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Clinical judgment should drive referrals for diet and exercise behavioral counseling for adults with a low risk for cardiovascular disease (CVD), according to a new recommendation statement from the U.S. Preventive Services Task Force published online July 11 in JAMA.
“Persons who are interested and ready to make behavioral changes may be most likely to benefit from behavioral counseling,” according to the statement (JAMA 2017 Jul 11;318:167-74. doi: 10.1001/jama.2017.7171).
The recommendation is a C, which means that clinicians should consider patient preferences and clinical judgment, wrote David C. Grossman, MD, of Kaiser Permanente Washington Health Research Institute, Seattle, and his colleagues.
To assess the value of behavioral counseling in adults at low risk for cardiovascular disease, the USPSTF reviewed 88 trials including more than 120 interventions related to a healthful diet, physical activity, or both. None of the trials included in the review noted specific adverse events related to counseling.
Although the evidence was insufficient to support benefits from behavioral counseling for reducing death or CVD rates, the data showed that behavioral counseling was associated with improved systolic and diastolic blood pressure levels, cholesterol, body mass index, and waist circumference over 6-12 months.
In data from 34 trials, behavior counseling resulted in significant changes to several CVD risk factors, with average improvements of –1.26 mm Hg for systolic blood pressure, –0.49 mm Hg for diastolic blood pressure, –2.85 mg/dL for total cholesterol, –0.41 kg/m2 for body mass index, –1.04 kg for weight, and –0.19 cm for waist circumference.
The current recommendation updates the 2012 recommendations that primary care clinicians “selectively provide or refer patients who do not have hypertension, dyslipidemia, diabetes, or CVD to behavioral counseling to promote a healthful diet and physical activity rather than incorporating counseling into the routine care of adults.”
Separate USPSTF recommendations focus on behavioral counseling in adults with risk factors including obesity, abnormal blood glucose levels, diabetes, or CVD, therefore, the current recommendation “focuses on persons without these risk factors,” the researchers noted.
In the evidence report accompanying the recommendations, Carrie D. Patnode, PhD, of Kaiser Permanente in Portland, Ore., and her colleagues concluded that higher-intensity interventions may promote greater improvements in health outcomes, but that “there is very limited evidence on longer-term intermediate and health outcomes or on harmful effects of these interventions” (JAMA 2017;318:175-93. doi: 10.1001/jama.2017.3303).
The researchers had no financial conflicts to disclose.
“The evidence is strong, consistent, and persuasive that CVD risk factor prevention and treatment are associated with lower rates of CVD,” wrote Philip Greenland, MD, and Valentin Fuster, MD, PhD, in an accompanying editorial (JAMA 2017 Jul 11;318:130-1). “There are no universally effective solutions to accomplish this, but certain principles apply. Recommended dietary patterns focus on meals high in vegetables, fruit, whole grains, seafood, legumes, and nuts; moderate in low-fat and nonfat dairy products; lower in red and processed meat, foods and beverages containing added sugar, and refined grains,” they said. In addition, “physical activity must be encouraged in children and adults and emphasize a regular and consistent commitment to daily exercise habits. Research findings support the need to begin interventions in preschool children, [and should] involve the family, and continue lifelong,” they noted.
Although the guidelines address the challenges faced by clinicians in controlling CVD risk factors, “risk factor control in the clinical setting begins with risk assessment, aims at targeting all risk factors above ideal levels, and moves patients in measured steps toward more ideal cardiovascular health,” the editorialists said.
Dr. Greenland is affiliated with the department of preventive medicine at Northwestern University, Chicago. Dr. Fuster is director of the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, N.Y. They had no financial conflicts to disclose.
“The evidence is strong, consistent, and persuasive that CVD risk factor prevention and treatment are associated with lower rates of CVD,” wrote Philip Greenland, MD, and Valentin Fuster, MD, PhD, in an accompanying editorial (JAMA 2017 Jul 11;318:130-1). “There are no universally effective solutions to accomplish this, but certain principles apply. Recommended dietary patterns focus on meals high in vegetables, fruit, whole grains, seafood, legumes, and nuts; moderate in low-fat and nonfat dairy products; lower in red and processed meat, foods and beverages containing added sugar, and refined grains,” they said. In addition, “physical activity must be encouraged in children and adults and emphasize a regular and consistent commitment to daily exercise habits. Research findings support the need to begin interventions in preschool children, [and should] involve the family, and continue lifelong,” they noted.
Although the guidelines address the challenges faced by clinicians in controlling CVD risk factors, “risk factor control in the clinical setting begins with risk assessment, aims at targeting all risk factors above ideal levels, and moves patients in measured steps toward more ideal cardiovascular health,” the editorialists said.
Dr. Greenland is affiliated with the department of preventive medicine at Northwestern University, Chicago. Dr. Fuster is director of the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, N.Y. They had no financial conflicts to disclose.
“The evidence is strong, consistent, and persuasive that CVD risk factor prevention and treatment are associated with lower rates of CVD,” wrote Philip Greenland, MD, and Valentin Fuster, MD, PhD, in an accompanying editorial (JAMA 2017 Jul 11;318:130-1). “There are no universally effective solutions to accomplish this, but certain principles apply. Recommended dietary patterns focus on meals high in vegetables, fruit, whole grains, seafood, legumes, and nuts; moderate in low-fat and nonfat dairy products; lower in red and processed meat, foods and beverages containing added sugar, and refined grains,” they said. In addition, “physical activity must be encouraged in children and adults and emphasize a regular and consistent commitment to daily exercise habits. Research findings support the need to begin interventions in preschool children, [and should] involve the family, and continue lifelong,” they noted.
