LAUSR

Heart disease is the leading cause of death in the US and accounted for 693 021 (or 1 in 4) deaths in 2021.1 The US Preventive Services Task Force (USPSTF) has recently published updated recommendations on behav ioral counseling interventions to promote healthy eating and physical activity for cardiovascular disease (CVD) prevention in adults without known CVD risk factors.2 The recommendations, which were supported by an updated evidence report and systematic review,3 were given a grade of C based on evidence that behavioral counseling interventions provide a small benefit in improving physical activity levels and healthy eating, as well as a small improvement in CVD risk factors such as blood pressure, lowdensity lipoprotein cholesterol, and body weight, with little evidence for harm. The grade means that clinicians should individualize the decision to offer or refer adults without CVD risk factors to behavioral counseling interventions. The updated recommendations are similar to the previous ones in 2017,4 which received the same recommendation grade and are consistent with recommendations by the American Academy of Family Physicians and the National Institute for Health and Care Excellence. However, the updated USPSTF recommendations are narrower than other organizations, including the American College of Sports Medicine, the American Heart Association, the US Department of Health and Human Services, and the US Department of Veterans Affairs. That is, these other organizations recommend that health care professionals provide behavioral counseling on eating and physical activity to all of their adult patients, regardless of chronic conditions or risk factors. Notably, the only substantive change from the 2017 USPSTF recommendations is that the updated ones did not include studies limited to adults with elevated blood pressure because this research is included in another USPSTF review among adults with known CVD risk factors.5