Patients with established coronary heart disease (CHD) have a high risk of subsequent cardiovascular events, including myocardial infarction (MI), stroke, and death from cardiovascular disease (CVD) . Therapeutic lifestyle changes that include identification and treatment of established risk factors, especially hypertension, dyslipidemia, smoking, obesity/poor diet, physical inactivity, and diabetes, are primary and major strategies to diminish premature morbidity and mortality from CVD and are recommended in many societal guidelines [2,3]. (See "Overview of the risk equivalents and established risk factors for cardiovascular disease", section on 'Established risk factors for atherosclerotic CVD'.)
Therapeutic lifestyle changes in the form of increased physical activity, dietary modification/weight loss, and smoking cessation are of proven benefit and may improve outcomes in as quickly as six months. The adjunctive drug therapies of proven benefit include aspirin, statins, and, in patients with MI or heart failure, beta blockers and angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). (See 'Therapeutic lifestyle changes' below.)
The efficacy of risk factor reduction and other adjunctive therapies for the secondary prevention of CVD will be reviewed here. The efficacy of cardiac rehabilitation programs in improving outcomes in patients with coronary artery disease is discussed elsewhere. (See "Efficacy of cardiac rehabilitation in patients with coronary heart disease".) The secondary prevention of ischemic stroke is also discussed separately. (See "Secondary prevention of stroke: Risk factor reduction".)
Patients with coronary heart disease risk equivalents — Some patients without known CHD have a risk of subsequent cardiovascular events that is equivalent to that of patients with established coronary disease. All patients with a CHD risk equivalent should be managed as aggressively as those with prior CHD.
The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, or ATP III) published in 2002 classified high-risk patients with a prior CVD event or a CHD risk equivalent into three groups :