Cited by 1,759Antiplatelet Therapy and Cardiovascular DiseasesLipoproteins and Cardiovascular HealthAcute Myocardial Infarction Research

AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: A Guideline From the American Heart Association and American College of Cardiology Foundation

Open access
Smith, Sidney C., Benjamin, Emelia J., Bonow, Robert O., Braun, Lynne T., Creager, Mark A., Franklin, Barry A., Gibbons, Raymond J., Grundy, Scott M. +10 more·2011·Circulation

Abstract

The American Heart Association makes every effort to avoid any actual or potential

AI snapshot

Written from the paper’s full text.

TL;DR

This 2011 AHA/ACCF guideline updates secondary prevention and risk reduction recommendations for patients with coronary and other atherosclerotic vascular disease, expanding the scope to include peripheral artery, atherosclerotic aortic, and carotid artery disease. It emphasizes comprehensive risk factor management and provides ACCF/AHA class/level-of-evidence recommendations for lipids, lifestyle, diabetes, antiplatelet/anticoagulant therapy, vaccination, depression, and cardiac rehabilitation.

Key findings

  • For lipids, LDL-C should be <100 mg/dL for all patients with CHD and other clinical forms of atherosclerotic disease; treating very high-risk patients to LDL-C <70 mg/dL is reasonable; when triglycerides are ≥200 mg/dL, a non-HDL-C goal of <100 mg/dL is reasonable; if LDL-C is above 100 mg/dL, an adequate statin dose should achieve at least a 30% LDL-C lowering.
  • Lifestyle goals include BMI 18.5 to 24.9 kg/m², waist circumference <35 inches (<89 cm) in women and <40 inches (<102 cm) in men, 30 to 60 minutes of moderate-intensity aerobic activity at least 5 and preferably 7 days per week, and an initial weight-loss goal of approximately 5% to 10% from baseline.
  • Antiplatelet recommendations include aspirin 75–162 mg daily for all patients with coronary artery disease unless contraindicated; after ACS or PCI with stent placement, a P2Y12 receptor antagonist plus aspirin is indicated, with clopidogrel 75 mg daily, prasugrel 10 mg daily, or ticagrelor 90 mg twice daily for at least 12 months.
  • Other recommendations include annual influenza vaccination for patients with cardiovascular disease, referral of eligible patients to comprehensive outpatient cardiovascular rehabilitation, metformin as effective first-line pharmacotherapy for type 2 diabetes (Class IIa, Level of Evidence A), and a target HbA1c ≤7% that may be considered.

Methods

  • This is an AHA/ACCF guideline update that reviewed evidence from recent clinical trials and revised practice guidelines, using a process of partial adaptation of other guideline statements and reports plus supplemental literature review.
  • Literature searches were limited to studies, reviews, and other evidence in human subjects published in English; topics included clinical trials, secondary prevention, atherosclerosis, and coronary/cerebral/peripheral artery disease, and the writing group also reviewed prior AHA, ACCF, and National Institutes of Health documents.
  • Recommendations are expressed in ACCF/AHA format with Class of Recommendation and Level of Evidence.

Limitations

  • The writing group acknowledges that ethnic minorities, women, and the elderly are underrepresented in many trials and urges physician and patient participation in trials to provide additional evidence for these groups.
  • The paper states that no studies have directly tested treatment-to-target strategies; LDL-C and non-HDL-C targets are derived from achieved levels in randomized controlled trials and are considered Level of Evidence C.
  • The writing group agreed to make no further changes in dyslipidemia recommendations pending the expected 2012 NHLBI ATP guidelines and made similar deferrals for hypertension pending the expected JNC guidelines; the text also makes evident that this is a guideline/consensus document rather than a primary trial, with many recommendations based on Level B or C evidence.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1161/cir.0b013e318235eb4d

Cites

195 of 195 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 22 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    No studies have directly tested treatment to target strategies.

    “Although no studies have directly tested treatment to target strategies”
    Quote in the paperSubstantial claim
  • Findingcitation

    Lipid reduction trials published between 2002 and 2006 included more than 50,000 patients.

    “the lipid reduction trials published between 2002 and 2006 18,25,166 -168 included Ͼ50 000 patients”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [18] source

      Not checked in the free run.

    • cites [25] source

      Not checked in the free run.

    • cites [166] source

      Not checked in the free run.

    • cites [167]

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    • cites [168]

      Not checked in the free run.

  • Findingcitation

    Aspirin dosing regimens ranging from 100 to 325 mg daily for 1 year appear efficacious for reducing saphenous vein graft closure after coronary artery bypass grafting.

    “Dosing regimens ranging from 100 to 325 mg daily for 1 year appear to be efficacious.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [87] source

      Not checked in the free run.

    • cites [88] source

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    • cites [89]

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    • cites [90] source

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  • Findingcitation

    Many patients in whom therapies are indicated are not receiving them in actual clinical practice.

    “multiple studies of the use of these recommended therapies in appropriate patients, although showing slow improvement, continue to support the discouraging conclusion that many patients in whom therapies are indicated are not receiving them in actual clinical practice.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Treatment of depression has not been shown to improve cardiovascular disease outcomes.

