At Long Last, (Most) NHLBI Guidelines for CVD Released

Shelley Wood

November 14, 2013

WASHINGTON, DC — The long wait for National Heart, Lung, and Blood Institute (NHLBI)–sponsored CVD prevention guidelines is now, mostly, over. Developed in partnership with the American College of Cardiology (ACC)/American Heart Association (AHA), the four new guideline documents, including two first-time recommendations, contain a mix of established advice and surprising new perspectives on the management of adults at risk for cardiovascular disease [1–4].

heartwire has in-depth coverage of the four sets of guidelines, which include:

Among the many important updates across the set of guidelines include the abandonment of specific LDL- and non-HDL–cholesterol targets, the addition of stroke to CVD risk assessment, the rise of the Mediterranean diet (over a low-fat diet), and a change to the BMI cutoffs used to define the initiation of therapy in obesity.

Conspicuously absent, however, is the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8).

The four guideline documents released today will form the core of a special session recently announced for next week's American Heart Association (AHA)Scientific Sessions in Dallas, TX, as reported by heartwire . The obesity guidelines will also be in the spotlight this week at the Obesity Society Annual Scientific meeting in Atlanta, GA.

The cholesterol guidelines update the last National Institutes of Health (NIH)–sponsored adult cholesterol guidelines (Adult Treatment Panel III [ATP 3), which came out in 2001, with an update in 2004. The last, and only, overweight and obesity guidelines in obesity date back to 1998. Both the Prevention and CV Risk Assessment guideline documents are new. The missing NHLBI-sponsored hypertension guidelines are intended to replace their predecessor, JNC-7 , released in 2003.

JNC-Late Now JNC-Later

As previously reported by heartwire , the NHLBI made a surprise announcement back in June of this year, saying it was partnering with the ACC/AHA on getting the new guidelines out the door after years of delays. Going forward, said Drs Gary Gibbons and Michael Lauer (NHLBI, Bethesda, MD), the NHLBI would publish five "integrated cardiovascular guideline products" as evidentiary reviews "and will subsequently collaborate with other organizations to prepare and issue the related clinical-practice guidelines."

All of the NHLBI guideline working groups were officially dissolved November 1, 2013.

Back in June, JNC-8 was among the guidelines promised to be out "in a matter of months," although Gibbons left it open whether the same "monikers" would be used as in the past. But the omission of what many have called "JNC-Late" may speak to the institute's decision to partner with the ACC/AHA.

AHA president Dr Mariell Jessup (University of Pennsylvania, Philadelphia) told heartwire that the NHLBI "did originally commission a writing panel to develop the next JNC hypertension guidelines as part of this entire prevention portfolio."

But when the NHLBI "asked the ACC/AHA joint task force to assume the guideline process moving forward, the hypertension writing panel—as of this date—declined to be a part of the process."

In its place, the ACC/AHA has been working on its own "hypertension algorithm," working with the Centers for Disease Control and Prevention as well as "a number of other relevant societies—primary-care and specialty groups—beginning in 2014," Jessup said.

Indeed, a fifth presentation has been added to next week's in-depth guidelines session at the AHA meeting to discuss this process.

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