Gary H. Gibbons - November 12, 2013
In June, the NHLBI announced in an essay published in Circulation and the Journal of the American College of Cardiology that the Institute was focusing its efforts on knowledge generation and evidence synthesis by implementing a new collaborative partnership model to develop new cardiovascular clinical practice guidelines based upon NHLBI-sponsored systematic evidence reviews. In the short time since that announcement, four of the five Expert Panels/Working Groups embraced the collaborative model and worked successfully with the American Heart Association (AHA), the American College of Cardiology (ACC) and other professional societies to develop new cardiovascular disease (CVD) clinical practice guidelines for lifestyle, risk assessment, cholesterol, and obesity.
These new guidelines led by the AHA and ACC and endorsed by other professional societies provide a valuable updated roadmap to help clinicians and patients manage prevention and treatment challenges. There are many significant points in the new guidelines, and below are several items of note:
- Lifestyle: Recommendations include reducing saturated fat, trans fat and sodium intakes below current population levels and engaging in physical activity an average of 40 minutes of moderate to vigorous-intensity aerobic exercise, 3-4 times a week.
- Risk Assessment: The guideline has been broadened to include assessment for risk of stroke as well as heart attack and provide new sex- and race-specific formulas for predicting risk in African-American and white women and men.
- Cholesterol: The guideline identifies four major groups of patients for whom cholesterol-lowering HMG-CoA reductase inhibitors, or statins, have the greatest chance of preventing stroke and heart attacks.
- Overweight & Obesity: The report summarizes knowledge on diets for weight loss, the efficacy and effectiveness of comprehensive lifestyle interventions on weight loss and weight loss maintenance, and the benefits and risks of bariatric surgery.
The pace of scientific advances today requires systematic synthesis for developing guidelines that will assist busy practitioners. We believe that professional societies like the AHA, ACC, and other endorsing societies are well equipped to develop, review, and disseminate guidelines to help those on the front lines of clinical practice to implement them. We hope that these guidelines together with other available scientific evidence provide practitioners with the knowledge needed to tailor CVD prevention and treatment options to the individual circumstances and risk factors of each patient.
The process of transitioning to the collaborative partnership model to generate clinical guidelines on hypertension will require more time. The NHLBI, AHA and ACC will work with other professional societies to produce a clinical guideline that will provide guidance to clinicians on this aspect of CVD risk management. The new collaborative partnership model and consensus-building endorsement approach follows recommendations formulated by the Institute of Medicine and affirmed by two NHLBI Advisory Council Working Groups. In addition, the NHLBI will continue to serve its unique leadership role – supporting essential research and evidence syntheses, serving as a trusted source of health information that educates patients and informs clinical practice.
We appreciate the outstanding work and dedication of the panelists who helped shape the NHLBI evidence reviews, as well as the collaborative contributions of the professional societies, for their extensive efforts to disseminate these guidelines to the public. The guidelines reflect the most comprehensive and rigorous systematic evidence reviews to date on these topics, and we are pleased that the reviews provided by NHLBI-convened expert panels enabled the professional society partners to move with such deliberate speed.
The NHLBI looks forward to continuing to develop accurate and timely evidence reviews, fueled by our investment in primary research on cardiovascular disease as well as implementation science to improve public health.
- AHA: Clinical Practice Guidelines for Prevention: http://my.americanheart.org/professional/ScienceNews/Clinical-Practice-Guidelines-for-Prevention_UCM_457211_Article.jsp
- ACC: ACC: New ACC/AHA Prevention Guidelines Address Blood Cholesterol, Obesity, Healthy Living and Risk Assessment: http://www.cardiosource.org/news-media/publications/cardiology-magazine/2013/11/new-accaha-prevention-guidelines-address-blood-cholesterol-obesity.aspx