Cited by 476Antiplatelet Therapy and Cardiovascular DiseasesCoronary Interventions and DiagnosticsAcute Myocardial Infarction Research

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Primary and Secondary Prevention of Cardiovascular Disease

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Vandvik, Per Olav, Lincoff, A. Michael, Gore, Joel M., Gutterman, David D., Sonnenberg, Frank A., Alonso-Coello, Pablo, Akl, Elie A., Lansberg, Maarten G., Guyatt, Gordon H., Spencer, Frederick A.·2012·Chest

DOI 10.1378/chest.11-2306PMC PMC3278064

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Abstract

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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Antiplatelet agents versus control or anticoagulation for heart failure in sinus rhythm
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Prediction of coronary heart disease using risk factor categories
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Kearon (2012) · doi:10.1378/chest.11-2301 · Cited by 6,119
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Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the hypertension optimal treatment (HOT) randomised trial
Hansson, L., Zanchetti, A., Carruthers, S. G., Dahlöf, B., Elmfeldt, D., Julius, S., Ménard, J., Rahn, K. H., Wedel, H., & Westerling, S. (1998) · The Lancet · doi:10.1016/s0140-6736(98)04311-6 · Cited by 5,728
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Wilson, 1998, Prediction of coronary artery disease using risk factor categories, Circulation, 97, 1837, 10.1161/01.CIR.97.18.1837 · DOI · Paper page

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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: Vandvik, Per Olav
Lincoff, A. Michael
Gutterman, David D.
Sonnenberg, Frank A.
Akl, Elie A.
Lansberg, Maarten G.
Guyatt, Gordon H.
Spencer, Frederick A.
Venue: Chest
Publisher: Elsevier BV
Published: 2012-02
Volume: 141
Issue: 2
Pages: e637S-e668S
ISSN: 0012-3692 (ISSN-L)
DOI: 10.1378/chest.11-2306
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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 › Cardiology and Cardiovascular Medicine › 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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