Cardiovascular Disease Risk Reduction, Adults
Cholesterol Guidelines Update, ATP IV
Hypertension Guidelines Update, JNC 8
Obesity Guidelines Update, Adults

As part of its strategic plan, NHLBI is embarking on a new guideline effort aimed at developing an evidence-based, comprehensive, integrated set of clinical guidelines for cardiovascular risk reduction directed principally at primary care practitioners to help adult patients reduce their risk for CVD. This includes both a long-term strategy of developing integrated guidelines and a shorter-term strategy of producing focused updates of the existing guidelines for high blood pressure, cholesterol, and obesity as elements of the overall integrated guideline process.

As part of this process, NHLBI will convene an Expert Panel for the Integrated Guidelines to review and update the scientific evidence regarding the assessment and management of CV risk factors. The review will be based on an evidence model that will give rise to a set of critical questions to be answered by the scientific evidence. Unlike previous guideline panels, which have focused their efforts on developing individual guidelines in one specific area (e.g., cholesterol assessment and treatment), this guideline development effort will focus on developing a comprehensive integrated guideline across all CV risk factors to more closely mimic "real world" clinical scenarios faced by individuals and clinicians. However, even well-written guidelines that are based on the best available evidence are of limited value if they are not used. Therefore, in addition to reviewing and updating the scientific content and integrating multiple CV risk factors into one comprehensive guideline, much of this effort will also focus on implementation - developing more user-friendly guidelines that will make it easier for clinicians and patients to put into practice. This includes the development and use of innovative tools to facilitate guideline adoption and adherence to recommendations in order to improve the current state of suboptimal risk factor assessment and management. This new effort will be the first of its kind to address overall CV risk factor identification and treatment in adults within one guideline.

Concurrent with the development of the integrated CV risk reduction guideline, NHLBI will update existing guidelines on the prevention, detection, evaluation, and treatment of high blood cholesterol/dyslipidemia (ATP III), hypertension (JNC 7), and overweight/obesity (Obesity Guidelines). We will therefore convene three expert panels, as subpanel components of the integrated guidelines panel, to examine the most recent scientific evidence and update the recommendations in each of these areas. Similar to the integrated guideline effort, these panels will start with an evidence model that gives rise to a set of critical questions to be answered by the scientific evidence. It is not expected that these updates will result in an entire overhaul of the guideline; instead they will focus on updating the most pertinent issues that could improve important health outcomes. As part of the update process, they will also focus on strategies for improving dissemination and implementation of the updated guidelines.

It is expected that all components of this guideline effort will utilize rigorous and standardized approaches for identifying, retrieving, reviewing, and evaluating the evidence, including standardized methods for developing evidence tables, rating the evidence, and determining the strength of recommendations. The update panels will function as subpanels of the integrated guidelines panel, contributing their expertise on the individual risk factors to the overall process. In turn, this guideline development effort will feed into NHLBI's longer-term vision of developing a cardiovascular knowledge network (CKN). The CKN is intended to facilitate interaction among the domains of knowledge generation, knowledge translation and dissemination, knowledge utilization, and knowledge technology to bridge the gap between discovery and delivery, identify knowledge gaps that should be addressed by future research, bring user communities together to better meet their needs, and speed translation of research into practice through use of more effective approaches for synthesizing and organizing evidence.

To help the NHLBI shape this expanded initiative to develop and promote clinical guidelines to reduce the risk for cardiovascular disease, the Institute will convene a Clinical Guidelines Leadership Group consisting of representatives of major professional and patient stakeholder communities. The Guidelines Leadership Group will meet annually.