• USPSTF Draft Recommendation

    Offer Behavioral Counseling to Prevent CVD in at-Risk Adults

    May 20, 2020, 08:37 am News Staff – Each year, about one-third of all deaths in the United States -- more than 868,000 -- are caused by cardiovascular disease events such as heart attack and stroke. Although some risk factors for CVD (e.g., age and gender) can't be modified, individuals can make adjustments to other factors (e.g., diet and activity levels) that may reduce CVD risk.

    physician talking with patient

    On May 12, the U.S. Preventive Services Task Force issued a draft recommendation statement and draft evidence review on behavioral counseling interventions to promote a healthy lifestyle to prevent CVD in adults with risk factors.

    Based on its review of the evidence, the task force recommended that clinicians offer or refer adults with CVD risk factors to behavioral counseling interventions to promote a healthy diet and physical activity. This is a "B" recommendation.

    "Almost half of all adults in the U.S. have risk factors for cardiovascular disease such as high blood pressure or elevated cholesterol, but the good news is there are steps people can take to reduce their risk," said task force member Marti Kubik, Ph.D., R.N., in a USPSTF news release. "Evidence shows that behavioral counseling interventions to improve diet and increase physical activity can help reduce cardiovascular disease."

    The draft recommendation applies to adults with specific risk factors, such as hypertension, elevated blood pressure and dyslipidemia, as well as to those with mixed or multiple risk factors, such as metabolic syndrome or an estimated 10-year CVD risk of 7.5% or greater.

    The recommendation does not apply to adults with certain other known modifiable cardiovascular risk factors, such as abnormal blood glucose levels, obesity and smoking. Interventions to reduce CVD risk in adults with those risk factors are covered in other recommendations.


    Update of Existing Recommendation

    The current draft recommendation updates and replaces the task force's existing recommendation statement on the topic, which was published in September 2014.

    At the time, the USPSTF recommended intensive behavioral counseling interventions for adult patients who were overweight or obese and had additional risk factors for CVD such as hypertension, dyslipidemia, impaired fasting glucose or glucose intolerance, and metabolic syndrome; this was also a "B" recommendation. The AAFP supported the 2014 recommendation.

    It should be noted that although the 2014 recommendation covered adults with impaired glucose tolerance or type 2 diabetes, the current draft recommendation posted does not. Rather, interventions for adults with those risk factors are addressed in a separate recommendation.

    To update its 2014 recommendation, the USPSTF commissioned a systematic evidence review of 94 trials. Although some trials evaluated interventions that focused only on physical activity or diet, most trials in the review evaluated interventions that combined diet and physical activity.

    The review found that behavioral counseling interventions were associated with a lower likelihood of CVD events based on results from 12 trials that reported CVD event outcomes. The overall pooled effect revealed a 20% lower risk of CVD events with behavioral counseling interventions.

    Based on the review, the task force concluded that medium- and high-contact multisession behavioral counseling interventions that promoted a healthy lifestyle were effective in reducing CVD events, blood pressure, total cholesterol and adiposity-related outcomes in adults with hypertension or elevated blood pressure, or dyslipidemia or elevated lipid levels, with little to no risk of serious harm.

    "There are a variety of interventions available that promote a healthy diet and physical activity," noted family physician and task force member John Epling, M.D., M.S.Ed., in the release. "A healthy diet and physical activity are the foundations of a plan to help people at risk for cardiovascular disease stay healthy. Clinicians should work with their patients to determine which interventions are best for them."

    Up Next

    The USPSTF is accepting comments on the draft recommendation statement and draft evidence review until 8 p.m. EDT on June 8. All comments received will be considered as the task force prepares its final recommendation.

    The AAFP will review the USPSTF's draft recommendation statement and supporting evidence and will provide comments to the task force. The Academy will release its own recommendation on the topic after the task force finalizes its guidance.