4
Definitions and Classifications
Note: The numbering of the following tables and figures may differ from that of
the Clinical Practice Guideline.
Colors in tables and figures correspond to Class of Recommendations and
Level of Evidence tables on pages 104–105.
2.1. Definitions
➤ Cardiovascular-kidney-metabolic syndrome: The common
characteristics of the cardiovascular-kidney-metabolic (CKM) syndrome
include abdominal obesity (high body mass index [BMI] and/or
large waist circumference), insulin-resistant glucose metabolism
(hyperinsulinemia, impaired fasting glucose, impaired glucose
tolerance, type 2 diabetes), dyslipidemia (high serum TG and low
serum high-density lipoprotein cholesterol [LDL-C] concentrations),
increased blood pressure, and sometimes microalbuminuria,
proteinuria, or chronic kidney disease (CKD).
➤ Children: In this guideline, children are defined as age 18 years
or younger.
➤ Clinical ASCVD: ASCVD includes history of acute coronary syndromes
(ACS), myocardial infarction (MI), stable or unstable angina, coronary
or other arterial revascularization, stroke, transient ischemic attack
(TIA), or peripheral artery disease (PAD). ASCVD at very high risk is
defined as ≥2 major ASCVD events (ACS within the past 12 months,
history of MI [other than recent ACS], history of ischemic stroke,
symptomatic PAD) or with 1 major ASCVD event and ≥2 high-risk
features (age ≥65 years, coronary bypass or percutaneous intervention,
current smoker, diabetes, history of heart failure [HF], hypertension,
LDL-C ≥100 mg/dL [2.6 mmol/L] despite maximally tolerated statin
plus ezetimibe).
➤ Dyslipidemias: Dyslipidemias considered in this guideline include
elevated blood cholesterol, hypertriglyceridemia, and elevated Lp(a).
➤ Lifestyle management: Lifestyle management encompasses an
assessment of each individual's baseline behavioral habits and
counseling regarding healthy lifestyle habits. It includes information
regarding heart-healthy eating patterns, regular physical activity,
avoidance of all nicotine-delivery products, healthy sleep habits, and
maintaining a healthy weight. This includes the lifestyle elements of the
AHA's Life's Essential 8
™
in addition to stress management.
➤ Subclinical atherosclerosis: Subclinical atherosclerosis is identified by
the presence of atheromatous disease in ≥1 arterial territories before
there are any signs, symptoms, or events attributable to clinically
manifest atherosclerotic disease in those territories.
