Author + information
- Lori Mosca, MD, MPH, PhD* ()
- ↵*Medicine/Cardiology, Columbia University, 622 West 168th Street, PH 10-203B, New York, NY 10032
I appreciate Dr. Kessler's interest in our guidelines (1) and his thoughtful comments about the importance of data to support evidence-based clinical recommendations. This is precisely why the expert panel assigned a class and level of evidence to express the strength of the recommendation and the amount of data to support it. Although I agree that recommendations for drug interventions, such as hormone therapy, should be supported by randomized controlled trials, I do not agree that basic lifestyle recommendations such as not smoking, engaging in regular physical activity, eating a primarily plant-based diet, and maintaining a healthy weight, require randomized controlled trials to be given our strongest recommendation for clinical practice. As noted, such research may not be feasible or ethical. Moreover, a class I recommendation has not historically precluded further research.
Dr. Geoffrey Rose, a founding father of modern cardiovascular epidemiology, established the principle that randomized controlled trials are not necessary for interventions that restore us to our evolutionary norms. Given the burgeoning epidemic of obesity and the well-documented adverse consequences of smoking in our society, I hope Dr. Kessler would agree that interventions to restore individuals to a heart-healthy lifestyle should be a top priority for clinical practice and for public health.
- American College of Cardiology Foundation