Secondary prevention of CAD

General internists and family physicians must become experts at secondary prevention. The AHA and ACC have released their latest guideline – Updated Secondary Prevention Guidelines Issued for CVD

For the first time, the guidelines recommend influenza vaccination for patients with chronic cardiovascular disease due to a heightened risk for complications from flu. “This is an important new addition to our guidelines that should significantly improve outcomes for patients with cardiovascular diseases,” Dr. Sidney C. Smith, Jr., of the University of North Carolina, Chapel Hill and chairman of the writing committee said in a statement.

Among the other key updates — a target LDL-cholesterol level of less than 100 mg/dL for all patients with coronary heart disease and other forms of atherosclerotic vascular disease. The guidelines also state that it is now considered “reasonable” to bring LDL-C levels to below 70 mg/dL in these patients.

Nearly 2 years ago, the National Cholesterol Education Program recommended an optional LDL-C goal of 70 mg/dL in very high-risk patients. Since that time, new data have become available that strengthen and extend this recommendation to all patients with established CHD, the committee notes. The updated guidelines also state that if triglycerides are equal to or greater than 200 mg/dL, non-HDL-C should be less than 130 mg/dL and it is reasonable to aim for a level less than 100 mg/dL.

The updated recommendation for physical activity is 30 to 60 minutes 7 days per week or a minimum of 5 days per week. The earlier guidelines called for 30 to 60 minutes of exercise three or four times per week.

The updated guidelines also recommend complete smoking cessation and no exposure to environmental tobacco smoke; BP < 140/90 mm Hg; if the patient has diabetes or chronic kidney disease, BP < 130/80 mm Hg is the goal.

For weight management, the goal remains a body mass index of 18.5 to 24.9 kg/m2 and a waist circumference < 40 inches for men and < 35 inches for women.

For diabetic patients, hemoglobin A1c levels should be less than 7 percent, according to the guidelines.