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The ACC/AHA Guideline targets primary care providers. The guideline comprises answers to developed critical questions (CQs) based on results from randomized controlled trials (RCTs), observational studies, meta-analyses, and systematic reviews of studies carried out in adults (≥18 years) and were reported between 1998 and 2009. There are two CQs concerning diet: “what is the effect of dietary patterns and/or macronutrient composition on cardiovascular disease (CVD) risk factors, when compared to no treatment or to other types of interventions ?” and “what is the effect of dietary intake of sodium and potassium on CVD risk factors and outcomes, when compared to no treatment or to other types of interventions ?” Dietary patterns and particular macronutrient compositions were investigated for their effect on blood lipids and blood pressure and recommendations were made only with regard to effects on plasma LDL-cholesterol (LDL-C) and blood pressure (Table 1). Data on nutritional supplements provided in pharmaceutical preparations was excluded from the analysis because such supplements may not have similar effects and are not considered “lifestyle” interventions. The CQ concerning physical activity was “what is the effect of physical activity on blood pressure and blood lipids when compared to no treatment, or to other types of interventions ?” The effects of aerobic exercise and resistance exercise training on LDL-C, non HDL-cholesterol (non HDL-C), HDL-cholesterol (HDL-C), triglycerides (TG), and blood pressure were investigated, and aerobic physical activity was recommended to reduce LDL-C and non HDL-C and to lower blood pressure (Table 1).

Comment on the 2013 ACC/AHA Guidelines on Lifestyle Management to Reduce Cardiovascular Risk by the JAS Guidelines Committee