JAMA PATIENT PAGE | Preventive Medicine
Counseling on Healthy Living to Prevent Cardiovascular
Disease in Adults Without Risk Factors
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, obe-
sity, 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,cardiovasculardiseasecanalsobepresentinpeoplewho
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 ex-
ercise, guidelines recommend at least 2.5 hours of moderate exer-
cise or 75 minutes of intense exercise every week. Effective coun-
seling 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 im-
provements 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.
Author: Jill Jin, MD, MPH
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
210 JAMA July 11, 2017 Volume 318, Number 2 (Reprinted)
© 2017 American Medical Association. All rights reserved.
Downloaded From: on 04/19/2018
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 be-
havioral counseling to promote a healthful diet and physical activ-
ity to nonobese patients without specific risk factors for cardiovas-
cular disease (“C” recommendation).
Behavioral Counseling to Promote a Healthful Diet
and Physical Activity for Cardiovascular Disease (CVD)
Prevention in Adults Without CVD Risk Factors
Population USPSTF recommendation grade
Recommendation depends
on the patient’s situation
ADULTS
who are not obese and do not
have known CVD risk factors
FOR MORE INFORMATION
US Preventive Services Task Force
www.uspreventiveservicestaskforce.org/Page/Document/draft
-recommendation-statement/healthful-diet-and-physical-activity
-for-cardiovascular-disease-prevention-in-adults-without-known
-risk-factors-behavioral-counseling
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