AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American Coll


Smith SC Jr, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, et al.






Since the original publication (in 1995) of the American Heart Association (AHA) consensus statement on secondary prevention, which was endorsed by the American College of Cardiology (ACC), important evidence from clinical trials has emerged that further supports the merits of aggressive risk reduction therapies for patients with atherosclerotic cardiovascular disease. As noted in that statement, aggressive risk factor management clearly improves patient survival, reduces recurrent events and the need for interventional procedures, and improves the quality of life for these patients. The compelling evidence from recent clinical trials was the impetus to revise the 1995 guidelines (Table). As examples, the many lipid reduction trials have generated significant changes in the National Heart, Lung, and Blood Institute’s Adult Treatment Panel III report. This report further defined target cholesterol levels, expanded indications for drug treatment, and initiated therapy earlier. Accumulating ß-blocker data have resulted in broader indications for a larger patient group. The Heart Outcomes Prevention Evaluation (HOPE) trial has demonstrated the benefit of ACE inhibitor therapy in high-risk patients with cardiovascular disease without a history of an acute event. Further data from ongoing trials should provide insight into the potential benefits of treating lower risk patients with combined therapies. The Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial has provided evidence for clopidogrel benefit in certain patients. Diabetes management recommendations have been updated to include recent guidelines from the American Diabetes Association for risk factor management of diabetics and the growing body of evidence showing diabetics at high risk for cardiovascular events. The Heart and Estrogen/progestin Replacement Study (HERS) documented that hormone replacement therapy is ineffective for secondary prevention. The writing group revising this document also considered other important trials and reports, and they are included in the selected reading list. AHA/ACC Secondary Prevention for Patients With Coronary and Other Vascular Disease: 2001 Update. In the 6 years since the guidelines were first published, 2 other developments have made them even more important in clinical care: the aging of the population continues to expand the number of patients living with a diagnosis of cardiovascular disease (now estimated at 12.4 million), and the multiple studies of the actual use of these recommended therapies in appropriate patients, while showing slow improvement, have continued to support the discouraging conclusion that a large proportion of patients in whom therapies are indicated are not receiving those therapies in actual clinical practice. The AHA and ACC continue to urge that all medical care settings in which these patients are managed organize a specific plan to identify appropriate patients, provide practitioners with useful reminder clues based on the guidelines, and continuously assess the success achieved in providing all appropriate therapies to all of the patients who can benefit from them.