Putting Prevention into Practice
An Evidence-Based Approach
Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults with Cardiovascular Risk Factors
Am Fam Physician. 2021 Oct ;104(4):411-412.
Author disclosure: No relevant financial affiliations.
A 36-year-old patient, L.B., with a history of hypertension presents for a wellness visit. The patient's mother had a stroke at 65 years of age and the patient's older brother recently had a heart attack. L.B. has an estimated 10-year cardiovascular risk of 6%, and L.B.'s body mass index is 29 kg per m2. The rest of the patient's history and physical examination is unremarkable.
Case Study Questions
1. According to the U.S. Preventive Services Task Force (USPSTF), which one of the following is the most appropriate behavioral counseling approach to promote a healthy diet and physical activity to prevent cardiovascular disease?
A. Providing educational materials on healthy eating and ways to improve physical activity level.
B. No counseling should be provided because there is little to no net benefit of counseling for this patient.
C. Providing a one-time, in-office counseling visit on healthy eating and physical activity, with motivational interviewing techniques and goal setting.
D. Providing intensive behavioral counseling on healthy eating and physical activity, with multiple contacts over an extended period.
2. The USPSTF recommends offering behavioral counseling for cardiovascular disease prevention to patients with which one of the following cardiovascular risk factors?
A. Abnormal blood glucose level.
D. Estimated 10-year cardiovascular risk of 7.5% or greater.
3. According to the USPSTF, which of the following statements about benefits and harms of behavioral counseling to promote a healthy diet and physical activity are correct?
A. There is inadequate evidence that counseling interventions improve blood pressure.
B. There is adequate evidence that counseling interventions improve healthy eating habits.
C. There is adequate evidence that counseling interventions reduce overall cardiovascular disease events.
D. There is inadequate evidence to determine the harms of counseling interventions.
The correct answer is D. The USPSTF recommends
1. Krist AH, Davidson KW, Mangione CM, et al. Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: US Preventive Services Task Force recommendation statement. JAMA. 2020;324(20):2069–2075.
2. O'Connor EA, Evans CV, Rushkin MC, et al. Behavioral counseling to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2020;324(20):2076–2094.
See related U.S. Preventive Services Task Force Recommendation Statement at https://www.aafp.org/afp/2021/0315/p366.html.
This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/healthy-diet-and-physical-activity-counseling-adults-with-high-risk-of-cvd.
This series is coordinated by Kenny Lin, MD, MPH, deputy editor.
A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.
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