[Societal aspects of the risk of cardiovascular disease]

A 57-year-old man of Turkish descent is treated for coronary artery disease. In addition to drug treatment and percutaneous revascularization, modification of lifestyle-related risk factors is indicated. His risk profile includes smoking, hypertension and inadequate physical activity. Adherence to medication is suboptimal and his wife is a smoker too. Limited health literacy and acculturation, and resource limitations impede adequate lifestyle changes. Guidance of this patient is challenging; it is not straightforward to influence the societal components of his issues from a medical office. Evidence-based lifestyle interventions are scarce, and their validation - if validated at all - was performed in populations that are not representative of the patient in question. However, physicians can contribute to achieving societal change by participating in national programs aimed at improving infrastructure, improving health literacy, development of ethnicity-specific interventions, availability of healthy food, discouragement of smoking, and creating an infrastructure that promotes physical activity in daily life.