ASCVD and CAD: Distinct but Related Entities
ASCVD and CAD are not the same thing—CAD is a subset of ASCVD. While they may share CPT coding for billing purposes, these terms represent different scopes of atherosclerotic disease with important clinical distinctions 1.
Definitions and Scope
ASCVD is the broader umbrella term that encompasses multiple manifestations of atherosclerotic disease throughout the arterial system 1:
- History of acute coronary syndrome or myocardial infarction
- Stable or unstable angina
- Coronary heart disease with or without revascularization (this is CAD)
- Other arterial revascularization procedures
- Stroke or transient ischemic attack
- Peripheral artery disease including aortic aneurysm
- All atherosclerotic in origin 1
CAD specifically refers only to coronary artery disease—the atherosclerotic involvement of the coronary arteries supplying the heart 1. The 2023 AHA/ACC guidelines explicitly list CAD as one component within the broader ASCVD category 1.
Clinical Implications of the Distinction
The distinction matters for risk stratification and treatment intensity 1:
- Patients with established ASCVD (including but not limited to CAD) require the most aggressive preventive therapies including high-intensity statins, antiplatelet therapy, and consideration of SGLT2 inhibitors or GLP-1 receptor agonists in diabetic patients 1
- A patient with CAD has ASCVD, but a patient with ASCVD may not have CAD—they might have peripheral artery disease or prior stroke instead 1
- The presence of any ASCVD manifestation (not just CAD) triggers guideline-directed medical therapy for secondary prevention 1
Why CPT Coding May Be Shared
CPT codes are administrative billing tools that often group related conditions for reimbursement purposes and do not reflect precise clinical distinctions 2. The shared coding likely reflects that:
- Both conditions require similar diagnostic workup approaches (stress testing, imaging, catheterization) 1
- Both warrant similar preventive medical therapies (statins, antiplatelet agents, blood pressure control) 1
- Insurance coverage decisions often treat atherosclerotic diseases as a group for risk assessment purposes 2
Common Clinical Pitfall
Do not assume a patient with non-coronary ASCVD (such as stroke or PAD) has lower cardiovascular risk than someone with CAD 3. Patients with non-coronary vascular disease have a 2-fold increased risk of death, MI, or unstable angina, yet physicians frequently underestimate their obstructive CAD probability 3. Any manifestation of ASCVD warrants comprehensive atherosclerotic risk reduction regardless of which vascular bed is affected 1.