NCHR’s Comments on USPSTF’s Draft Recommendation Statement on Behavioral Counseling to Reduce Cardiovascular Disease in Adults Without Known Risk Factors

February 14, 2022

We are writing to express our views on the U.S. Preventive Services Task Force (USPSTF) draft recommendation statement regarding behavioral counseling to promote a healthy diet and physical activity to prevent cardiovascular disease (CVD) in adults without known risk factors. 

The National Center for Health Research is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.

Reviewing the evidence, we agree that behavioral counseling for adults without known CVD risk factors will likely provide only a small net benefit in terms of lowering CVD risk. Given the lack of evidence of a more meaningful benefit, we support the “C” grade recommendation that clinicians make decisions for these individual patients about whether to offer or refer them to behavioral counseling.

We commend USPSTF for providing guidance and additional resources to help clinicians determine who is most likely to benefit from behavioral counseling services. For example, we appreciate the USPSTF’s acknowledgement of social determinants of health and how social factors, such as access to healthy foods, may play a role in the effectiveness of behavioral counseling. We agree that future research should explore best practices for navigating existing social and environmental barriers that are undermining efforts to increase physical activity or help achieve a healthy diet.