Heart Disease Risk in Women is Focus of New Guidelines

[Feburary 21, 2007] In updated guidelines released this week, the American Heart Association has revised and sharpened recommendations for preventing heart disease in women.

The focus now is on a woman's lifetime risk for heart disease, not just her short-term risk, as was the case in the 2004 guidelines.

The 2007 Guidelines for Preventing Cardiovascular Disease in Women were published in a special issue of the journal Circulation devoted to women's health.

This 2007 update provides the most current clinical recommendations for preventing cardiovascular disease (CVD) in women age 20 and older. These recommendations are based on a systematic search of the highest quality science interpreted by experts in the fields of cardiology, epidemiology, family medicine, gynecology, internal medicine, neurology, nursing, public health, statistics, and surgery.

Among other things, the guidelines refresh recommendations on aspirin use, hormone replacement therapy, and vitamin and mineral supplementation.

"The new updated guidelines are extremely exciting, because they advance our science quite a bit and our ability to provide guidance to physicians and other health care providers on the best practices for prevention for women," says Dr. Lori Mosca, chair of the American Heart Association's (AHA) expert panel that devised the guidelines. She is also director of preventive cardiology at New York-Presbyterian Hospital in New York City.

Heart Disease Leading Killer of Women

Heart disease among women is practically epidemic, accounting for one in three female deaths.

"Cardiovascular disease is the leading cause of death among women," Dr. Mosca says. "The rate of awareness [about cardiovascular disease] among women has increased from 30 to almost 60 percent, but we still need to work on the confusion around preventive strategies. We are very encouraged that the release of these new guidelines can help clear up some of this confusion and help our women engage in more conversations with physicians and health care providers as to what are the best strategies to reduce the burden of the number-one killer of women."

The AHA recommends that healthcare professionals should focus on women’s lifetime heart disease risk, not just short-term risk.

Lifestyle Factors Emphasized

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 healthcare providers should consider aspirin in women to prevent stroke,” says Dr. Mosca.

She adds, “In addition, providers should not use menopausal therapies such as hormone replacement therapy (HRT) or selective estrogen receptor modulators (SERMs) such as raloxifene or tamoxifen 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 AHA 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,” Dr. Mosca says.

“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,” she continues.

Risk Reduction is Key

According to the authors of the new guidelines, “Nearly all women are at risk for CVD, underscoring the importance of a heart-healthy lifestyle in everyone. 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, Dr. Mosca says. 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 says. “Medicine is still an art but these guidelines are meant to guide healthcare professionals on the best science available.”

Always consult your physician for more information.