1. Identifying and treating persons with established disease and those at very high risk of developing cardiovascular disease.
2. Treating and rehabilitating patients who have had a heart attack or stroke to prevent a second cardiovascular or cerebrovascular event.

AHA Recommendation

Although risk interventions significantly improve clinical outcomes, their application is inconsistent across medical care settings and patient groups. The American Heart Association urges that every effort be made throughout the spectrum of medical care to promote more comprehensive application of risk reduction in all eligible patients.

What can secondary prevention achieve?

Compelling scientific evidence, including data from recent studies in patients with coronary artery disease, demonstrates that comprehensive risk factor interventions:

• extend overall survival.
  
• improve quality of life.
  
• decrease need for interventional procedures such as angioplasty and bypass grafting.
  
• reduce the incidence of subsequent myocardial infarction (heart attack).

• Before your next visit, tell your doctor you'd like an assessment of your fasting lipid profile. You'll receive simple instructions before the test. If you need to lower your blood cholesterol, find out whether drug therapy
  or a low-fat diet or simpler treatment is warranted.
  
• During your visit, ask your doctor to suggest an appropriate level of exercise that you can do for 30–60 minutes 3–4 times per week.
  
• Ask what your ideal weight is, and if you exceed it by more than 20 percent, ask your doctor to prescribe a diet and exercise program.
  
• Have your blood pressure checked regularly. If you have high blood pressure, you may be put on medication. You'll also be told about weight control, physical activity, drinking alcohol and sodium intake.
  
• Ask your doctor if you should take aspirin daily or another medication.
  
• If you smoke, ask about counseling, nicotine replacement methods and formal cessation programs to help you quit.
  
• Always see your doctor regularly, follow instructions and ask questions.
  

Smoking

Goal : Complete cessation

Recommendations:

• Strongly encourage patient and family to stop smoking.
  
• Provide counseling, nicotine replacement and formal cessation programs as appropriate.

Primary goal: LDL<100 mg/dL

Secondary goals: HDL>35 mg/dL Triglycerides<200 mg/dL

Recommendations:

• Start AHA Step II Diet in all patients: Picture> 30% of calories as fat, <7% of calories as saturated fat, <200 mg/dL dietary cholesterol per day.
  
• Assess fasting lipid profile. In post-myocardial infarction patients, lipid profile may take 4 to 6 weeks to stabilize.
• Add drug therapy according to the following guide:
  
  
  
  • LDL <100 mg/dL
    No drug therapy
    
    
  • LDL 100 to 130 mg/dL
    Consider adding drug therapy to diet.
    
    
  • LDL >130 mg/dL
    Add drug therapy to diet.
    
    
  • HDL <35 mg/dL
    Emphasize weight management and physical activity. Advise smoking cessation. If needed to achieve LDL goals, consider niacin, statin, fibrate.
  
  

• Triglycerides <200 mg/dL
  Statin, resin, niacin
  
  
• Triglycerides 200-400 mg/dL
  Statin, niacin
  
  
• Triglycerides >400 mg/dL
  Consider combined drug therapy (niacin, fibrate, statin)

Minimum goal: 30 minutes 3 to 4 times per week

Recommendations: