Definition of Atherosclerotic Cardiovascular Disease (ASCVD)
ASCVD is defined as a history of acute coronary syndrome, myocardial infarction (MI), stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack (TIA), or peripheral artery disease (PAD) including aortic aneurysm—all presumed to be of atherosclerotic origin. 1, 2
Complete Clinical Definition
The American Diabetes Association and American College of Cardiology/American Heart Association provide a comprehensive definition that includes:
- Acute coronary syndromes 1, 2
- History of myocardial infarction (MI) 1, 2
- Stable or unstable angina 1, 2
- Coronary heart disease with or without revascularization 1
- Other arterial revascularization procedures 1, 2
- Stroke 1, 2
- Transient ischemic attack (TIA) 1, 2
- Peripheral artery disease (PAD) including aortic aneurysm, presumed to be atherosclerotic in origin 1, 2
Critical Qualifier
All manifestations must be of atherosclerotic origin—this is the essential qualifier that distinguishes ASCVD from other cardiovascular conditions. 2 The atherosclerotic etiology is what unifies these diverse clinical presentations under a single disease category. 1
Clinical Significance
ASCVD represents the leading cause of morbidity and mortality in multiple patient populations, including those with diabetes. 1 This broad definition ensures that all patients with established atherosclerotic disease—regardless of which vascular bed initially manifested disease—receive appropriate intensive secondary prevention strategies. 2
Patients meeting this definition qualify for the most aggressive risk-reduction therapies, including high-intensity statin therapy as a Class I recommendation. 2, 3
Common Pitfall to Avoid
Do not exclude patients with peripheral manifestations or cerebrovascular disease from the ASCVD category. 2 A patient with PAD or prior stroke carries the same ASCVD designation and warrants the same treatment intensity as someone with prior MI. 2 The vascular bed affected does not change the fundamental diagnosis or treatment approach—atherosclerosis is a systemic disease process. 2