Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Disease Risk Factors

Abstract

ImportanceCardiovascular disease (CVD), which includes heart disease, myocardial infarction, and stroke, is the leading cause of death in the US. [1][2][3] By 2035, nearly half of US adults are anticipated to have some form of CVD. 4 A large proportion of CVD cases can be prevented by ad-dressing modifiable risk factors, including smoking, obesity, diabetes, elevated blood pressure or hypertension, dyslipidemia, lack of physical activity, and unhealthy diet. 2,4 Adults who adhere to national guidelines for a healthy diet 5 and physical activity 6 have lower rates of cardiovascular morbidity and mortality than those who do not; however, many US adults do not consume healthy diets or engage in physical activity at recommended levels. 7,8 All persons, IMPORTANCE Cardiovascular disease (CVD), which includes heart disease, myocardial infarction, and stroke, is the leading cause of death in the US. A large proportion of CVD cases can be prevented by addressing modifiable risk factors, including smoking, obesity, diabetes, elevated blood pressure or hypertension, dyslipidemia, lack of physical activity, and unhealthy diet. Adults who adhere to national guidelines for a healthy diet and physical activity have lower rates of cardiovascular morbidity and mortality than those who do not; however, most US adults do not consume healthy diets or engage in physical activity at recommended levels.OBJECTIVE To update its 2017 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of behavioral counseling interventions to promote healthy behaviors in adults without CVD risk factors.POPULATION Adults 18 years or older without known CVD risk factors, which include hypertension or elevated blood pressure, dyslipidemia, impaired fasting glucose or glucose tolerance, or mixed or multiple risk factors such as metabolic syndrome or an estimated 10-year CVD risk of 7.5% or greater. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that behavioral counseling interventions have a small net benefit on CVD risk in adults without CVD risk factors. RECOMMENDATION The USPSTF recommends that clinicians individualize the decision to offer or refer adults without CVD risk factors to behavioral counseling interventions to promote a healthy diet and physical activity. (C recommendation)

Contribution of genetics and lifestyle to the risk of major cardiovascular and thromboembolic complications following COVID-19

“…The US Preventive Services Task Force updated its guidelines in 2022, recommending behavioural counselling for cardiovascular disease prevention for all adults aged 18 years and older. 12,14 Our data support this recommendation by showing that a composite healthy lifestyle can also benefit acute CVE outcomes after COVID-19, regardless of genetic risk. This benefit should be emphasized in future lifestyle intervention programmes during the ongoing pandemic.…”

Contribution of genetics and lifestyle to the risk of major cardiovascular and thromboembolic complications following COVID-19

“…The US Preventive Services Task Force updated its guidelines in 2022, recommending behavioural counselling for cardiovascular disease prevention for all adults aged 18 years and older. 12,14 Our data support this recommendation by showing that a composite healthy lifestyle can also bene t acute CVE outcomes after COVID-19, regardless of genetic risk. This bene t should be emphasized in future lifestyle intervention programmes during the ongoing pandemic.…”

“…The US Preventive Service Task Force updated its recommendations in 2022, promoting healthy behaviour counselling for all adults as a national strategy for primary cardiovascular prevention. 12 However, all current clinical and public health guidelines 13,14 lack insights into the potential role of healthy lifestyle modi cations in alleviating COVID-19 cardiovascular complications, likely due to a paucity of evidence.…”

Evidence and opportunity costs of lifestyle interventions in clinical medicine

“…For instance, a recently updated USPSTF guideline recommending behavioural counselling to encourage healthy diets and physical activity for the prevention of cardiovascular disease in adults 18 years or older had been based on evidence of moderate level of certainty showing a small net benefit. 3 Moreover, in evaluating the evidence behind such recommendations, much of the focus has been on the benefits of such lifestyle recommendations. By comparison, there has been limited evaluation of the potential harms of targeting such interventions to individual patients.…”