Heart Risk :: Guidelines on Women’s Lifetime Heart Risk

Health care professionals should focus on women’s lifetime heart disease risk, not just short-term risk, according to updated American Heart Association guidelines.

The 2007 Guidelines for Preventing Cardiovascular Disease in Women — published today in a special women’s health issue of Circulation: Journal of the American Heart Association — also include new directions for using aspirin, hormone therapy and vitamin and mineral supplements in heart disease and stroke prevention in women.

“The updated guidelines emphasize the lifetime risk of women, not just the more short-term focus of the 2004 guidelines,” said Lori Mosca, M.D., Ph.D., director of preventive cardiology at New York-Presbyterian Hospital and chair of the American Heart Association expert panel that wrote the guidelines. “We took a long-term view of heart disease prevention because the lifetime risk of dying of cardiovascular disease (CVD) is nearly one in three for women. This underscores the importance of healthy lifestyles in women of all ages to reduce the long-term risk of heart and blood vessel diseases.”

The guidelines include a new paradigm for risk assessment based on risk factors and family history, as well as the Framingham risk score. (First published in 1998, the Framingham risk score estimates the risk of developing coronary heart disease within 10 years.)

The new guidelines include expanded recommendations on lifestyle factors such as physical activity, nutrition and smoking cessation, as well as more in-depth recommendations on drug treatments for blood pressure and cholesterol control.

Furthermore, guidelines on hormone and aspirin therapy and antioxidant and folic acid supplements are revised based on recently published data.

“Since the last guidelines were developed, more definitive clinical trials became available to suggest that health care providers should consider aspirin in women to prevent stroke,” Mosca said. “In addition, providers should not use menopausal therapies such as hormone replacement therapy (HRT) or selective estrogen receptor modulators (SERMs) such as raloxifene or tamoxifene to prevent heart disease because they have been shown to be ineffective in protecting the heart and may increase the risk of stroke.”

A recent American Heart Association survey showed that women are confused about methods to prevent heart disease including the role of aspirin, hormones and dietary supplements.

“The new guidelines reinforce that unregulated dietary supplements are not a method proven to prevent heart disease. For example, recent studies have shown that folic acid is ineffective to protect the heart despite widespread use by patients and physicians hoping for a heart benefit,” Mosca said. “These recent findings emphasize the importance of using well-conducted clinical trial data to develop national recommendations to help patients and their doctors use best practices to prevent heart disease — practices based on data rather than myth or wishful thinking.”

CVD is the largest single cause of mortality among women, accounting for 38 percent of all female deaths. The public health impact of CVD in women is not solely related to mortality, as advances in science and medicine allow many women to survive heart disease. For example, in the United States 42.1 million (36.6 percent) women live with CVD and the population at risk is even larger.

In fact, “nearly all women are at risk for CVD, underscoring the importance of a heart-healthy lifestyle in everyone,” the authors wrote. “Some women are at significant risk of future heart attack or stroke because they already have CVD and/or multiple risk factors. These women are candidates for more aggressive preventive therapy and we define them as high risk.”

Physicians can easily identify high-risk women, but tools to determine other levels of risk are limited, Mosca said. The authors have aligned their recommendations with treatments proven to work and give strong advice for what not to do, as well.

“Therefore, we have more aggressive recommendations for high-risk women, and strongly emphasize lifestyle strategies to reduce risk in all women,” she said. “Medicine is still an art but these guidelines are meant to guide health care professionals on the best science available.”

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