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Based on 2018 AHA/ACC/Multisociety treatment guidelines, you may be at
very high risk of another heart attack or stroke if you've had the following:
  • A heart attack
    This happens when the heart can't get the oxygen and nutrients it needs to work properly. It usually occurs due to a buildup of high levels of LDL-C which can clog the blood vessels. This can prevent blood from reaching the heart.
  • A stroke
    This can happen when an artery (vessel) in the brain becomes blocked. It may be a result of high levels of LDL-C, which can create clogs in the blood vessel. When the vessel is clogged, this can interrupt blood flow to the brain.
  • Symptomatic peripheral artery disease (PAD)
    This is a condition that most commonly affects the arms or legs. It occurs when blood vessels narrow or become blocked, typically due to a buildup of plaque (also known as atherosclerosis).
  • Recent acute coronary syndrome (ACS) (within the past year)
    This describes several conditions that all relate to sudden reduced blood flow to the heart. These conditions can include a heart attack and unstable angina (chest pain).
Multiple major events iconMultiple major events icon

Two or more of the
following MAJOR EVENTS:
1 major event + multiple high-risk condition icon1 major event + multiple high-risk condition icon

One of the following
MAJOR EVENTS:
  • A heart attack
    This happens when the heart can't get the oxygen and nutrients it needs to work properly. It usually occurs due to a buildup of high levels of LDL-C which can clog the blood vessels. This can prevent blood from reaching the heart.
  • A stroke
    This can happen when an artery (vessel) in the brain becomes blocked. It may be a result of high levels of LDL-C, which can create clogs in the blood vessel. When the vessel is clogged, this can interrupt blood flow to the brain.
  • Symptomatic peripheral artery disease (PAD)
    This is a condition that most commonly affects the arms or legs. It occurs when blood vessels narrow or become blocked, typically due to a buildup of plaque (also known as atherosclerosis).
  • Recent acute coronary syndrome (ACS) (within the past year)
    This describes several conditions that all relate to sudden reduced blood flow to the heart. These conditions can include a heart attack and unstable angina (chest pain).
And if you meet two or more of these HIGH-RISK CONDITIONS
  • Age 65 or older
  • High bad cholesterol (LDL-C at least 100 mg/dL) even when treated with a statin and Zetia® (ezetimibe)
  • Diabetes
    This is a condition that happens when your blood sugar (also called "glucose") is too high.
  • High blood pressure
    Also known as "hypertension," this is a condition where there's too much pressure in your blood vessels.
  • Current smoker
  • Have had coronary artery bypass surgery
    Also known as "CABG" or a "coronary artery bypass graft," this is a procedure done to create a new path of blood around a blocked or partially blocked blood vessel in the heart in order to improve blood flow.
  • Have had percutaneous coronary intervention (PCI)
    This is a procedure done to open up a clogged artery in your heart to restore blood flow; it is commonly used to treat conditions such as heart attack or coronary artery disease.
  • Chronic kidney disease (CKD)
    This happens when your kidneys aren't working correctly due to damage over time. As a result, they can't do important jobs like removing waste and keeping blood pressure normal.
  • Heterozygous familial hypercholesterolemia (HeFH)
    This is a genetic condition that affects the way the body processes cholesterol and puts people at higher risk of heart disease. People who have HeFH have very high levels of LDL-C (bad cholesterol).
  • History of heart muscle weakness
    Also known as congestive heart failure (CHF), this is a long-term condition where your heart is unable to pump blood well enough to other parts of your body. This can lead to blood being backed up, causing a buildup of fluid in places like your lungs, legs, and feet.

FOR EXAMPLE…

Kenneth: an ASCVD patient at very high riskKenneth: an ASCVD patient at very high risk

THIS IS KENNETH

Kenneth is at very high risk because he’s had two major events (recent ACS and stroke).

Susan: an ASCVD patient at very high riskSusan: an ASCVD patient at very high risk

THIS IS SUSAN

Susan is at very high risk because she’s had one major event (a heart attack) and has two high-risk conditions (she has diabetes, and she's a smoker).

Not real patients.

You can't control some risk factors like age, sex, family history, and ethnicity.

But here are the risk factors you can manage:

LDL-c iconLDL-c icon

LDL-C (bad cholesterol): this is one of the most important controllable factors.

smoke iconSmoking
Type 2 diabetes iconType 2 diabetes
stress iconStress
excercise iconExercise
diet iconDiet
weight iconWeight
smoke iconSmoking
diet iconDiet
excercise iconExercise
stress iconStress
Type 2 diabetes iconType 2 diabetes
weight iconWeight
See how to manage your LDL-C
Stethoscope-DocStethoscope-Doc

If you have cardiovascular disease and are at very high risk of another event,

ask your doctor how you can get your LDL-C below 55 mg/dL.

Mike’s living in the red. Are you?