Measures for Reducing the Incidence of Events in Patients With CVD Are Available but Too Often Are Not Applied(2)

In 1995, the American Heart Association published, and the American College of Cardiology endorsed, the original consensus statement on the secondary prevention of heart attack and death in patients with established atherosclerotic cardiovascular disease (CVD). The emergence of significant evidence in support of aggressive risk reduction from recent clinical trials has led these organizations to update their consensus statement and to include recent guidelines from the American Diabetes Association for patients with diabetes. The importance of these guidelines is underscored by the increasing numbers of patients living to older ages with a diagnosis of CVD and the demonstration that a large proportion of patients for whom risk-reduction therapy could prove valuable do not receive the recommended strategies.

The following table is provided as a partial indication of the secondary prevention goals included in the Guidelines. The Guidelines themselves should be referred to for full intervention recommendations.





Complete cessation

Blood pressure

<140/90 mm Hg or
<130/85 mm Hg if heart failure or renal insufficiency
<130/80 mm Hg if diabetes

Lipid management

Primary goal: LDL <100 mg/dL
Secondary goal: If TG =200 mg/dL, then non&Atilde;&cent;??HDL should be <130 mg/dL

Physical activity

Minimum goal: 30 min 3 ot 4 days a week
Optimal goal: daily

Weight management

BMI 18.5 to 24.9 kg/m2 

Diabetes management

HbA1c <7%

Antiplatelet agents/anticoagulants

ASA 75 to 325 mg/d: start and continue indefinitely if not contraindicated.
If ASA contraindicated, consider clopidogrel 75 mg/d or warfarin

ACE inhibitors

For all patients, indefinitely after MI.
Consider long-term therapy for other patients with coronary or other vascular disease if not contraindicated


Start and continue indefinitely in all patients after an MI and in those with acute ischemic syndrome unless contraindicated
Use as needed in other patients to manage angina, rhythm disturbances, or BP

The above summary is adapted from the cited reference.

Smith SC Jr, Blair SN, Bonow RO, et al. AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients With Atherosclerotic Cardiovascular Disease: 2001 Update. A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology. J Am Coll Cardiol. 2001;38:1581-1583. 

Last Modified: 2/5/2013