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Women and Heart Disease: A New Paradigm

In the past, although many of the studies done on heart disease included women, the outcomes focused on how they related to men.

The Agency for Healthcare Research and Quality (AHRQ) has been conducting research to identify key areas requiring further study to enable design of guidelines for risk factors for women.

In 2004, AHRQ reported that systematic review is feasible to identify risk factors for heart disease among women based on co-morbidities of diabetes, high homocysteine, hyperlipidemia, hypertension, and obesity. It also determined a need for the study of aspirin and beta blocker use for secondary prevention in women.

On Feb. 19, 2007, the American Heart Association (AHA) updated its guidelines focused on women and cardiovascular disease. The AHA suggested physicians should focus on the lifetime risk of women for heart disease and identified some key risk assessment factors to consider.

Some of the steps recommended to reduce risk factors included:

• Lifestyle changes to manage blood pressure, including weight control, physical activity (60-90 minutes daily as possible), alcohol moderation, and sodium restriction
• Smoking cessation using available therapies to enhance success
• Saturated fat intake reduced to 7 percent of calories
• Omega-3 fatty acid intake with supplementation of 850-1000mg of epicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)
• Routine low dose aspirin for women age 65 and older (if benefits outweigh an individual’s risk), with upper dosage of 325mg aspirin for high risk women
• LDL cholesterol lowered to less than 70mg/dL

Hormone replacement therapy and selective estrogen receptor modulators (SERMS) are not recommended to prevent heart disease.

With all these studies, confusion continues for women on how best to protect themselves from heart disease.

“The new AHA guidelines on cardiovascular health in women appropriately focus on early and sustained lifestyle intervention as a foundation for improved outcomes,” said Daniel Edmundowicz, MD, of Pittsburgh, President of the Pennsylvania Chapter of the American College of Cardiology and a member of the Pennsylvania Medical Society. “Women may innocently but mistakenly delay these interventions with a false sense of security. These interventions form the foundation for improved outcomes."

Dr. Edmundowicz, stressing that heart disease remains the number one killer of women in this country, continued, "While we think of strokes and heart attacks as problems that occur as estrogen levels wane in the post-menopausal years, it is clear that pre-menopausal risk factor levels set the stage for these devastating events."

It is hoped, however, that these guidelines will provide women and their health care providers with the information they need to make important choices for a healthy heart.

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