AHA’s New Heart-Health Guidelines A Wake-Up Call For Women
08/16/2004.
Heart disease is the leading killer of both men and women in the United States. In the past, prevention and treatment guidelines for women were based on clinical research performed primarily on middle-aged white men. Even now, most research studies contain less than 25% women as research subjects.
This Spring, the American Heart Association outlined measures for women to combat and prevent cardiovascular disease, the first evidence-based guidelines for women. The concept of cardiovascular disease as a have or have-not condition has been replaced with the idea that cardiovascular disease develops over time and every woman is somewhere on the continuum.
All women above the age of 25 should be evaluated for cardiovascular risk factors. The new prevention guidelines aimed at women urge at least 30 minutes of moderate physical activity most days; quitting smoking; eating a heart-healthy diet; and that high-risk women receive cholesterol-lowering drugs, preferably statins, and take omega-3 (fish oil) and folic acid supplements. Routine statin therapy has not previously been recommended for these women, but recent studies have shown a benefit in this subgroup. The use of niacin and fibrates, as well as other cholesterol-lowering drugs of particular benefit in specific cases, is also discussed. Overwhelming evidence suggests that over 2/3 of heart attacks and strokes can be prevented in both women and men.
Also included are some guidelines of what not to do. The AHA says doctors should not recommend hormone replacement therapy. Recent data suggests that HRT increases the risk of stroke, myocardial infarction, deep venous thrombosis, dementia, and uterine cancer. HRT does decrease the risk of bone fracture and colon cancer. If HRT is used for estrogen withdrawal symptoms, attempts to wean them off should be made every 2 years. Newer estrogen therapies such as selective estrogen receptor modulators (SERMs) aren’t the same as HRT. They don’t treat menopausal symptoms and don’t seem to increase the risk of breast cancer — but they are effective in treating osteoporosis and preventing fractures. Studies are under way to find out if they lower the risk of heart disease.
The routine use of aspirin in lower-risk women was also discouraged but encouraged in high-risk women. Women with a 10 percent or less risk of having a heart attack in the next 10 years are considered low risk; those with a 10 percent to 20 percent chance are intermediate-risk, and those with a 20 percent or higher chance are high-risk. ACE-inhibitors and beta-blockers were also recommended for all high-risk women. For stroke prevention, women with atrial fibrillation and intermediate or high risk for embolic stroke are recommended to take warfarin. If they cannot take warfarin, or if they are at low risk for stroke, they should be given aspirin.
AHA figures show that about half a million women die of heart disease and strokes each year, killing more than the next seven causes of death combined, including cancer.
This Spring, the American Heart Association outlined measures for women to combat and prevent cardiovascular disease, the first evidence-based guidelines for women. The concept of cardiovascular disease as a have or have-not condition has been replaced with the idea that cardiovascular disease develops over time and every woman is somewhere on the continuum.
In comparisons between the genders, 38 percent of women and 25 percent of men die within one year of a heart attack; women are twice as likely as men to die after a bypass; and 35 percent of female and 18 percent of male heart attack survivors will have another heart attack within six years.
First Lady Laura Bush has begun an aggressive campaign this year to raise awareness about heart disease among women. “Women just don't expect to have a heart attack. They think heart attacks are for men,” she said. “So women seek help a lot later than men do...and because of that, they suffer more damage because they get to the hospital later when they are having a heart attack than most men do.”
According to the National Coalition for Women with Heart Disease, more women than men die of heart disease each year, yet women receive only 36 percent of open-heart surgeries and 33 percent of angioplasties.
Heart disease manifests itself differently in women than men. Cardiac ischemic symptoms in women traditionally include feelings of indigestion or backache, dizziness, fatigue and numbness, sleeplessness, and shortness of breath; whereas, classic symptoms in men include pressure and squeezing pain in the center of the chest, nausea, intense sweating, and fainting.
The AHA says new research shows that women are beginning to realize the importance of good heart health. The group's first survey in 1997 found that only 30 percent of women knew that heart disease was their leading cause of death. But today, about 46 percent of women realize the danger, according to the information released February 4, 2004.
Risk factors for cardiovascular disease in both men and women include high cholesterol and blood pressure, smoking, not exercising, obesity, stress, diabetes, and a family history of heart disease and stroke.