The American Heart Association (AHA) announced new guidelines for the prevention of cardiovascular disease (CVD) in women today. Published in Circulation: Journal of the American Heart Association, the guidelines call for individualized treatment linked to whether a woman has low, intermediate or high risk of having a heart attack in the next 10 years.
That risk level is based on a standardized scoring method developed by the Framingham Heart Study. Low risk means a woman has a less than 10 percent chance of having a heart attack in the next 10 years, intermediate risk is a 10 to 20 percent chance, and high risk is a greater than 20 percent chance.
"This is the first major evidence-based approach to specific coronary prevention in women with recommendations based on an individual woman's level of risk," says Emory Heart Center cardiologist Nanette K. Wenger, MD, Chief of Cardiology at Grady Hospital and one of the co-authors of the new guidelines.
"These guidelines are different because they are based on a thorough, systematic review of the scientific data which shows sex does matter when it comes to cardiovascular disease. They are truly a consensus of the clinical care community, created with input from representatives from twelve professional organizations and twenty-two co-sponsors."
The new guidelines include a call for smoking cessation, regular physical activity, a heart-healthy diet and weight maintenance for all women. Aspirin, ACE inhibitors and beta-blockers are recommended for all high-risk women. Statin therapy is also recommended for high-risk women, even if their LDL cholesterol levels are below 100 mg/dL. Niacin and fibrate therapies are given a strong recommendation for high-risk women with specific cholesterol abnormalities; supplementation with omega-3 fatty acids and folic acid may be considered in some high-risk women.
Blood pressure-lowering drugs are recommended when blood pressure is greater than or equal to 140/90 . However, the new guidelines say blood pressure should be maintained at less than 130/80 when a woman has blood pressure-related target end-organ damage or diabetes. For stroke prevention, warfarin is recommended for women with atrial fibrillation and intermediate or high risk for embolic stroke. If they cannot take warfarin, or if they are at low risk for stroke, they should be given aspirin.
The guidelines also state that women with diabetes should have their blood sugar carefully controlled, as defined by achieving near-normal glycosylated hemoglobin levels (less than 0.7 percent). Hormone therapy and antioxidant vitamin supplements are not recommended for CVD prevention for women at any level of risk. In addition , the new recommendations say women with cardiovascular disease should be evaluated for depression and treated or referred for treatment when indicated.
Writing in the lead editorial entitled "You've Come a Long Way, Baby: Cardiovascular Health and Disease in Women, Problems and Prospects" which accompanies the new guidelines in the current issue of Circulation, Dr. Wenger states: " Emerging data have displayed important sex-based differences in CHD (coronary heart disease): its pathophysiology, clinical presentation, diagnostic strategies, response to therapies, and adverse outcomes. Exploration of sex-related differences in CHD provides a basis for clinical strategies to improve outcomes for women. The goal is the lessening of the sex-based disparities in morbidity and mortality rates for women, in particular addressing the excess mortality rate for myocardial infarction and CABG surgery in younger women compared with their male peers."