Management of Atherosclerosis

Risk Assessment and Stratification

The American College of Cardiology recommends assessing total cardiovascular disease risk to determine treatment priorities, considering that an individual's risk should be judged in the context of the overall CVD risk of the population 1
Patients with established atherosclerotic vascular disease are at high risk of recurrent cardiovascular events and require intensive intervention, according to the American Heart Association 1
The prevention approach is the same regardless of which arterial territory is symptomatic, as atherosclerosis is a systemic disease, as stated by the American College of Cardiology 1

The American College of Cardiology recommends starting dietary therapy in all patients, limiting saturated fat to 7% and cholesterol to 200 mg/day, and assessing fasting lipid profile 2, 3
For LDL ≥130 mg/dL, the American College of Cardiology recommends intensifying LDL-lowering therapy with statins or resins and adding lifestyle therapies 2, 3
For triglycerides 200-499 mg/dL, the American College of Cardiology recommends considering fibrate or niacin after LDL-lowering therapy 2, 3

The American College of Cardiology recommends starting and continuing aspirin 75-325 mg/day indefinitely if not contraindicated 4
The American College of Cardiology recommends considering clopidogrel 75 mg/day if aspirin is contraindicated 4

The American College of Cardiology recommends initiating lifestyle modifications for all patients with BP ≥130/80 mmHg 4
The American College of Cardiology recommends adding BP medication if blood pressure exceeds 140/90 mmHg or 130/85 mmHg for those with heart failure or renal insufficiency 4

The American College of Cardiology recommends ACE inhibitors for all post-MI patients indefinitely 4
The American College of Cardiology recommends beta-blockers for all post-MI and acute ischemic syndrome patients and continuing indefinitely 4

The American College of Cardiology strongly encourages patients and families to stop smoking and avoid secondhand smoke 4
The American College of Cardiology recommends providing complete cessation counseling, pharmacological therapy, and formal smoking cessation programs 4

The American College of Cardiology recommends assessing risk with exercise testing to guide prescription 4
The American College of Cardiology recommends encouraging 30-60 minutes of aerobic activity daily or at least 3-4 times weekly 4

The American College of Cardiology recommends calculating BMI and measuring waist circumference, and monitoring response to therapy 4
The American College of Cardiology recommends targeting BMI range: 18.5-24.9 kg/m² 4

The American College of Cardiology recommends implementing appropriate hypoglycemic therapy to achieve near-normal fasting plasma glucose, as indicated by HbA1c 4
The American College of Cardiology recommends addressing other risk factors, such as physical activity, weight management, blood pressure, and cholesterol 4

The American Heart Association states that patients with cerebrovascular disease due to thrombosis often have concurrent coronary heart disease and should be managed accordingly 1

The American College of Cardiology notes that surveys show that lifestyle and risk factor management often falls short of evidence-based guidelines 1
The American College of Cardiology recommends that nitrates should not be used to improve long-term prognosis after MI, as stated by the Praxis Medical Insights 5
The American College of Cardiology notes that calcium channel blockers have weaker evidence for benefit compared to beta-blockers, as stated by the Praxis Medical Insights 5