AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update: Endorsed by the National Heart, Lung, and Blood Institute

Abstract

ince the 2001 update of the American Heart Association (AHA)/American College of Cardiology (ACC) consensus statement on secondary prevention, 1 important evidence from clinical trials has emerged that further supports and broadens the merits of aggressive risk-reduction therapies for patients with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease, and carotid artery disease.This growing body of evidence confirms that aggressive comprehensive risk factor management improves survival, reduces recurrent events and the need for interventional procedures, and improves quality of life for these patients.Compelling evidence from recent clinical trials and revised practice guidelines provided the impetus for this update of the 2001 recommendations with evidence-based results (Table 1).Classification of Recommendations and Level of Evidence are expressed in ACC/AHA format, as detailed in Tables 2 and 3. Recommendations made herein are based largely on major practice guidelines from the National Institutes of Health and ACC/AHA.In many cases, these practice guidelines were supplemented by research findings published after the publication of the primary reference(s).Thus, the development of the present statement involved a process of partial adaptation of other guideline statements and reports and supplemental literature searches.(For specific search criteria, see the Appendix.)The findings from additional lipid reduction trials [33][34][35][36][37] involving more than 50 000 patients resulted in new optional therapeutic targets, which were outlined in the 2004 update of the National Heart, Lung, and Blood Institute's Adult Treatment Panel (ATP) III report.6 These changes defined optional lower target cholesterol levels for very high-risk coronary heart disease (CHD) patients, especially those with acute coronary syndromes, and expanded indications for drug treatment.Subsequent to the 2004 update of ATP III, 2 additional trials 8,9 demonstrated cardiovascular benefit for lipid lowering significantly below current cholesterol goal levels for those with chronic CHD.These new trials allow for alterations in guidelines, such that low-density lipoprotein cholesterol (LDL-C) should be Ͻ100 mg/dL for all patients with CHD and other clinical forms of atherosclerotic disease, but in addition, it is reasonable to treat to LDL-C Ͻ70 mg/dL in such patients.When the *Dr Pasternak withdrew from the Writing Group on June 22, 2004, when he accepted an offer of employment as Vice President, Clinical Research, Cardiovascular and Atherosclerosis, at Merck Research Laboratories.The remaining members of the Writing Group were advised of his change in status