USPSTF: Use shared decision-making to prevent CVD in patients without risk factors

The U.S. Preventive Services Task Force has issued a draft recommendation encouraging clinicians to use shared decision-making when considering behavioral counseling to promote healthy diet and physical activity for CVD prevention.

The “C” grade recommendation only applies to adults without risk factors for CVD and does not apply to adults with obesity, the USPSTF wrote.

A 2020 report from the CDC showed that CVD claimed about 659,000 lives in the U.S. in 2018, making it the leading cause of death for U.S. men, women and people of historically underrepresented populations. Healio has previously reported that the COVID-19 pandemic will likely exacerbate the death toll attributable to CVD. According to the USPSTF, nearly half of U.S. adults are expected to have some form of CVD by 2035.

The task force’s draft recommendation is based on a review of 113 randomized clinical trials that included 129,993 men and women of diverse racial backgrounds and a wide range of ages, according to the authors of the evidence review.

“Healthy diet and physical activity behavioral interventions for persons without a known risk of CVD were associated with very small but statistically significant benefits across a variety of important intermediate health outcomes and small-to-moderate effects on dietary and physical activity behaviors,” they wrote. “Very limited evidence exists regarding the health outcomes or harmful effects of these interventions.”

The new USPSTF draft recommendation runs parallel to its 2017 final recommendation, which is supported by the American Academy of Family Physicians. The American Heart Association recommends that clinicians promote physical activity for CVD prevention to all adult patients, according to the USPSTF.

The task force noted that it released a separate “B” grade recommendation in 2020 on behavioral counseling interventions for adults who have established risk factors for CVD.

“We found that people who are interested in making changes to their diet and physical activity are most likely to benefit from counseling, so clinicians are encouraged to talk with their patients and decide together if behavioral counseling is right for them,” Lori Pbert, PhD, a task force member and associate chief of the division of preventive and behavioral medicine at the UMass Chan Medical School, said in a press release.

Comments on the draft recommendation are being accepted from now until Feb. 14 at www.uspreventiveservicestaskforce.org/tfcomment.htm.

References

• Behavioral counseling to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without cardiovascular disease risk factors: U.S. Preventive Services Task Force Draft Recommendation Statement. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/healthy-diet-and-physical-activity-for-cvd-prevention-adults-without-known-risk-factors-behavioral-counseling. Published Jan. 18. 2022. Accessed Jan. 18, 2022.
• Evidence synthesis: Behavioral counseling to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: Updated systematic review for the U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/healthy-diet-and-physical-activity-for-cvd-prevention-adults-without-known-risk-factors-behavioral-counseling. Published Jan. 18. 2022. Accessed Jan. 18, 2022.
• Heart disease facts. https://www.cdc.gov/heartdisease/facts.htm. Accessed Jan. 14, 2022.
• U.S. Preventive Services Task Force issues draft recommendation on behavioral counseling to promote a healthy lifestyle in adults without cardiovascular risk factors. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/healthy-diet-physical-activity-low-risk-CVD-counseling-draft-rec-bulletin.pdf. Published Jan. 18, 2022. Accessed Jan. 18, 2022.