ACC/AHA updates secondary-prevention guidelines without new BP and lipid guidance

Posted by: admin on: March 6, 2012

With more emphasis on prevention than cure AHA has come out with new guidelines which are easy on the CAD patients in order to prevent cardiovascular events or reduce such risks on these patients.


The American Heart Association and American College of Cardiology Foundation have issued new guidelines for secondary prevention and risk reduction in patients with atherosclerotic vascular disease, even though it is still waiting for the new Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) guidelines and new Adult Treatment Panel 4 (ATP 4) guidance on lipid management [1].

The new guidelines, published online November 3, 2011 in Circulation, update the 2006 guidelines on secondary prevention and change the title to include risk-factor reduction, “because important evidence from clinical trials has emerged that further supports and broadens the merits of intensive risk-reduction therapies for patients with established coronary and other atherosclerotic vascular disease,” including peripheral artery disease, the writing committee explains.

The guidelines “continue to be very straightforward, simple, and easy to use,” writing committee chair Dr Sidney Smith (University of North Carolina, Chapel Hill) told heartwire. The foundation of the guidelines continues to be patient behavior, including physical exercise, smoking cessation and avoidance of second-hand smoke, and weight management. Smith highlighted the guidelines’ recommendations that patients get in about 30 minutes of physical activity every day. Emphasis was on smoking, exercise, weight control, etc—in addition to the kinds of medications we should be taking. That’s important because often patients rely on medications, and physicians don’t emphasize lifestyle sufficiently.”

The 2006 secondary-prevention guidelines incorporated the National Cholesterol Education Program (NCEP) ATP 3 guidelines from 2004, which confirmed the benefits of intensive cholesterol lowering, setting a target for LDL cholesterol under 100 mg/dL for all patients with coronary artery disease and other forms of vascular disease and under 70 mg/dL as a reasonable target for patients with chronic heart disease, even though evidence that lowering LDL below 70 is beneficial is still forthcoming. The writing group was hoping to have the newest ATP 4 guidelines to incorporate into this new guidance, but the National Heart, Lung, and Blood Institute (NHLBI) now projects those won’t be available until 2012.

Commenting on the new guidelines, Dr Roger Blumenthal (Johns Hopkins University, Baltimore, MD) told heartwire that the new guidelines are very well written and referenced, but their main limitation “is that the long-awaited cholesterol, blood-pressure, and obesity guideline documents are still not available. We had hoped that they would be available for the AHA meeting, but this process has been delayed because of a desire to make the new recommendations compatible with the Institute of Medicine [IOM] recommendations. I do not know what this entails, but clinicians really want to see what the expert panels have come up with. Hopefully, the review process will be expedited in the future, since it seems that the IOM construct is delaying the process more than it should.”


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