There is a population who is at the highest risk of having major cardiovascular events, i.e. a non fatal stroke or a fatal MI. Usually they already have had a prior cardiovascular event. Atherosclerosis has damaged the patient’s vessels. This means there is evidence of prior heart damage or vascular damage.
Remember that evidence of vascular damage means damage to main arteries, brain vessels, retinal vessels, kidney vessels and limb vessels. This is why having an aortic aneurysm, or intermittent claudication almost automatically brings our patient to the a very high risk category.
Treatment of the modifiable risk factors, such as hypertension, diabetes, smoking cessation, changes in lifestyle and statins for elevated cholesterol is necessary to reduce the cardiovascular risk, reducing the probability of a new event. This is what we call secondary prevention. This is opposed to primary prevention which is treating modifiable risk factors in a patient who has never had cardiovascular event yet.
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Augusto Saldaña, MD