|Area for Intervention||Recommendations|
|Goal: Complete cessation. No exposure to environmental tobacco smoke||Class I|
|Blood pressure control||Note: The writing committee did not think that the 2006 recommendations for blood pressure control (below) should be modified at this time. The writing committee anticipates that the recommendations will be reviewed when the updated JNC guidelines are released.|
|Goal: &amp;amp;amp;lt;140/90 mm Hg|
|Lipid managementGoal: Treatment with statin therapy; use statin therapy to achieve an LDL-C of &amp;amp;amp;lt;100 mg/dL; for very high risk* patients an LDL-C &amp;amp;amp;lt;70 mg/dL is reasonable; if triglycerides are ≥200 mg/dL, non–HDL-C† should be &amp;amp;amp;lt;130 mg/dL, whereas non–HDL-C &amp;amp;amp;lt;100 mg/dL for very high risk patients is reasonable||Note: The writing committee anticipates that the recommendations will be reviewed when the updated ATP guidelines are released.|
|Physical activity||Class I|
|Goal: At least 30 minutes, 7 days per week (minimum 5 days per week)|
|Weight management||Class I|
|Body mass index: 18.5 to 24.9 kg/m2|
|Waist circumference: women &amp;amp;amp;lt;35 inches (&amp;amp;amp;lt;89 cm), men &amp;amp;amp;lt;40 inches (&amp;amp;amp;lt;102 cm)|
|Type 2 diabetes mellitus management||Note: Recommendations below are for prevention of cardiovascular complications.|
|Antiplatelet agents/anticoagulants||Class I|
|Antiplatelet agents/anticoagulants cont'd|
|Renin-angiotensin-aldosterone system blockers|
|ACE inhibitors||Class I|
|Aldosterone blockade||Class I|
|β-Blockers cont'd||Class IIb|
|Influenza vaccination||Class I|
|Cardiac rehabilitation||Class I|
JNC indicates the report of the National Heart, Lung, and Blood Institute's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines; ACE, angiotensin-converting enzyme; ATP, Adult Treatment Panel; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; HbA1c, hemoglobin A1c; ACS, acute coronary syndrome; PCI, percutaneous coronary intervention; TIA, transient ischemic attack; INR, international normalized ratio; and ARB, angiotensin receptor blocker.
↵* Presence of established CVD plus 1) multiple major risk factors (especially diabetes), 2) severe and poorly controlled risk factors (especially continued cigarette smoking), 3) multiple risk factors of the metabolic syndrome (especially high triglycerides ≥200 mg/dL plus non–HDL-C ≥130 mg/dL with low HDL-C &amp;amp;amp;lt;40 mg/dL), and 4) patients with ACSs.
↵† Non–HDL-C=total cholesterol minus HDL-C.
↵‡ The use of bile acid sequestrants is relatively contraindicated when triglycerides are ≥200 mg/dL and is contraindicated when triglycerides are ≥500 mg/dL.
↵§ Dietary supplement niacin must not be used as a substitute for prescription niacin.
↵∥ The combination of high-dose statin plus fibrate (especially gemfibrozil) can increase risk for severe myopathy. Statin doses should be kept relatively low with this combination.
↵¶ Pregnant and lactating women should limit their intake of fish to minimize exposure to methylmercury.
↵# Estimated creatinine clearance should be &amp;amp;amp;gt;30 mL/min.
↵** Potassium should be &amp;amp;amp;lt;5.0 mEq/L.