AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: Intervention Recommendations With Class of Recommendation and Level of Evidence Area for Intervention Recommendations Smoking Goal: Complete cessation. No exposure to environmental tobacco smoke Class I 1. Patients should be asked about tobacco use status at every office visit.2,3,4,5,7 (Level of Evidence: B) 2. Every tobacco user should be advised at every visit to quit.4,5,7,9 (Level of Evidence: A) 3. The tobacco user s willingness to quit should be assessed at every visit. (Level of Evidence: C) 4. Patients should be assisted by counseling and by development of a plan for quitting that may include pharmacotherapy and/or referral to a smoking cessation program.4 9 (Level of Evidence: A) 5. Arrangement for follow up is recommended. (Level of Evidence: C) 6. All patients should be advised at every office visit to avoid exposure to environmental tobacco smoke at work, home, and public places.10,11 (Level of Evidence: B) Blood pressure control Goal: ,140/90 mm Hg Note: The writing committee did not think that the 2006 recommendations for blood pressure control (below) should be modified at this time. The writing committee anticipates that the recommendations will be reviewed when the updated JNC guidelines are released. Class I 1. All patients should be counseled regarding the need for lifestyle modification: weight control; increased physical activity; alcohol moderation; sodium reduction; and emphasis on increased consumption of fresh fruits, vegetables, and low-fat dairy products.12 16 (Level of Evidence: B) 2. 