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Submitted by Dr. Yasser Mokhtar, MD. Critical Care Medicine fellow,
University of Pittsburgh Medical Center.
Sunday, 29th February 2004
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American Heart Association outlined the first guidelines for women to combat
and prevent cardiovascular disease
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Until now, women had to rely on
prevention and treatment guidelines for coronary heart disease based
on research on men.
This month, the American Heart Association outlined measures for
women to combat and prevent
cardiovascular disease, the first
evidence-based guidelines for women.
Coronary heart disease (CHD) is often fatal, and because nearly two thirds of women who die
suddenly have no previously recognized symptoms, it is thus essential
to prevent
CHD. AHA figures show that about half a million women die
of heart disease and
strokes each year, killing more than the next
seven causes of death combined, including
cancer.
In comparisons between the genders, WomenHeart, the National
Coalition for Women with Heart Disease, says that women are more
likely than men to die within one year of a
heart attack; women are
twice as likely as men to die after a
bypass; and 35 percent of female
and 18 percent of male
heart attack survivors will have a recurrent
heart attack within six years.
Risk factors for cardiovascular disease in both men and women
include high cholesterol and blood pressure, smoking, not exercising,
obesity, stress and a family history of
heart disease and
stroke.
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TABLE 1. Spectrum of CVD Risk in Women
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Risk Group |
Framingham Global Risk
(10-y Absolute CHD Risk) |
Clinical Examples |
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High risk |
> 20% |
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Intermediate risk |
10% to 20% |
- Subclinical CVD (eg, coronary calcification)
- Metabolic syndrome
- Multiple risk factors
- Markedly elevated levels of a single risk factor
- First-degree relative(s) with early-onset (age: 55 y in men
and 65 y in women) atherosclerotic CVD
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Lower risk |
<10% |
- May include women with multiple risk factors, metabolic
syndrome, or 1 or no risk factors
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Optimal risk |
<10% |
- Optimal levels of risk factors and heart-healthy lifestyle
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CHD indicates coronary heart disease; CVD, cardiovascular
disease.
Most women with a single, severe risk factor will have a 10-year risk
10%.
Women with a 10 percent or less risk of having a
heart attack in
the next 10 years are considered low risk; those with a 10 percent to
20 percent chance are intermediate-risk, and those with a 20 percent
or higher chance are high-risk.
The new prevention guidelines aimed at women urge at least 30
minutes of moderate physical activity most days; quitting smoking; and
that high-risk women receive
cholesterol-lowering drugs, preferably statins, and take omega 3 and folic acid supplements.
Also included are some guidelines of what not to do. The AHA says
doctors should not recommend hormone replacement therapy, once thought
to increase heart health. In recent years, however, HRT has come under
fire for increasing the risk for a number of diseases including
cancer.
The routine use of
aspirin in lower-risk women was also discouraged
but encouraged in high-risk women. The guidelines are published in the AHA's Circulation journal.
References
Evidence-Based Guidelines for Cardiovascular Disease Prevention in
Women
Tracking Women?s Awareness of Heart Disease, an American Heart
Association National Study
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