Cardiovascular Risk Reduction Guidelines in Adults:
Cholesterol Guideline Update (ATP IV)
Hypertension Guideline Update (JNC 8)
Obesity Guideline Update (Obesity 2)
Integrated Cardiovascular Risk Reduction Guideline

Content

1. Overview
2. Timeline
3. Guidelines Development Approach
4. Background
   
   

Overview

The National Heart, Lung, and Blood Institute is leading the development of an integrated set of cardiovascular risk reduction guidelines for adults using state-of-the-art methodology. Cholesterol, hypertension, and obesity guidelines are being updated, and an integrated cardiovascular risk reduction guideline is being developed.

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Timeline

• Cholesterol Guideline Update (ATP IV)

  • Expected availability for public review and comment:  2012
  • Expected release date:  2012
    
    

• Hypertension Guideline Update (JNC 8)

  • Expected availability for public review and comment:  2012
  • Expected release date:  2012
    
    

• Obesity Guideline Update (Obesity 2)

  • Expected availability for public review and comment:  2012
  • Expected release date:  2012
    
    

• Integrated Cardiovascular Risk Reduction Guideline

  • Timeline TBD
    
    

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Guidelines Development Approach

The NHLBI Adult Cardiovascular Risk Reduction guidelines effort includes both a shorter-term strategy of updating the existing guidelines for blood cholesterol, high blood pressure, and obesity as well as a longer-term strategy of developing an integrated cardiovascular risk reduction guideline. Two strategies are being undertaken because identification and management of individual risk factors, as well as a comprehensive integrated cardiovascular risk reduction approach to patients, are both important.

NHLBI has convened three Expert Panels to update the existing guidelines on blood cholesterol, high blood pressure, and obesity. In addition, three Work Groups have been convened to examine crosscutting issues that will inform the individual guideline updates as well as the future integrated guideline. The Work Groups are on Risk Assessment, Lifestyle, and Implementation.

The Panels and Work Groups are using state-of-the-art principles of evidence-based medicine and innovative electronic tools to identify, review, and evaluate the scientific evidence. The process starts with evidence models and a set of prioritized critical questions identified as important for clinical practice. The critical questions are being answered by conducting systematic reviews of the scientific evidence using a rigorous and standardized approach for searching and evaluating the literature.

The process from identification of questions to final guidelines includes several steps: formulating critical questions and study eligibility; identifying, retrieving, reviewing, and rating the quality of the relevant studies; developing evidence tables that summarize key information from the studies; summarizing and rating the body of evidence for each critical question; and determining and grading evidence-based clinical practice recommendations. The resulting recommendations will then be compiled into user-friendly guidelines.

The work of the Panels and Work Groups will inform the development of the integrated cardiovascular risk reduction guideline. This guideline will address multiple cardiovascular risk factors as well as other cardiovascular risk reduction issues.

To ensure that the guidelines address the needs of practicing clinicians, the process also includes implementation aspects. Included are approaches to developing user-friendly guidelines and strategies to help clinicians, systems, and patients put the guidelines into practice.

This project is large, complex, and detailed, with many components and steps and attention to various relevant and interrelated issues. The NHLBI envisions the products as a set of clinical guidelines that will greatly advance the delivery of evidence-based practice in cardiovascular disease risk reduction. The ultimate goal of this major effort is to translate scientific evidence into clinical practice to reduce disease burden and improve health outcomes for cardiovascular diseases - the leading causes of death in the United States.

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Background

The National Heart, Lung, and Blood Institute (NHLBI) provides global leadership through research and education to enhance the health of all individuals so that they can live longer and more fulfilling lives. To enact this vision, in 2007 the NHLBI released a strategic plan, "Shaping the Future of Research." The plan contains three goals: Goal 1 is to increase understanding of the molecular and physiological basis of health and diseases; Goal 2 is to improve understanding of the clinical mechanisms of disease and thereby enable better prevention, diagnosis, and treatment; and Goal 3 is to translate research into practice for the benefit of personal and public health. Development, dissemination, and implementation of clinical practice guidelines are key components of Goal 3.

The NHLBI has a long history of developing clinical practice guidelines, particularly those addressing cardiovascular risk factors. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure released the first JNC report in 1976, followed by several additional JNC reports, with the most recent JNC 7 released in 2003. The Adult Treatment Panel (ATP) released clinical guidelines on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults in 1988, followed by ATP II and III, with an update in 2004. The Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults were released in 1998. These guidelines have been extremely successful in calling attention to, and improving care for, the cardiovascular risk factors of hypertension, high blood cholesterol, and obesity.

The NHLBI has now embarked upon a new vision for the cardiovascular disease prevention guidelines - taking them to the next level by using an integrative approach and employing new state-of-the-art evidence-based methods. This vision emanated from recommendations by experts, practitioners, and stakeholders.

In 2005, NHLBI convened a "Cardiovascular Disease Thought Leaders Meeting" to seek input for developing the next generation of clinical guidelines on cardiovascular risk. Recommendations included maintaining risk-factor-specific clinical guidelines as well as establishing a process to integrate the science and clinical recommendations for cardiovascular risk reduction. In 2006, NHLBI convened a meeting of "Clinical Guidelines Users and Developers". Recommendations included creating an integrated guideline that would address real-world clinical issues, attend to various approaches for risk assessment, include unified lifestyle recommendations, and focus on implementation aspects for clinical practice. In 2007, NHLBI convened a "Clinical Guidelines Leadership Group Meeting" to obtain more specific input on process and approach from both public and private sectors, including representatives from key stakeholder organizations, researchers, and practitioners.

The result of all these deliberations is the current major effort at NHLBI in leading the development of a set of evidence-based, comprehensive clinical guidelines for cardiovascular risk reduction in adults. The guidelines will be principally aimed at primary care practitioners and their patients to assist adults in reducing their cardiovascular risk, but will also be valuable to cardiovascular specialists and their patients. The process also will identify areas where additional research is needed to obtain evidence that can inform practice.

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Last Updated September 2011