The AHA Guidelines and Scientific Statements Handbook

Secondary Prevention for Patients

With Coronary and Other

Atherosclerotic Vascular Disease

Sidney C. Smith, Jr.

5

Organization and evidence

Changes since publication of the 2006 Guidelines for

Secondary Prevention

Comprehensive risk reduction for patients with

coronary and other vascular disease

Smoking

Goal: Complete cessation, no exposure to

environmental tobacco smoke

Blood pressure control

Goal: Less than 140/90 mm Hg or less than

130/80 mm Hg if patient has diabetes or chronic

kidney disease

Lipid management

Goal: LDL-C substantially less than 100 mg per dL

Physical activity

Goal: 30 minutes 5 days per week; optimal daily

Weight management

Goal: BMI: 18.5 to 24.9 kg/m^2

Diabetes management

Goal: HbA1c less than 7%

Antiplatelet agents/anticoagulants: aspirin

Antiplatelet agents/anticoagulants: clopidogrel

Antiplatelet agents/anticoagulants: warfarin

Renin–angiotensin–aldosterone system blockers:

ACE inhibitors

Renin–angiotensin–aldosterone system blockers:

angiotensin receptor blockers

Renin–angiotensin–aldosterone system blockers:

aldosterone blockade

Beta-blockers

Infl uenza vaccination

Comparison with other guidelines

Ongoing research efforts and future directions

Organization and evidence

Since the publication of the AHA/ACC Secondary

Prevention guidelines in 2001 [1], compelling evi-

dence has continued to evolve supporting the effi -

cacy of intensive secondary prevention therapies to

prevent future cardiovascular events in patients with

established atherosclerotic vascular disease. This

growing body of evidence confi rms that compre-

hensive implementation of these therapies improves

survival, reduces recurrent events and the need for

interventional procedures, and improves quality of

life for these patients. Evidence from many recent

clinical trials and revised practice guidelines pro-

vided the impetus for this update of the 2001 Sec-

ondary Prevention Guidelines. Members of the

writing group from AHA and ACC carefully reviewed

the new evidence and presented the recommenda-

tions as they appear herein in using the current Clas-

sifi cation of Recommendations and Level of Evidence

as expressed in the ACC/AHA format.

Changes since publication of the 2006

Guidelines for Secondary Prevention

Recommendations put forth by the ATP III Update

and JNC 7 are incorporated into these guideline

recommendations. Findings from additional lipid

reduction trials in more than 50,000 patients have

resulted in optional lipid lowering targets for LDL-C

of <70 mg/dL with a Class I recommendation that

all patients with atherosclerotic vascular disease

should have LDL-C <100 mg/dL. The JNC 7 recom-

mendations for treatment of hypertension have

The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978-1-405-18463-2