Patient: _______________________________ Diagnosis: _____________________________

Rx (Ÿ)	Risk Intervention	Recommendations
	Smoking: Goal-Complete cessation	Strongly encourage patient and family to stop smoking. Provide counselling, nicotine replacement, and formal cessation programs as appropriate.
	Lipid Management: Primary goal * LDL < 2.5 mmol/L	Start hypolipidemic diet in all patients: £30% fat,<7%saturated fat,< 200mg/day cholesterol. 10 % LDL ø achievable with diet. Assess fasting lipid profile. Baseline lipid profile < 24 after acute event. In post -MI patients, lipid profile may take 4 to 6 weeks to stabilize. Add drug therapy according to the following guide:
	Secondary goal * TC/HDL < 4 Tertiary goal * Metabolic Syndrome TG < 1.7 mmol/L HDL Ò 1.0mmol/L(men)/ Ò 1.3mmol/L (women) CWG on Hypercholesterolemia and other Dyslipidemias	LIPID Profile	1^st Line Therapy	2^nd Line Therapy
		LDL Ð	Statin	Resin
		LDL ÐÐ & TG Ð	Statin	Niacin or Fibrate
		LDL Ð & TG Ð & HDL ø	Fibrate or Niacin	Combination Therapy
		* Primary goal: For patients CHD Risk equivalent: any of CAD, TIA, CVA, AAA, PVD/bruits, DM with one additional categorical risk factor or for patients with very high 10-year risk for hard CV events (Ò 20%). á Target initial therapy with the medication dose required to achieve target LDL < 2.5 mmol/L. á For 10 yr CV risk for hard endpoints 10-20%, LDL target is 3.5 mmol/L. á For 10 yr CV risk for hard endpoints < 10%, LDL target is 4.5 mmol/L. á Initiate lipid lowering early in high-risk patients (in conjunction with dietary modification). For specific medications and dosing strategy see Lipid Optimization Tool
			Blood pressure control: Goal £135/85 mm Hg 2002 CHS www.chs.md Guidelines released May 2003	á Initiate lifestyle modification in all patients with blood pressure > 140 systolic or > 90 diastolic over 3 visits with target organ damage (TOD) or 5 visits with no TOD. Initiate Rx immediately if BP > 180/105. á Initial Rx for systolic/diastolic HTN in absence of compelling indication: Low dose thiazide; ACE-I /ARB; long-acting DHP-CCB; b-blocker. No age distinction in initial therapy. á Use Rx individualized to patient requirements if associated risk factors, target organ damage or concomitant disease/condition á Isolated systolic HTN: LDD/long-acting DHP-CCB/ARB á Avoid b-blocker or a-blocker as initial Rx HTN Ò 60yr. á ACE-I not recommended for blacks without another compelling indication. á Type 2 diabetes with micro-albuminuria, proteinuria or nephropathy ACE-I/ARBs are 1^st line Rx
	Diabetes 2003 CDA Guidelines released Dec 2003	á Dx DM: FBG Ò 7.0 mmol/L or 2 hr PCGÒ11.1 mmol/L.(Normal: A1C ≤ 6; FG 4-6 mmol/L; 2 hr PCG 5-8 mmol/L. IFG 6.1-6.9 mmol/L. IGT 2 hr PCG 7.8-11 mmol/L). á Target euglycemia ASAP. Initiate diet¨weight loss (5-10%), diabetes education & exercise program. Target A1C ≤ 7; FG 4-7 mmol/L; 2 hr PCG 5-10 mmol/L. Rx oral hypoglycemic for FBG Ò 7.0 mmol/L & A1C 7-9.Consider initial combination Rx for A1C ≥9 mmol/L. á Aggressive BP control. Target <130/80 Rx ACE-i , ARB, cardio-selective b-blocker, thiazide diuretic, long acting CCB. BP target 125/75 for diabetic nephropathy eliminated. (differs from CHS)
	Physical activity: Minimum goal 30 minutes 3 to 5 times/week	á Assess risk, preferably with exercise test, to guide prescription. á Encourage minimum of 30-40 minutes of moderate intensity activity 3 to 5 times weekly (walking, jogging, cycling or other aerobic activity) supplemented by an increase in daily lifestyle activities (e.g., walking breaks at work, using stairs, gardening, household work) á Max benefits 5 to 6 hours per week. Medically supervised programs for moderate to high-risk patients.
