What is Atherosclerotic Cardiovascular Disease (ASCVD)?
Atherosclerotic cardiovascular disease (ASCVD) is defined as coronary heart disease, cerebrovascular disease, or peripheral artery disease presumed to be of atherosclerotic origin, and represents the leading cause of morbidity and mortality globally. 1
Complete Clinical Definition
ASCVD encompasses acute coronary syndrome, history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, peripheral artery disease including aortic aneurysm—with the critical requirement that all manifestations must be of atherosclerotic origin. 1, 2
The American Diabetes Association and American College of Cardiology/American Heart Association use this comprehensive definition to ensure all patients with established atherosclerotic disease receive appropriate risk-reduction therapy regardless of which vascular bed initially manifested disease. 1, 2
Pathophysiology and Clinical Significance
ASCVD results from the buildup of atherosclerotic plaque within arterial walls, which contributes to the acute clinical manifestations including myocardial infarction, stroke, and peripheral arterial disease. 3
The disease is the largest contributor to direct and indirect costs of cardiovascular care, with an estimated $39.4 billion in cardiovascular-related spending per year associated with diabetes alone. 1
ASCVD also increases risk for dementia, chronic kidney disease, impaired mobility, sexual dysfunction, and multiple visceral impairments that adversely impact quality of life and aging. 4
Risk Factors and Epidemiology
Common conditions coexisting with type 2 diabetes—particularly hypertension and dyslipidemia—are clear risk factors for ASCVD, and diabetes itself confers independent cardiovascular risk. 1
Cardiovascular risk factors that should be systematically assessed at least annually include obesity/overweight, hypertension, dyslipidemia, smoking, family history of premature coronary disease, chronic kidney disease, and presence of albuminuria. 1
Under aggressive risk factor modification paradigms, measures of 10-year coronary heart disease risk among U.S. adults with diabetes have improved significantly over the past decade, and ASCVD morbidity and mortality have decreased. 1
Treatment Implications
Patients with established ASCVD require intensive secondary prevention strategies, including high-intensity statin therapy as a Class I recommendation from the American College of Cardiology/American Heart Association. 2
Large benefits are seen when multiple cardiovascular risk factors—including glycemic control, blood pressure management, and lipid control—are addressed simultaneously, with evidence for legacy benefits extending beyond the treatment period. 1
The comprehensive ASCVD definition ensures that patients with peripheral manifestations or cerebrovascular disease receive the same treatment intensity recommendations as those with prior myocardial infarction, avoiding the common pitfall of undertreating non-coronary atherosclerotic disease. 2