The American Heart Association’s Guidelines for Women
The American Heart Association’s new 2007 guidelines update the 2004 recommendations for preventing cardiovascular disease (CVD) in women aged 20 and older.
About 34% of US women are living with heart disease and an even larger percentage at risk for developing it. The American Heart Association (AHA) advises a broader approach to classify the likelihood of developing CVD—one that goes beyond the Framingham global risk score. The Framingham score places women in categories (from high risk to optimal) based on factors like age, total cholesterol, and blood pressure. The total score has been to calculate a woman’s 10-year risk of developing the disease. The problem with this is that a low score doesn’t necessarily reflect risk over the course of a lifetime.
With that in mind, the AHA recommends doctors take a more comprehensive view of cardiovascular risk. Adding to the Framingham score, doctors should examine the patient’s medical and lifestyle history, family history of CVD, as well as other genetic conditions. The AHA aims to tackle heart disease in women by evaluating lifetime risk and determining the most appropriate preventive measures. The goals also include more aggressive tactics for those at high risk.
The new classification focuses on three categories: high risk, at risk, and optimal risk. As stated in the guidelines, women in the “high risk” category meet the following criteria:
- Established ]]>coronary heart disease]]>
- Cerebrovascular disease (eg, ]]>stroke]]> )
- ]]>Peripheral artery disease]]>
- Abdominal aortic aneurysm
- Chronic kidney disease
- ]]>Diabetes]]> mellitus
- A high 10-year Framingham global risk score (over 20% chance of developing CVD)
Those “at risk” have:
- One or more risk factors for CVD, such as:
- ]]>Hypertension]]> (high blood pressure)
- Dyslipidemia (cholesterol problems or high triglycerides)
- Evidence of subclinical (asymptomatic) vascular disease (eg, coronary calcification)
- ]]>Metabolic syndrome]]> (combination of usually mild to moderate hypertension, dyslipidemia, overweight, as well as pre-diabetes)
- Poor exercise capacity on treadmill test and/or abnormal heart rate after stopping exercise
Women in the optimal risk category have a low Framingham score (less than 10% chance of developing CVD) and a healthy lifestyle (no risk factors).
In addition to the new, broader classification, other major recommendations based on the latest research findings advise that doctors should:
- Avoid aspirin therapy in healthy women less than age 65, and use selectively in all others
- Not prescribe menopausal therapies (eg, hormone therapy and selective estrogen-receptor modulators) to prevent heart disease
- Not recommend antioxidant vitamin supplements, such as vitamin E, C, and beta carotene, to prevent heart disease
- Not recommend folic acid as a preventive measure for heart disease since there is no evidence that the supplement offers any heart benefits
Intervention: Lifestyle Changes, Supplements, and Medications
The AHA encourages women at all risk levels to make necessary lifestyle changes, like reducing alcohol intake, ]]>quitting smoking]]> through cessation therapies, and increasing ]]>physical activity]]>.
For example, those who need to ]]>lose weight or keep the weight]]> off should engage in 60-90 minutes of moderate-intensity exercise on most (or all) days of the week in an effort to achieve and maintain a body mass index (BMI) in the normal range (18.5-24.9).
In addition, women are encouraged to eat a high fiber ]]>diet rich in fruits, vegetables]]>, ]]>whole grains]]>, which also includes at least two servings of oily fish (like salmon and tuna) per week.
Women already diagnosed with heart disease should consider taking an ]]>omega-3 fatty acid]]> supplement and should be screened for the possibility of depression. Also, those women who have recently suffered a cardiovascular event (eg, angina, heart attack, stroke, peripheral artery disease) or who are experiencing symptoms of heart failure should undergo a comprehensive rehabilitative program to manage their condition and lower their risk of recurrence or other future complications.
At Risk or High Risk
Interventions for women who are considered “at risk” or at “high risk” for CVD can include a combination of lifestyle changes and medications. The goals are to achieve:
- An optimal blood pressure reading (<120/80 mmHg)
- Healthy levels of high-density lipoprotein (HDL) cholesterol ( more than 50 mg/dL [1.3 mmol/L])
- Low-density lipoprotein (LDL) ]]>cholesterol]]> (less than 100 mg/dL [2.6 mmol/L])
All women at “high risk” should be taking daily ]]>aspirin]]> (75-325 mg) unless there is a compelling reason not to (eg, history of bleeding stomach ulcers). “At risk” women 65 and older should be considered for aspirin therapy if the benefits outweigh the risks. In addition, all women who have had a heart attack or similar coronary event should be considered for drug treatment with a beta-blocker, and in the event of heart failure or diabetes, should also be considered for angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blocker (ARB) medication.
American Heart Association
Go Red for Women
American Heart Association
National Heart, Lung and Blood Institute
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
Estimate of 10-year risk for coronary heart disease Framingham point scores. National Cholesterol Education Program. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/risk_tbl.htm#women . Accessed February 22, 2007.
Fish oils in heart cells can block dangerous heart rhythms. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3012101 . Accessed February 22, 2007.
How is blood cholesterol diagnosed? Diseases and Conditions Index. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Hbc/HBC_Diagnosis.html . Accessed February 22, 2007.
Mosca L, Banka CL, Benjamin EJ, et al. For: American Heart Association Expert Panel/Writing Group. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. American Heart Association website. Available at: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA Accessed February 22, 2007.
What is high blood pressure? Diseases and Conditions Index. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_WhatIs.html . Accessed February 22, 2007.
Last reviewed January 2009 by ]]>Igor Puzanov, MD ]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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