|Intervention Recommendations With Class of Recommendation and Level of Evidence|
|Complete cessation. No exposure to environmental tobacco smoke.|
|BLOOD PRESSURE CONTROL:||For all patients:|
|<140/90 mm Hg|
|<130/80 mm Hg if patient has diabetes or chronic kidney disease|
|For patients with blood pressure ≥140/90 mm Hg (or ≥130/80 mm Hg for individuals with chronic kidney disease or diabetes):|
|[For compelling indications for individual drug classes in specific vascular diseases, see Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).]4|
|LIPID MANAGEMENT:||For all patients:|
|LDL-C <100 mg/dL|
|If triglycerides are ≥200 mg/dL, non-HDL-C should be <130 mg/dL†|
|For lipid management:|
|Assess fasting lipid profile in all patients, and within 24 hours of hospitalization for those with an acute cardiovascular or coronary event. For hospitalized patients, initiate lipid-lowering medication as recommended below before discharge according to the following schedule:|
|30 minutes, 7 days per week (minimum 5 days per week)|
|Body mass index: 18.5 to 24.9 kg/m2|
|Waist circumference: men <40 inches, women <35 inches|
|ANTIPLATELET AGENTS/ ANTICOAGULANTS:|
|RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM BLOCKERS:||ACE inhibitors:|
|Angiotensin receptor blockers:|
|Consider chronic therapy for all other patients with coronary or other vascular disease or diabetes unless contraindicated. IIa (C)|
|INFLUENZA VACCINATION:||Patients with cardiovascular disease should have an influenza vaccination. I (B)|
↵⁎ Patients covered by these guidelines include those with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease, and carotid artery disease. Treatment of patients whose only manifestation of cardiovascular risk is diabetes will be the topic of a separate AHA scientific statement. ACE indicates angiotensin-converting enzyme.
↵† Non-HDL-C=total cholesterol minus HDL-C.
↵‡ Pregnant and lactating women should limit their intake of fish to minimize exposure to methylmercury.
↵§ When LDL-lowering medications are used, obtain at least a 30% to 40% reduction in LDL-C levels. If LDL-C <70 mg/dL is the chosen target, consider drug titration to achieve this level to minimize side effects and cost. When LDL-C <70 mg/dL is not achievable because of high baseline LDL-C levels, it generally is possible to achieve reductions of >50% in LDL-C levels by either statins or LDL-C–lowering drug combinations.
↵∥ Standard dose of statin with ezetimibe, bile acid sequestrant, or niacin.
↵¶ The combination of high-dose statin+fibrate can increase risk for severe myopathy. Statin doses should be kept relatively low with this combination. Dietary supplement niacin must not be used as a substitute for prescription niacin.
↵# Patients with very high triglycerides should not consume alcohol. The use of bile acid sequestrant is relatively contraindicated when triglycerides are >200 mg/dL.
↵⁎⁎ Creatinine should be <2.5 mg/dL in men and <2.0 mg/dL in women.
↵†† Potassium should be <5.0 mEq/L.