We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Viewpoint |

Clinical Practice Guidelines for Chronic Cardiovascular Disorders: A Roadmap for the Future

Elliott M. Antman, MD1; Mariell Jessup, MD2
[+] Author Affiliations
1Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
2University of Pennsylvania School of Medicine, Penn Heart and Vascular Center, Philadelphia, Pennsylvania
JAMA. 2014;311(12):1195-1196. doi:10.1001/jama.2014.1742.
Text Size: A A A
Published online


The World Health Organization lists ischemic heart disease and stroke as the top 2 leading causes of death worldwide in 2011, responsible for 7 million and 6.2 million deaths, respectively.1 The concept of risk factors for atherosclerotic cardiovascular disease (CVD) was introduced in 1961, based on epidemiologic observations from the Framingham Heart Study. Hypertension and abnormal blood lipid levels were key risk factors shown to be associated with an increased risk of angina pectoris, myocardial infarction, and sudden cardiac death; later, stroke was identified as an important outcome as well, especially in women and racial/ethnic subgroups. Accordingly, clinicians want to provide their patients with the best possible advice with respect to the management of cardiovascular risk, often implementing evidence-based clinical practice guidelines designed to improve health outcomes.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Different Methods for Acquiring Evidence in Relation to the Biologic Continuum of Disease

The biologic continuum of disease progresses from ideal health through the development of risk factors (eg, hypertension, hypercholesterolemia) and the transition to disease (eg, atherosclerosis) with development of outcome events (eg, myocardial infarction, stroke). Three categories (A, B, C) of RCTs illustrate the available evidence reviewed by committees for clinical practice guidelines. In epidemiologic observational studies, patients enter the study cohort at different stages along the continuum and vary in the duration they are at risk for an outcome event. The proposed solution to the limitations of the current evidence base is to embed randomized trials in large free-living cohorts of patients who enter the trial and are randomized at different stages throughout the biologic continuum. See text.

Graphic Jump Location



Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

4 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Related Multimedia

Author Reading

audio player

Articles Related By Topic
Related Collections
PubMed Articles

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Is There Potentially Compelling Evidence for a Class Effect?

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Are the End Points in Randomized Clinical Trials Important to Patients?