methods: A systematic review of randomized controlled trials (RCTs) was conducted. Databases (PubMed, Embase, CENTRAL, CINAHL) were searched for RCTs comparing multi-component lifestyle interventions (diet, exercise, smoking cessation) with usual care in adults post-ACS. Given substantial clinical and methodological heterogeneity across trials, findings were synthesized narratively rather than pooled quantitatively. Results: Fourteen RCTs (n>9,000 patients) were included. Interventions were delivered via cardiac rehabilitation, nurse-led, digital, and community health worker models. While the largest trials reported a non-significant reduction in its primary MACE endpoint (hazard ratio [HR] 0.88, 95% CI 0.74–1.04), significant reductions in key secondary endpoints like non-fatal MI (HR 0.52) and cardiovascular mortality were observed. Other trials demonstrated significant reductions in rehospitalization and composite MACE. Interventions consistently and significantly improved systolic blood pressure, lipid profiles, body weight, physical activity, and smoking cessation rates. Conclusion: Structured lifestyle interventions post-ACS consistently and significantly improve cardiovascular risk factors and health behaviors. While effects on composite MACE are heterogeneous, significant benefits for key individual hard outcomes and mortality are evident, particularly with intensive, sustained programs. These findings reinforce the critical role of structured lifestyle support as an adjunct to pharmacotherapy in secondary prevention.