2013 American Heart Association/American College of Cardiology Guideline on Lifestyle Management to Reduce Cardiovascular Risk: Practice Opportunities for Registered Dietitian Nutritionists

H EALTHY LIFESTYLE BEHAVIORS, INCLUDING optimal dietary and physical activity patterns, are the cornerstones of disease prevention and management. The maintenance of healthy lifestyle behaviors is particularly important in preventing cardiovascular disease (CVD), the leading cause of morbidity and mortality in the United States. Therefore, in 2008, the National Heart, Lung, and Blood Institute (NHLBI), in conjunction with efforts to update expert guidelines on overweight/obesity, cholesterol, and blood pressure (BP), assembled a Lifestyle Workgroup to examine the relationships between diet, physical activity, and CVD prevention and management. Lifestyle behaviors are not only factors associated with CVD risk reduction, but also determinants of overall health that the individual can manage in conjunction with sound professional guidance. In 2012, the NHLBI partnered with the American College of Cardiology (ACC) and American Heart Association (AHA) to adopt and publish the Lifestyle Workgroup’s recommendations and guidelines. In this commentary, we review and discuss the major findings and recommendations of the 2013 Guideline on Lifestyle Management to Reduce Cardiovascular Disease Risk, published jointly by the ACC and AHA. This new guideline on lifestyle management was restricted to the following components of lifestyle: diet modification, dietary patterns, type of fat, sodium and potassium intake, and levels and types of physical activity. The Lifestyle Guideline is meant to provide clinicians with recommendations on the most effective diet and physical activity strategies to manage dyslipidemia and hypertension to promote cardiovascular health. In a companion commentary on the Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society, we summarize the background and general processes NHLBI followed in both guideline reports. In brief, during a 5-year period, the expert groups defined and evaluated Critical Questions and developed guidelines specific to their topic areas. Because of limitations in resources, only three questions were assessed by the Lifestyle Workgroup. For each specified question, the group reviewed published literature comprised of systematic reviews, randomized clinical trials, and observational studies (which included hard end points as outcomes) rated as fair and good quality, spanning the time frame from 1998 through 2009. It then utilized this body of evidence to formulate recommendations and to prepare the guideline. Given the limited scope of the Workgroup’s review (ie, only three Critical Questions), it is recognized that there are gaps in its expert recommendations.