	Obesity/weight management:	Start intensive diet and appropriate physical activity intervention, as outlined above, in patients >120% of ideal weight for height. Particularly emphasise need for weight loss in patients with hypertension, elevated triglycerides or elevated glucose levels. Ideal body weight BMI < 25.
	Antiplatelet agents/ anticoagulants:	Start aspirin 80-325 mg per day if not contraindicated. Consider clopidogrel 75mg OD post MI, post CABG, CVA, PVD in ASA intolerant or allergic patients (CAPRIE Trial). Consider clopidogrel 75mg OD + ASA for ACS: unstable angina/non-ST elevation MI (CURE Trial: duration of therapy 9-12 months) Consider warfarin for post MI patients not able to take aspirin (maintain INR 2-3).
	ACE inhibitors Post-MI/LV Dysfunction:	Start early post-MI in stable high risk patients (anterior MI, previous MI, Killip class II (S3 gallop, rales, radiographic CHF). Continue indefinitely for all with LV dysfunction (EF<40%) or symptoms of CHF. Use as needed to manage HPT or symptoms in all other patients.
	ACE inhibitors Vascular disease/Diabetes	Rx ACE inhibitors in all patients >55 yrs with evidence of vascular disease or DM and one other risk factor: HOPE Trial-Ramipril 2.5¨10 mg OD or all CAD patients >18 yrs EUROPA Trial-Perindopril 4¨8 mg OD
	Beta-blockers: Post-MI	Start acutely or within a few days of event in all post-MI patients (unless contra-indication). Continue indefinitely if residual ischemia, heart failure,LV dysfunction or severe co-morbidity. Continue indefinitely in low risk patients (IIa). Rx as needed to manage angina, arrhythmia or HPT.
	Beta-blockers: CHF	Rx Beta-blocker to ACE-inhibitor/diuretic/+/- digoxin in stable Class II-IV CHF/LVEF £ 40% Bisoprolol 1.25 ¨ 10 mg OD, carvedilol 3.125 mg BID ¨ 25 mg BID (50 mg BID if weight > 85 kg) or metoprolol 12.5 mg ¨ 75-100 mg BID
	Homocyst(e)ine Target £ 10 mmol/L	Check in patients with premature CAD/CVD/PVD; family history premature atherosclerosis or manifest atherosclerosis & no identifiable risk factors. Folic acid 2.5 mg, B6 25 mg, B12 250 mcg.
	Estrogens:	HRT not recommended for 1^0 prevention. Use established preventative strategies. Consider HRT or SERMS for non-cardiac indications. Individualize recommendations consistent with other health risks (VTE, endometrial or breast CA). HRT not indicated in 2^0prevention. D/C HRT in ACS, MI, PTCA,CABG,CHF,Sx.

Rx (Ÿ)	Risk Intervention	Date Ÿ Achieved	Date Ÿ Achieved	Date Ÿ Achieved	Date Ÿ Achieved	Date Ÿ Achieved	Date Ÿ Achieved
	Ideal body weight: BMI < 25 __________ Target ____________
	Girth: Targets F< 90 cm M< 100 cm
	Physical activity: Minimum goal 30 minutes 3 to 5 times/week (total/wk)
	Smoking Goal: Complete cessation
	Lipid Management:
	Primary goal: LDL < 2.5 mmol/L
	Secondary goal_ TC/HDL< 4
	Metabolic Syndrome HDL Ò 1.0 mmol/L M HDL Ò 1.3 mmol/L F
	TG < 1.7 mmol/L
	Blood pressure: Target £135/85 mm Hg on home BP/ABP
	Diabetes: Targets FBS 4-7 mmol/L 2hr PCG 5-10 mmol/L A1C £ 7%
	MAU: Targets Spot urine < 20 mg/L ACR < 2.0 Men ACR < 2.8 Women
	Antiplatelet agents:
	Anticoagulants: Target INR ______
	ACE inhibitors: Post-MI
	ACE inhibitors: Vascular disease
	Beta-blockers: Post-MI
	Beta-blockers/CHF:
	Homocyst(e)ine £ 10 mmol/L
	LP(a) < 30 mg/dL
	hs-CRP< 3.0 mg/L
	HRT: On/off