On Tuesday, the American Heart Association released new guidelines for the prevention of cardiovascular disease (CVD) in women.
According to the AHA, in 2007, CVD caused about one death per minute among women in the U.S. This represents over 420,000 deaths -- more deaths than cancer, chronic lung disease, Alzheimer’s disease, and accidents combined. And as CVD is the leading cause of death in women in every major developed country, there is a strong need to provide doctors and patients with evidence-based recommendations on how to address this monumental health problem.
The panel of experts convened to put the new guidelines together warns that awareness of specific CVD risk factors continues to be a barrier to women for receiving optimal care. So I decided to ask Penn’s own Mariell Jessup, MD, medical director of the Penn Medicine Heart and Vascular Center and an international expert on women’s heart health, to explain how these new guidelines will help fight CVD.
Q. Why are special guidelines needed for treating CVD in women?
Evolving science suggests that the overwhelming majority of recommendations to prevent CVD are similar for women and men, with a few exceptions. Notably, aspirin is routinely recommended for the prevention of heart attacks in men but not all women.
However, there is a growing appreciation that there may be gender differences in the potential benefits and risks of preventive interventions for heart disease. The panel of experts who authored the guidelines acknowledged unique opportunities to identify women at risk for CVD and addressed concerns that women often have more medical conditions that exist in addition to heart disease (known as comorbidities) and are older than men when they experience coronary heart disease.
Q. What are the major changes to this current guideline from the previous guideline?
The new recommendations are based upon an extensive literature search since the last guidance for women, in 2007. A major change in the current guidelines is that the threshold for who is considered "high risk” was lowered, meaning more women will be indentified at risk.
The previous threshold for what is considered "high risk" among women has been lowered, from a greater than 20 percent risk of dying from a heart attack in the next 10 years to a greater than 10 percent risk of dying from any cardiovascular event in the next 10 years.
These new guidelines also place greater emphasis on recommendations shown to be effective in the "real world" as opposed to those based on just clinical research settings.
The AHA compiled a “Top 10” list of things to know about the new guidelines which is very helpful.
Q. Who is most at risk for developing CVD?
Women with all of the risk factors we traditionally think of, including a family history of CVD, high cholesterol and blood pressure, obesity, diabetes, and smoking.
In addition, the guidelines state that certain illnesses can increase heart disease risk in women, including lupus, rheumatoid arthritis and pregnancy complications such as preeclampsia, gestational diabetes, or pregnancy-induced hypertension.
Finally, the guidelines also point out that certain racial or ethnic groups have a higher prevalence of risk factors for CVD such as hypertension among black women or diabetes mellitus in women of Hispanic descent.
Q. Do the guidelines incorporate any new screening methods for women who may have CVD?
The updated guidelines include depression screening as part of an overall evaluation of women for cardiovascular risk, because while treating depression has not been shown to directly improve cardiovascular health, depression might affect whether women follow their doctor’s advice.
Q. What can women do to help protect their hearts?
There are some tried and true recommendations that we make for everyone to help protect their hearts.
First, if you smoke, stop now. About 20 percent of all deaths from heart disease in the U.S. are directly related to cigarette smoking. That's because smoking is a major cause of coronary artery disease. In addition, women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease and stroke compared with nonsmoking women who use oral contraceptives.
Second, talk with your doctor about keeping your blood pressure optimally controlled. Ideally, your blood pressure should be below 120/80 mm Hg.
I also recommend that women visit the "Life’s Simple 7” page on the AHA website. The AHA has clearly defined "ideal cardiovascular health" and linked it to seven simple measures ("Life's Simple 7") that people can manage through diet and lifestyle changes to move from poor and intermediate to ideal health.
The website also offers an online assessment tool. In just a few minutes, you can find out the state of your heart health and learn simple steps you may need to take to improve your heart health and quality of life.
In addition to these new guidelines, cardiovascular researchers continue to shed new light on various aspects of heart disease in women. Dr. Jessup recently gave a rundown of the latest new research findings on women’s heart health from the AHA’s Annual Meeting in Chicago.