Primary and Secondary Prevention of Cardiovascular Disease
Open accessAbstract
Background This guideline focuses on long-term administration of antithrombotic drugs designed for primary and secondary prevention of cardiovascular disease, including two new antiplatelet therapies. Methods The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results We present 23 recommendations for pertinent clinical questions. For primary prevention of cardiovascular disease, we suggest low-dose aspirin (75-100 mg/d) in patients aged > 50 years over no aspirin therapy (Grade 2B). For patients with established coronary artery disease, defined as patients 1-year post-acute coronary syndrome, with prior revascularization, coronary stenoses > 50% by coronary angiogram, and/or evidence for cardiac ischemia on diagnostic testing, we recommend long-term low-dose aspirin or clopidogrel (75 mg/d) (Grade 1A). For patients with acute coronary syndromes who undergo percutaneous coronary intervention (PCI) with stent placement, we recommend for the first year dual antiplatelet therapy with low-dose aspirin in combination with ticagrelor 90 mg bid, clopidogrel 75 mg/d, or prasugrel 10 mg/d over single antiplatelet therapy (Grade 1B). For patients undergoing elective PCI with stent placement, we recommend aspirin (75-325 mg/d) and clopidogrel for a minimum duration of 1 month (bare-metal stents) or 3 to 6 months (drug-eluting stents) (Grade 1A). We suggest continuing low-dose aspirin plus clopidogrel for 12 months for all stents (Grade 2C). Thereafter, we recommend single antiplatelet therapy over continuation of dual antiplatelet therapy (Grade 1B). Conclusions Recommendations continue to favor single antiplatelet therapy for patients with established coronary artery disease. For patients with acute coronary syndromes or undergoing elective PCI with stent placement, dual antiplatelet therapy for up to 1 year is warranted.
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Evidence supports use of either ticagrelor or clopidogrel if no percutaneous coronary intervention was performed and clopidogrel, ticagrelor, or prasugrel if a percutaneous coronary intervention was performed.
“Evidence supports use of either ticagrelor or clopidogrel if no percutaneous coronary intervention was performed and clopidogrel, ticagrelor, or prasugrel if a percutaneous coronary intervention was performed (199).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [199]
Section 3.2.1–3.2.5 recommends ticagrelor or clopidogrel for patients who have not undergone PCI, and ticagrelor, clopidogrel, or prasugrel for those who have undergone PCI with stent placement. The claim omits the recommendations’ limits to the first year after acute coronary syndrome, the stent-placement condition for the PCI group, and the requirement that each drug be used with low-dose aspirin. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEvidence supports use of either ticagrelor or clopidogrel if no percutaneous coronary intervention was performed and clopidogrel, ticagrelor, or prasugrel if a percutaneous coronary intervention was performed.
“Evidence supports use of either ticagrelor or clopidogrel if no percutaneous coronary intervention was performed and clopidogrel, ticagrelor, or prasugrel if a percutaneous coronary intervention was performed (187).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [187]
Evidence supports use of either ticagrelor or clopidogrel if no PCI, and clopidogrel, ticagrelor, or prasugrel if PCI.
“Evidence supports use of either ticagrelor or clopidogrel if no percutaneous coronary intervention was performed and clopidogrel, ticagrelor , or prasugrel if a percutaneous coronary intervention was performed (162).”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [162]
Co-prescription of OAC with antiplatelet therapy, in particular triple therapy, increases the absolute risk of major haemorrhage.
“Co-prescription of OAC with antiplatelet therapy, in particular triple therapy, 1501 increases the absolute risk of major haemorrhage.445,517,518”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [517]
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- Authors
- Vandvik, P. O., Lincoff, A. M., Gore, J. M., Gutterman, D. D., Sonnenberg, F. A., Alonso-Coello, P., Akl, E. A., Lansberg, M. G., Guyatt, G. H., & Spencer, F. A.
- Affiliations
- Innlandet Hospital Trust (NO)
- Cleveland Clinic (US)
- University of Massachusetts Chan Medical School (US)
- Medical College of Wisconsin (US)
- University of Medicine and Dentistry of New Jersey (US)
- University at Buffalo, State University of New York (US)
- Stanford Medicine (US)
- McMaster University (CA)
- Corresponding author
- Spencer, Frederick A.
- ORCID
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 141
- Issue
- 2
- Pages
- e637S-e668S
- ISSN
- 0012-3692 (ISSN-L)
- PMC
- PMC3278064
- OpenAlex
- W2116051185
- Cited by
- 476
- References
- 118
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 11 · 2023: 6 · 2022: 23 · 2021: 19 · 2020: 32 · 2019: 36 · 2018: 29 · 2017: 44 · 2016: 46 · 2015: 59 · 2014: 58 · 2013: 64 · 2012: 37
- FWCI
- 44.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- CHEST Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Sanofi
- National Heart, Lung, and Blood Institute (R13HL104758)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- cardiovascular disease prevention, antithrombotic therapy, antiplatelet therapy, low-dose aspirin, clopidogrel, ticagrelor, prasugrel, dual antiplatelet therapy, single antiplatelet therapy, acute coronary syndrome, percutaneous coronary intervention, coronary artery disease, drug-eluting stents, bare-metal stents, long-term aspirin therapy
- MeSH terms
- Aged, Cardiovascular Diseases, Combined Modality Therapy, Coronary Disease, Dose-Response Relationship, Drug, Drug Therapy, Combination, Fibrinolytic Agents, Humans, Long-Term Care, Middle Aged, Platelet Aggregation Inhibitors, Risk Factors, Societies, Medical, Thrombosis, Stents, Angioplasty, Balloon, Coronary, Myocardial Ischemia, Evidence-Based Medicine, Secondary Prevention
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