AHA/ACCF Issue 2011 Update of the Guideline for Secondary Prevention and Risk Reduction Therapy for Patients With Atherosclerotic Disease

November 3, 2011—The American Heart Association (AHA) and the American College of Cardiology Foundation (ACCF) announced the publication of the 2011 update of the guideline for secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease. The document is available online ahead of print in Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology.

According to the AHA/ACCF, for the first time, the guideline recommends that all patients be referred to a comprehensive cardiac rehabilitation program after a heart attack, stroke, bypass surgery, or the diagnosis of heart-related chest pain or blockages in leg arteries. In addition, the guideline notes that it is useful to screen heart disease patients for depression, a common occurrence after heart attack or bypass surgery that can interfere with quality of life and the ability to initiate positive changes in health behaviors.

The guideline recommends that patients with coronary disease and other vascular disease, such as stroke and peripheral artery disease, stop smoking and avoid exposure to tobacco smoke; exercise 5 to 7 days a week for at least 30 minutes a day; reduce weight if they are overweight, obese, or have a large waist; receive an annual flu shot; and take low-dose aspirin daily unless your doctor prescribes a higher dose or recommends against it because of medical contraindications.

The AHA/ACCF noted that in response to evidence from recent clinical trials, the guideline makes several changes for health professionals in the recommended use of antiplatelet agents/anticoagulants. The guideline now includes the use of new drugs such as prasugrel or ticagrelor, which may be used instead of clopidogrel in combination with aspirin for patients receiving coronary stents.

Additionally, the guideline emphasizes the importance of adequate dosages for statin therapy for all patients with known atherosclerotic vascular disease. Low-dose aspirin therapy (75–162 mg) continues to be recommended for patients with known heart disease.

The writing group deferred modifying recommendations on high blood pressure and high blood cholesterol levels because it expects that new guidelines will be released in 2012 from panels of the National Heart, Lung, and Blood Institute that work specifically on these issues, stated the AHA/ACCF.

According to Sidney C. Smith Jr, MD, Chair of the guideline writing group, the guideline is important because increasing numbers of older adults are living with cardiovascular disease, and in clinical practice, many patients are not receiving indicated therapies. Dr. Smith commented, “Unless improvements are made in your behavior and medical therapy, the same blood vessel problem that caused your first heart attack or stroke can occur again—and may result in death—so long-term changes need to be initiated to get the vascular disease under control.”