Behavioral counseling decisions should be individualized for people without CVD risk factors: USPSTF
USA: Clinicians individualize the decision to offer or refer adults with no CVD risk factors to behavioral counseling interventions that will promote a healthy diet and physical activity, the U.S. Preventive Services Task Force (USPSTF) has recommended. The recommendations were published in the Journal of the American Medical Association (JAMA).
Cardiovascular disease (CVD) that includes myocardial infarction, heart disease, and stroke, is the leading death cause in the US. By addressing modifiable risk factors, including obesity, smoking, diabetes, dyslipidemia, elevated blood pressure or hypertension, unhealthy diet, and lack of physical activity. Adults who adhere to national guidelines for a physical activity and healthy diet have lower rates of cardiovascular morbidity and mortality compared to those who do not, however, most US adults do not consume healthy diets or engage in physical activity at recommended levels.
Considering the above, the USPSTF updated its 2017 recommendation by commissioning a review of the evidence on the benefits and harms of behavioral counseling interventions to promote healthy behaviors in adults without CVD risk factors.
The updated review included 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. Interventions to reduce CVD risk in adults with known modifiable risk factors (i.e hypertension or dyslipidemia) and weight management interventions are mentioned in separate USPSTF recommendations.
A total of 113 randomized clinical trials including 129,993 people from a variety of demographics were included.
The USPSTF recommends selectively offering or providing behavioral counseling interventions to patients based on clinician professional judgment and patient preferences.
- Common dietary counseling advice promotes increased consumption of fruits, vegetables, and fiber; reduced consumption of saturated fats, sodium, and sugar-sweetened beverages; or both.
- Physical activity counseling often encourages patients to gradually increase aerobic activity (walking is often emphasized) to achieve at least 150 minutes (2 hours and 30 minutes) per week of equivalent moderate-intensity activity.
- Interventions can be delivered individually, in a group, or both, with or without follow-up (telephone calls or emails), or delivered remotely through a combination of print materials, telephone calls, technology-based activities, or some combination thereof.
- Typical counseling techniques include behavioral change techniques such as goal setting, problem solving, and self-monitoring; approaches including motivational interviewing principles or portions of the "5 A's" model (assess, advise, agree, assist, and arrange) are common.
- A wide range of specially trained professional can deliver these interventions.
- Intensity or interaction time with a clinician may range from 30 minutes to 6 hours over 6 months or longer
The USPSTF concluded with moderate certainty that behavioral counseling interventions have a small net benefit on CVD risk in adults without CVD risk factors.
Reference:
US Preventive Services Task Force. Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Disease Risk Factors: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;328(4):367–374. doi:10.1001/jama.2022.10951
