Changing one’s lifestyle is difficult and adherence to medication in people at high cardiovascular risk and established cardiovascular disease is low. Lifestyle is usually based on longstanding patterns and is highly determined by social environment and socioeconomic status. Additional factors such as chronic stress, cognitive impairment, and negative emotions (e.g. depression, anxiety) further impede the ability to adopt a healthy lifestyle, as does complex or confusing advice by medical caregivers. In clinical practice, increased awareness of these factors will facilitate empathetic counselling and the provision of simple and explicit advice. Established cognitive-behavioural strategies are important tools to help with behaviour change and medication adherence. Specialized healthcare professionals (e.g. nurses, dieticians, psychologists) should be involved whenever necessary and feasible. Reducing dosage demands to the lowest applicable level is the single most effective means for enhancing adherence to medication.