Feb. 4, 2004 (New York) -- Protecting women from their No. 1 ki
Feb. 4, 2004 (New York) -- Protecting women from their No. 1 killer is about to get personal.
New guidelines issued today by the American Heart Association (AHA) and endorsed by more than 30 other organizations call for women and their doctors to adopt a more personal approach to reducing their risk of heart disease and stroke.
"Less than 50% of women recognize that heart disease is their leading killer," says Lori Mosca, MD, MPH, PhD, director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center in New York City and chairwoman of the collaborative group that compiled the guidelines. "The first step to reducing risk is to know that you are at risk."
According to the AHA, heart disease claims the lives of nearly 500,000 women in the U.S. each year, which is more than the next seven leading causes of death combined, including cancer.
Mosca presented the guidelines as well as the results of a 2003 survey of women's awareness about heart disease at a news conference today in New York. The complete guidelines and survey results appear in the current issue of Circulation: Journal of the American Heart Association.
Women's Risks Determine Treatment
Rather than using a one-size-fits-all approach to preventing heart disease in women, the guidelines link the aggressiveness of treatment to whether a woman has a low, intermediate, or high risk of having a heart attack in the next 10 years, based on a standardized heart risk scoring method developed by the Framingham Heart Study.
Risk is based on several factors, including:
- Age
- Smoking status
- Cholesterol levels
- Blood pressure
Low-risk women are defined as those who have a less than 10% chance of having a heart attack within the next 10 years. Intermediate risk women have a 10%-20% chance, and high-risk women have a 20% or higher chance.
Women who have had a heart attack, have diabetes, or have other vascular diseases are also considered high risk.
Once a woman's risk is determined by her health care provider, researchers say that risk level should help define her best personal strategy for heart disease prevention.
Women are encouraged to adopt lifestyle factors known to reduce the risk of heart disease, such as smoking cessation; regular physical activity of at least 30 minutes several times per week; a heart-healthy diet that includes plenty of fruits, vegetables, and whole grains and limits saturated fats; and maintaining a healthy weight.
In addition, the guidelines also advise against using hormone therapy or antioxidant vitamin supplements for heart disease prevention in women at any level of risk due to a lack of research supporting their effectiveness in heart disease prevention.
But beyond that, the recommended strategy varies according to the woman's personal risk of heart disease. For example, aspirin therapy is recommended for prevention in all high-risk women but is not recommended for low-risk women due to the risk of potential side effects.
In particular, the guidelines call for the following treatments at each level:
- High-risk: ACE inhibitors, beta-blockers, and statins for all, even if their "bad" LDL cholesterol levels are below 100. Niacin and fibrate therapies are recommended if there are specific cholesterol issues such as a low level of "good" HDL cholesterol or high trigylcerides. Women with existing heart disease should also be evaluated for depression and treated when necessary. Aspirin therapy is recommended. Supplementation with omega-3 fatty acids and folic acid may also be considered.
- Intermediate-risk: Aspirin therapy can be considered as long as blood pressure is controlled and the benefit is likely to outweigh the risks of side effects such as gastrointestinal bleeding or hemorrhagic stroke.
- Any level of risk: Blood pressure lowering-drugs are recommended when blood pressure is greater than 140/90. Women with diabetes should have their blood sugar carefully controlled.
Women Still Don't Know Their Risks
The results of the American Heart Association's latest nationwide survey of women's attitudes about heart disease show there's a gap between what women know about heart disease risk factors in general and what they do about their own.
For example, 90%-100% of those surveyed recognized that exercise, losing weight, quitting smoking, avoiding foods high in cholesterol, and reducing salt intake can reduce the risk of heart disease. But 70% did not know their own cholesterol levels, either the "bad" low-density lipoprotein (LDL) or "good" high-density lipoprotein (HDL) levels that make up a person's cholesterol profile.
"What we are telling women is that you must know your individual risk," says Nanette K. Wenger, MD, professor of medicine in the department of cardiology at Emory University in Atlanta, who also spoke at the briefing. "Know your numbers because these are factors that can save your life."
Researchers say the risks associated with uncontrolled cholesterol, blood pressure, and other risk factors increase with age, but the benefits of treatment are almost immediately apparent for every age group, including older women.
"The perception that nothing can be done is quite erroneous," says Mosca.
The survey also showed that many women believe in unproven strategies as ways to lower their risk of heart disease. The survey showed 64% of women said antioxidant vitamin supplements, including vitamins E, C, and A, could prevent heart disease, although many studies have showed no benefit. In addition, nearly 30% of women cited aromatherapy (inhaling fragrances) as a way to protect their hearts despite a lack of research to support this method.
