Clinical ASCVD would indeed be under secondary prevention and an event is not required:
Documented coronary artery disease (CAD; one or more of the following primary criteria must be satisfied):
• Documented multi vessel CAD (≥50% stenosis in at least two major epicardial
coronary arteries – with or without antecedent revascularization);
• Documented prior MI;
• Hospitalization for high-risk non-ST-segment elevation acute coronary syndrome
(NSTE-ACS) (with objective evidence of ischemia: ST-segment deviation or
biomarker positivity).
2. Documented cerebrovascular or carotid disease (one of the following primary criteria must be satisfied):
• Documented prior ischemic stroke;
• Symptomatic carotid artery disease with ≥50% carotid arterial stenosis;
• Asymptomatic carotid artery disease with ≥70% carotid arterial stenosis per
angiography or duplex ultrasound;
• History of carotid revascularization (catheter-based or surgical).
3. Documented peripheral arterial disease (PAD; one or more of the following primary criteria must be satisfied):
• Ankle-brachial index (ABI) <0.9 with symptoms of intermittent claudication;
• History of aorto-iliac or peripheral arterial intervention (catheter-based or
surgical).
Primary prevention requires you to have diabetes type 1 or type 2 plus one additional risk factor in the reduce-it trial.
If you have diabetes and your additional risk factor is, say, ankle-brachial index (ABI) <0.9 with symptoms of intermittent claudication, or anything from the previous table, you will be counted as secondary not primary.
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