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Title: 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association task force on practice guidelines

item ECKEL, ROBERT - University Of Colorado
item JAKICIC, JOHN - University Of Pittsburgh
item ARD, JAMY - Wake Forest Baptist Medical Center
item HUBBARD, VAN - National Institutes Of Health (NIH)
item DE JESUS, JANET - National Institutes Of Health (NIH)
item LEE, I-MIN - Harvard University
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item LORIA, CATHERINE - National Institutes Of Health (NIH)
item MILLEN, BARBARA - Boston University
item HOUSTON MILLER, NANCY - Stanford University
item NONAS, CATHY - New York Department Of Health
item SCKS, FRANK - Harvard University
item SMITH, SIDNEY - University Of North Carolina
item SVETKEY, LAURA - Duke University
item WADDEN, THOMAS - American Heart Association
item YANOVSKI, SUSAN - National Institutes Of Health (NIH)

Submitted to: Circulation
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/23/2013
Publication Date: 11/12/2013
Citation: Eckel, R.H., Jakicic, J.M., Ard, J.D., Hubbard, V.S., De Jesus, J.M., Lee, I., Lichtenstein, A.H., Loria, C.M., Millen, B.E., Houston Miller, N., Nonas, C.A., Scks, F.M., Smith, S.C., Svetkey, L.P., Wadden, T.W., Yanovski, S.Z. 2013. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 129(25 Suppl 2):S76-S99.

Interpretive Summary:

Technical Abstract: The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular (CV) diseases, improve the management of people who have these diseases through professional education and research, and develop guidelines, standards and policies that promote optimal patient care and CV health. Toward these objectives, the ACC and AHA have collaborated with the National Heart, Lung, and Blood Institute (NHLBI) and stakeholder and professional organizations to develop clinical practice guidelines for assessment of CV risk, lifestyle modifications to reduce CV risk, and management of blood cholesterol, overweight and obesity in adults. In 2008, the NHLBI initiated these guidelines by sponsoring rigorous systematic evidence reviews for each topic by expert panels convened to develop critical questions (CQs), interpret the evidence and craft recommendations. In response to the 2011 report of the Institute of Medicine on the development of trustworthy clinical guidelines (1), the NHLBI Advisory Council (NHLBAC) recommended that the NHLBI focus specifically on reviewing the highest quality evidence and partner with other organizations to develop recommendations (2,3). Accordingly, in June 2013 the NHLBI initiated collaboration with the ACC and AHA to work with other organizations to complete and publish the 4 guidelines noted above and make them available to the widest possible constituency. Recognizing that the expert panels did not consider evidence beyond 2011 (except as specified in the methodology), the ACC, AHA and collaborating societies plan to begin updating these guidelines starting in 2014. The joint ACC/AHA Task Force on Practice Guidelines (Task Force) appointed a subcommittee to shepherd this transition, communicate the rationale and expectations to the writing panels and partnering organizations and expeditiously publish the documents. The ACC/AHA and partner organizations recruited a limited number of expert reviewers for fiduciary examination of content, recognizing that each document had undergone extensive peer review by representatives of the NHLBAC, key Federal agencies and scientific experts. Each writing panel responded to comments from these reviewers. Clarifications were incorporated where appropriate, but there were no substantive changes as the bulk of the content was undisputed. Although the Task Force led the final development of these prevention guidelines, they differ from other ACC/AHA guidelines. First, as opposed to an extensive compendium of clinical information, these documents are significantly more limited in scope and focus on selected CQs in each topic, based on the highest quality evidence available. Recommendations were derived from randomized trials, meta-analyses, and observational studies evaluated for quality, and were not formulated when sufficient evidence was not available. Second, the text accompanying each recommendation is succinct, summarizing the evidence for each question. The Full Panel Reports include more detailed information about the evidence statements (ESs) that serves as the basis for recommendations. Third, the format of the recommendations differs from other ACC/AHA guidelines. Each recommendation has been mapped from the NHLBI grading format to the ACC/AHA Class of Recommendation/Level of Evidence (COR/LOE) construct (Table 1) and is expressed in both formats. Because of the inherent differences in grading systems and the clinical questions driving the recommendations, alignment between the NHLBI and ACC/AHA formats is in some cases imperfect. Explanations of these variations are noted in the recommendation tables, where applicable.