Although the guidelines address the challenges faced by clinicians in controlling CVD risk factors, “risk factor control in the clinical setting begins with risk assessment, aims at targeting all risk factors above ideal levels, and moves patients in measured steps toward more ideal cardiovascular health,” the editorialists said.
Dr. Greenland is affiliated with the department of preventive medicine at Northwestern University, Chicago. Dr. Fuster is director of the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, N.Y. They had no financial conflicts to disclose.
Clinical judgment should drive referrals for diet and exercise behavioral counseling for adults with a low risk for cardiovascular disease (CVD), according to a new recommendation statement from the U.S. Preventive Services Task Force published online July 11 in JAMA.
“Persons who are interested and ready to make behavioral changes may be most likely to benefit from behavioral counseling,” according to the statement (JAMA 2017 Jul 11;318:167-74. doi: 10.1001/jama.2017.7171).
The recommendation is a C, which means that clinicians should consider patient preferences and clinical judgment, wrote David C. Grossman, MD, of Kaiser Permanente Washington Health Research Institute, Seattle, and his colleagues.
To assess the value of behavioral counseling in adults at low risk for cardiovascular disease, the USPSTF reviewed 88 trials including more than 120 interventions related to a healthful diet, physical activity, or both. None of the trials included in the review noted specific adverse events related to counseling.
Although the evidence was insufficient to support benefits from behavioral counseling for reducing death or CVD rates, the data showed that behavioral counseling was associated with improved systolic and diastolic blood pressure levels, cholesterol, body mass index, and waist circumference over 6-12 months.
In data from 34 trials, behavior counseling resulted in significant changes to several CVD risk factors, with average improvements of –1.26 mm Hg for systolic blood pressure, –0.49 mm Hg for diastolic blood pressure, –2.85 mg/dL for total cholesterol, –0.41 kg/m2 for body mass index, –1.04 kg for weight, and –0.19 cm for waist circumference.
The current recommendation updates the 2012 recommendations that primary care clinicians “selectively provide or refer patients who do not have hypertension, dyslipidemia, diabetes, or CVD to behavioral counseling to promote a healthful diet and physical activity rather than incorporating counseling into the routine care of adults.”
Separate USPSTF recommendations focus on behavioral counseling in adults with risk factors including obesity, abnormal blood glucose levels, diabetes, or CVD, therefore, the current recommendation “focuses on persons without these risk factors,” the researchers noted.
In the evidence report accompanying the recommendations, Carrie D. Patnode, PhD, of Kaiser Permanente in Portland, Ore., and her colleagues concluded that higher-intensity interventions may promote greater improvements in health outcomes, but that “there is very limited evidence on longer-term intermediate and health outcomes or on harmful effects of these interventions” (JAMA 2017;318:175-93. doi: 10.1001/jama.2017.3303).
The researchers had no financial conflicts to disclose.
Clinical judgment should drive referrals for diet and exercise behavioral counseling for adults with a low risk for cardiovascular disease (CVD), according to a new recommendation statement from the U.S. Preventive Services Task Force published online July 11 in JAMA.
“Persons who are interested and ready to make behavioral changes may be most likely to benefit from behavioral counseling,” according to the statement (JAMA 2017 Jul 11;318:167-74. doi: 10.1001/jama.2017.7171).
The recommendation is a C, which means that clinicians should consider patient preferences and clinical judgment, wrote David C. Grossman, MD, of Kaiser Permanente Washington Health Research Institute, Seattle, and his colleagues.
To assess the value of behavioral counseling in adults at low risk for cardiovascular disease, the USPSTF reviewed 88 trials including more than 120 interventions related to a healthful diet, physical activity, or both. None of the trials included in the review noted specific adverse events related to counseling.
Although the evidence was insufficient to support benefits from behavioral counseling for reducing death or CVD rates, the data showed that behavioral counseling was associated with improved systolic and diastolic blood pressure levels, cholesterol, body mass index, and waist circumference over 6-12 months.
In data from 34 trials, behavior counseling resulted in significant changes to several CVD risk factors, with average improvements of –1.26 mm Hg for systolic blood pressure, –0.49 mm Hg for diastolic blood pressure, –2.85 mg/dL for total cholesterol, –0.41 kg/m2 for body mass index, –1.04 kg for weight, and –0.19 cm for waist circumference.
The current recommendation updates the 2012 recommendations that primary care clinicians “selectively provide or refer patients who do not have hypertension, dyslipidemia, diabetes, or CVD to behavioral counseling to promote a healthful diet and physical activity rather than incorporating counseling into the routine care of adults.”
Separate USPSTF recommendations focus on behavioral counseling in adults with risk factors including obesity, abnormal blood glucose levels, diabetes, or CVD, therefore, the current recommendation “focuses on persons without these risk factors,” the researchers noted.
In the evidence report accompanying the recommendations, Carrie D. Patnode, PhD, of Kaiser Permanente in Portland, Ore., and her colleagues concluded that higher-intensity interventions may promote greater improvements in health outcomes, but that “there is very limited evidence on longer-term intermediate and health outcomes or on harmful effects of these interventions” (JAMA 2017;318:175-93. doi: 10.1001/jama.2017.3303).
The researchers had no financial conflicts to disclose.
FROM JAMA
Key clinical point: Even adults with no CVD risk factors benefit from behavioral counseling about diet and exercise, according to the USPSTF.
Major finding: In 34 trials involving intermediate outcomes, behavior counseling was associated with significant improvements in systolic blood pressure, diastolic blood pressure, total cholesterol, BMI, weight, and waist circumference.
Data source: The data come from a USPSTF review of 88 trials and more 120 interventions.
Disclosures: The researchers had no relevant financial conflicts to disclose.