Why secondary prevention determines long-term outcomes in coronary disease

Define chronic coronary disease (CCD) as conceptualised in the 2023 ACC/AHA guideline and explain why secondary prevention is the dominant determinant of long-term outcomes in this population.

Quantify residual cardiovascular risk in patients with established atherosclerotic disease and identify the principal drivers of recurrent events.

Describe the four pillars of guideline-directed management and therapy (GDMT) for secondary prevention: lipid lowering, antiplatelet/antithrombotic therapy, risk-factor control, and lifestyle and cardiac rehabilitation.

Apply the principles of team-based care and shared decision-making to the longitudinal management of CCD.

Recognise the impact of multimorbidity, frailty, and polypharmacy on therapeutic decisions, including the role of the Geriatric 5Ms framework in older adults.

Atherosclerotic cardiovascular disease is the leading cause of death worldwide, and the number of patients living with established disease keeps growing as more survive the acute event. These patients are not cured. They carry a lifelong risk of recurrent events far higher than the primary-prevention population, and the intervention that shapes their outcome is not the acute procedure but sustained secondary prevention. This module sets out the foundations: how the 2023 ACC/AHA guideline frames chronic coronary disease, where residual risk comes from, and the four pillars of guideline-directed therapy that address it, namely lipid lowering, antithrombotic therapy, risk-factor control, and lifestyle with cardiac rehabilitation. It also covers team-based care, shared decision-making, and how multimorbidity, frailty, and polypharmacy change the calculus in older adults.

Module 1: Foundations of Secondary Prevention

NCD Academy

Secondary Prevention in Cardiovascular Disease

ACC/AHA-aligned secondary prevention of cardiovascular disease.

MedShr Editor

Lifestyle change and cardiac rehab as Class 1 secondary prevention

Module 2: Lifestyle Intervention & Cardiac Rehabilitation

LDL-C goals and the stepwise lipid pathway in established ASCVD

Module 3: Lipid Management & Atherosclerotic Risk

Balancing ischaemic and bleeding risk in antithrombotic therapy

Module 4: Antithrombotic Therapy & Ischaemic Risk

Cutting ischaemic time from symptom onset to reperfusion in ACS

Module 5: Acute Coronary Syndromes - "Time is Muscle"

Heart failure GDMT and the long-term secondary prevention pathway

Module 6: Heart Failure & Long-Term Secondary Prevention

This NCD Academy course developed by MedShr with the American College of Cardiology delivers a structured educational program for doctors and healthcare professionals focused on the secondary prevention of cardiovascular disease (CVD): the actions required to reduce recurrent events, hospitalisation, and premature mortality.&nbsp;Aligned with contemporary guidance from the American College of Cardiology / American Heart Association, the course translates evidence into practical, implementable clinical decision-making across the full patient pathway – from post-event optimisation to long-term risk management.&nbsp;A central theme is that secondary prevention remains incomplete without both optimal medical therapy and structured lifestyle intervention, delivered through systems such as cardiac rehabilitation.&nbsp;Educational ObjectivesThis course is designed to deliver measurable improvements in:Knowledge: Understanding of guideline-directed secondary prevention strategies across lipid management, antithrombotic therapy, risk factor control, and lifestyle interventionCompetence: Ability to apply evidence-based therapies in real-world cases, including escalation decisions and risk stratificationPerformance: Implementation of key actions in practice, including optimisation of medications, referral to cardiac rehabilitation, and delivery of behaviour change interventions Course FacultySenior EditorDr Asif Qasim - Consultant Cardiologist at King's College Hospital and Cleveland Clinic London, UK. EditorsDr Miguel Alvarez - Director of Interventional Heart Failure at Lennox Hill Hospital, New York, USA. Dr Adhir Shroff - Chief of Service for Cardiology, University of Illinois School of Medicine, Chicago, USA DisclosuresThe NCD Academy is supported by educational grant funding to the American College of Cardiology Foundation from Viatris. The company has no control of the content of this independent medical education program. There are no relevant disclosures for the Faculty in relation to pharmaceutical and other ineligible companies as defined by ACCME.