Wednesday, February 21, 2007

AHA releases updated heart disease guidelines for women
By Julie McKeel

A focus on women's lifetime heart disease risk, not just short-term risk, as well as new directions for using aspirin, hormone therapy and vitamin and mineral supplements in heart disease and stroke prevention in women are included in a special women’s health issue of Circulation: Journal of the American Heart Association.

Cheryl Bushnell

Rowena Dolor

Kristin Newby

The American Heart Association (AHA) 2007 Guidelines for Preventing Cardiovascular Disease in Women were published this week and emphasize the lifetime risk of women, rather than just the short-term focus of the 2004 guidelines. The guidelines were developed by an AHA expert panel, chaired by Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital. DCRI co-authors of the 2007 guidelines are Drs. Cheryl Bushnell, Rowena Dolor, and Kristin Newby.

According to the Mosca's statement in the press release, the panel "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 provide a new framework for risk assessment based on risk factors, family history, and the Framingham risk score (which estimates the risk of developing coronary heart disease within 10 years).

The new guidelines expand earlier recommendations on lifestyle factors such as physical activity, nutrition and smoking cessation. They also provide more in-depth advice about drug treatments for blood pressure and cholesterol control. Guidelines on hormone and aspirin therapy and antioxidant and folic acid supplements were also revised based on recently published data.

Based on a recent American Heart Association survey, 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," Mosca said in the press release. "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 death among women, accounting for 38% of all female deaths. Yet, due to advances in science and medicine that allow many women to survive heart disease, the public health impact of CVD in women is not solely related to death.

According to the guideline authors, "nearly all women are at risk for CVD, underscoring the importance of a heart-healthy lifestyle in everyone"

While physicians can easily identify high-risk women, the tools to determine other levels of risk are limited. The guideline authors have aligned their recommendations with treatments proven to work.

The 2007 guidelines represent the most current clinical recommendations for preventing CVD in women 20 and older, and are based on a systematic review of the highest quality science provided by experts in the fields of cardiology, epidemiology, family medicine, gynecology, internal medicine, neurology, nursing, public health, statistics and surgery.

2007 Highlights include:

• Alter lifestyle to help manage blood pressure: monitor weight, increase exercise activity, limit alcohol consumption, reduce sodium, and increase the amount of fresh fruits, vegetables, and low-fat dairy products.
• Quit smoking, via counseling, nicotine replacement, or other forms of smoking cessation therapy.
• For women who need to lose weight or sustain weight loss, add a minimum of 60-90 minutes of moderate-intensity activity (e.g., brisk walking) on most, and preferably all, days of the week.
• Reduce saturated fats intake to less than 7% of calories if possible.
• Eat oily (omega-3 fatty acid) fish at least twice a week. Women with heart disease should consider taking a capsule supplement of 850-1000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid); two to four grams for women with high triglycerides.
• Hormone replacement therapy (HRT) and selective estrogen receptor modulators (SERMs) are not recommended to prevent heart disease in women.
• Don’t use antioxidant supplements (such as vitamin E, C and beta-carotene) for primary or secondary prevention of CVD.
• Folic acid is not recommended to prevent CVD – a change from the 2004 guidelines that did recommend it be considered for use in certain high-risk women.
• Consider using routine low dose aspirin therapy in women age 65 or older regardless of CVD risk status, if benefits are likely to outweigh other risks.