Population: Adults at risk for ASCVD considering lifestyle interventions.

This recommendation includes adults with elevated BP or known hypertension, metabolic syndrome, dyslipidemia, or estimated 10-y CVD risk > 7.5%. It does not include those with abnormal blood glucose levels, obesity, or smoking, though all persons benefit from healthy eating and physical activity behaviors.

Organizations

USPSTF 2022, ESC 2016, AHA/ACC 2019

Prevention Recommendations

–Offer behavioral counseling, cognitive-behavioral strategies, and multidisciplinary/multimodal interventions to promote healthy diet and physical activity on an individualized basis.

–Avoid use of and exposure to tobacco products.

–Behavioral counseling:

• Intensive counseling with multiple contacts over extended periods of time.

• Interventions typically take 6–18 mo with an estimated 6 h of contact time over a median of 12 contacts.

–Dietary guidelines:

• Balance calorie intake and physical activity to achieve or maintain a healthy body weight.

• Increase the consumption of fruits, vegetables, whole grains, and fat-free or low-fat dairy; consume lean proteins and vegetable oils.

• Decrease the consumption of food and drink that contain high sodium, saturated fat, trans fat, and added sugars; limit alcohol intake.

• Follow these Prevention Recommendations for food consumed/prepared inside and outside of the home.

–Recommended diets: Dietary Approaches to Stop Hypertension (DASH), USDA Food Pattern, AHA Diet, or Mediterranean diet.

–Physical activity guidelines:

• 150 min/wk of moderate or 75 min/wk of vigorous aerobic activity in addition to strengthening activities twice per week. For adults unable to meet these Prevention Recommendations, aim for some moderate- or vigorous-intensity physical activity to reduce ASCVD risk.

• Decrease sedentary behavior.

Sources

–J Am Coll Cardiol. 2019;74(10):e177-e232.

–Eur Heart J. 2016;37:2315-2381.

–JAMA. 2017:318:167-174.

–USPSTF. JAMA. 2022;328(4):367-374.

–USPSTF. Ann Int Med. 2015;163(11):861-869.