    “Treatment of depression has not been shown to improve cardiovascular disease outcomes but may be reasonable for its other clinical benefits.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 3
  • May combine two claims. 2
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Ethnic minorities, women, and the elderly are underrepresented in many trials.

    “The committee acknowledges that ethnic minorities, women, and the elderly are underrepresented in many trials and urges physician and patient participation in trials that will provide additional evidence with regard to therapeutic strategies for these groups of patients.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    The use of bile acid sequestrants is relatively contraindicated when triglycerides are ≥200 mg/dL and is contraindicated when triglycerides are ≥500 mg/dL.

    “The use of bile acid sequestrants is relatively contraindicated when triglycerides are Ն200 mg/dL and is contraindicated when triglycerides are Ն500 mg/dL.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Comprehensive exercise-based outpatient cardiac rehabilitation is safe and beneficial for clinically stable outpatients with a history of heart failure.

    “A comprehensive exercise-based outpatient cardiac rehabilitation program can be safe and beneficial for clinically stable outpatients with a history of heart failure.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 159,159a-159c

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Metformin is an effective first-line pharmacotherapy for type 2 diabetes management (for prevention of cardiovascular complications) if not contraindicated.

    “Metformin is an effective first-line pharmacotherapy and can be useful if not contraindicated.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [74] source

      Not checked in the free run.

    • cites [75]

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4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Aspirin use increases the risk of bleeding.

    “Aspirin use reduces the risk of occlusive vascular events but increases the risk of bleeding; the balance of benefits and hazards for the prevention of first cardiovascular events in patients with diabetes is unclear.”

    From Effects of aspirin for primary prevention in persons with diabetes mellitus (2018) · cites this paper as [2]

    The Antiplatelet agents/anticoagulants recommendations (page unavailable) state that warfarin used with aspirin and/or clopidogrel is associated with increased bleeding risk. The References also list a study of bleeding complications at different aspirin doses, but the guideline passage does not establish the unqualified claim that aspirin use alone increases bleeding risk. (LLM, conf=0.81)

    Experimental — accuracy not yet measured
  • Aspirin use reduces the risk of occlusive vascular events.

    “Aspirin use reduces the risk of occlusive vascular events but increases the risk of bleeding; the balance of benefits and hazards for the prevention of first cardiovascular events in patients with diabetes is unclear.”
  • The balance of benefits and hazards for the prevention of first cardiovascular events in patients with diabetes is unclear.

    “Aspirin use reduces the risk of occlusive vascular events but increases the risk of bleeding; the balance of benefits and hazards for the prevention of first cardiovascular events in patients with diabetes is unclear.”

    From Effects of aspirin for primary prevention in persons with diabetes mellitus (2018) · cites this paper as [2]

    The Antiplatelet agents/anticoagulants recommendations (page unavailable) address aspirin for patients with established coronary or other atherosclerotic disease, not prevention of a first cardiovascular event in patients with diabetes. Searches for the claimed uncertainty and for aspirin’s benefits and bleeding hazards in diabetic primary prevention found no passage in our copy that addresses that balance. (LLM, conf=0.72)

    Experimental — accuracy not yet measured
  • The old folklore that behavior cannot be changed has been dispelled by numerous randomized controlled trials of effective behavioral interventions.

    “The old folklore that “behavior can’t be changed” has been dispelled by numerous randomized controlled trials of effective behavioral interventions.13–23”

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Wenger NK, Froelicher ES, Ades PA, Berra K, Blumenthal JA, Certo CME, Dattilo AM, Davis D, DeBusk RF, Drozda JP, Fletcher BJ, Franklin BA, Gaston H, Greenland P, McBride PE, McGregor CG, Oldridge NB, Piscatella JC, Rogers FJ. Cardiac Rehabilitation: Clinical Practice Guideline 17. Washington DC: US Department of Health Human Services; 1995. AHCPR publication No. 96–0672.
  2. 10.1056/NEJMoa040583 · DOI · Paper page
  3. 10.1161/CIRCULATIONAHA.106.174526 · DOI · Paper page

Cited by

Sorted by citations

Authors
Smith, S. C., Benjamin, E. J., Bonow, R. O., Braun, L. T., Creager, M. A., Franklin, B. A., Gibbons, R. J., Grundy, S. M., Hiratzka, L. F., Jones, D. W., Lloyd-Jones, D. M., Minissian, M., Mosca, L., Peterson, E. D., Sacco, R. L., Spertus, J., Stein, J. H., & Taubert, K. A.
Venue
Circulation
Published
2011-11-29
Volume
124
Issue
22
Pages
2458-2473
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
OpenAlex
W2144663588
Cited by
1,759
References
195
Citations by year
2026: 35 · 2025: 55 · 2024: 68 · 2023: 78 · 2022: 111 · 2021: 107 · 2020: 116 · 2019: 129 · 2018: 143 · 2017: 166 · 2016: 143 · 2015: 157 · 2014: 161 · 2013: 168 · 2012: 109
FWCI
99.20
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Funders
World Heart Federation
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords
secondary prevention, cardiovascular risk reduction, coronary artery disease, atherosclerosis, guideline revision, lipid-lowering therapy, antithrombotic therapy, statins, aspirin
MeSH terms
American Heart Association, Coronary Artery Disease, Humans, Societies, Medical, United States, Risk Reduction Behavior

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Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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