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JAMA Patient Page
July 11, 2017

Counseling on Healthy Living to Prevent Cardiovascular Disease in Adults Without Risk Factors

JAMA. 2017;318(2):210. doi:10.1001/jama.2017.8445

The US Preventive Services Task Force (USPSTF) has published recommendations on counseling about healthy living to prevent cardiovascular disease.

Who Should Be Concerned About Cardiovascular Disease?

Cardiovascular disease is the leading cause of death in the United States. The term can mean a number of things but generally refers to narrowed or blocked blood vessels, which can lead to heart attack and stroke. There are several known risk factors for cardiovascular disease, such as high blood pressure, high cholesterol, diabetes, obesity, and smoking. There is also a genetic component, so people with family members affected by cardiovascular disease are more likely to also be affected by it.

However, cardiovascular disease can also be present in people who have no risk factors. This means that people who are of normal weight and have normal blood pressure and cholesterol levels, no diabetes, and no family history can still get cardiovascular disease.

What Does “Healthy Living” Mean?

For the purposes of this recommendation statement, counseling about healthy living means providing in-depth education about the benefits of a heart-healthy diet and regular exercise. A heart-healthy diet is rich in vegetables, fruits, fiber, and whole grains and is low in salt, red and processed meats, and saturated fats. As for exercise, guidelines recommend at least 2.5 hours of moderate exercise or 75 minutes of intense exercise every week. Effective counseling generally requires multiple sessions.

What Is the Patient Population Under Consideration for Counseling About Healthy Living?

This USPSTF recommendation applies to adults who are not obese and do not have any known risk factors for cardiovascular disease. This refers to people who are normal weight or overweight (body mass index between 18.5 and 30) and who do not have diabetes, high blood pressure, or high cholesterol. There is a separate USPSTF recommendation for counseling about healthy living in adults who do have risk factors for cardiovascular disease.

What Are the Potential Benefits and Harms of Counseling About Healthy Living in Adults Without Risk Factors?

There is some evidence that counseling about healthy living leads to improvements in body weight, blood pressure, and cholesterol levels. However, the data do not consistently show that these improvements are linked to decreased heart attacks, strokes, or deaths due to cardiovascular disease. Harms from counseling about healthy living have been found to be small to none.

How Strong Is the Recommendation to Counsel About Healthy Living to Prevent Cardiovascular Disease in Adults Without Risk Factors?

Based on the current evidence, the USPSTF concludes that overall, the net benefit of counseling people who are already relatively healthy about healthy living is small but still positive. Counseling is more likely to make a difference in people who are interested in and ready to make lifestyle changes. Therefore, the decision to provide counseling should be an individualized one.

Bottom Line: Current Recommendation for Counseling About Healthy Living to Prevent Cardiovascular Disease in Adults Without Risk Factors

The USPSTF recommends individualizing the decision to offer behavioral counseling to promote a healthful diet and physical activity to nonobese patients without specific risk factors for cardiovascular disease (“C” recommendation).

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Article Information

Source: US Preventive Services Task Force. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force Recommendation Statement. JAMA. doi:10.1001/jama.2017.7171

Topic: Preventive Medicine

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