Since the 2006 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) guidelines on secondary prevention, important evidence from clinical trials has emerged that further supports and broadens the merits of intensive risk-reduction therapies for patients with established coronary and other atherosclerotic vascular disease, including peripheral artery disease, atherosclerotic aortic disease, and carotid artery disease. These guidelines have been updated to incorporate evidence-based results from recent clinical trials and revised practice guidelines.