Heart-Healthy Young Women Have Lower Heart Risk Later

Young women who are heart-healthy and work to stay that way are likelier to see that lifestyle pay big dividends in their later years, according to a study in the Journal of the American Medical Association.

Women who have normal blood pressure, normal cholesterol, and normal body weight in their youth, and who do not have diabetes and do not smoke, are less likely to die from heart disease as they age, compared with women with one or more of these risk factors, the study finds.

First Study to Show Long-Term Benefits

Although a favorable risk profile has been shown to reduce the death rate from heart disease among men and middle-aged women, this is the first time it has been shown to benefit young women.

"We found the rate of mortality from cardiovascular and all-cause mortality is much lower in women with no risk factors compared with those who have one or more risk factors," says study author Dr. Martha L. Daviglus, an associate professor of preventive medicine and clinical pharmacology at Northwestern University.

"All of the cardiovascular risk levels that we call favorable are really the recommendations for a normal profile," she adds. "All young women in the US should be following these recommendations."

In its study, Dr. Daviglus' team collected data on 7,302 women 18 to 39 years of age. The women were part of the Chicago Heart Association Detection Project in Industry study, which included a total of 39,522 men and women.

Between 1967 and 1973, these women were identified as not having heart disease. Based on their risk factors, they were assigned to four risk groups. The researchers found that 20.1 percent of the women were at low risk for heart disease, but 58.5 percent had one or more risk factors. Most of the women in the low-risk group were younger, Caucasian, and better educated than their counterparts at higher risk.

Over 31 years of follow-up, 141 women died from coronary heart disease and coronary vascular disease, and 469 died from all other causes.

Even though there were changes over time in heart disease risk factors, the lowest death rate from heart disease and all other conditions was seen among women in the low-risk group. The rate increased as the number of heart disease risk factors increased, the researchers report.

Despite increases in risk factors over time, those who had no risk factors when they were young still had a lower death rate as they aged, Dr. Daviglus says.

"This is not genetically determined," she says. "Young women should try to be at low risk. They should exercise, not smoke, control their weight, blood pressure, and cholesterol."

Dr. Daviglus added that if a person is middle-aged, it is not too late to change lifestyle habits and improve health. "But the younger the better," she says.

"Young people whose lives are still relatively uncomplicated by adverse risk factor levels need to stay at low risk by pursuing a healthy lifestyle - avoiding or quitting smoking, adopting healthy eating patterns, and remaining or becoming physically active," Dr. Daviglus advises.

Heart Experts Concur with New Study

"Heart disease risks are early, not overnight," said Dr. Nieca Goldberg, chief of women's cardiovascular care at Lenox Hill Hospital and a spokeswoman for the American Heart Association. Risk factors at an early age help predict the risk of heart disease in the future, she adds.

"Young women really should be physically active, watch what they're eating, reduce saturated fats in their diet, eat more fruits and vegetables, whole grains and good fats, and not smoke," Dr. Goldberg says.

"This study underscores the importance of maintaining a low-risk profile," said Dr. Lori Mosca, an associate professor of medicine at Columbia University College of Physicians and Surgeons and director of Preventive Cardiology at New York-Presbyterian Hospital.

"A striking feature is that very few women actually have a low-risk profile," she says. Dr. Mosca, who was chairwoman of the American Heart Association committee that wrote the new guidelines for women, added, "This highlights the need to implement the American Heart Association guidelines for women that were published this year."

Young women need to maintain a heart-healthy lifestyle, Dr. Mosca says. This includes reducing high blood pressure and cholesterol.

"This study suggests that if they do, they will live longer," she says.

Always consult your physician for more information.

Online Resources

American Heart Association

Centers for Disease Control and Prevention (CDC)

Everyday Choices, AHA, ADA, and ACS

Go Red for Women Campaign, AHA

HealthierUS.Gov

National Heart, Lung, and Blood Institute (NHLBI)

National Institutes of Health (NIH)

National Library of Medicine

US Food and Drug Administration

US Health and Human Services

December 2004

Young, Healthy Women Have Lower Heart Risk Later

First Study to Show Long-Term Benefits

Heart Experts Concur with New Study

Experts Caution on All Cox-2 Inhibitors

Online Resources

Experts Caution on All
Cox-2 Inhibitors

Just days after Merck & Co. withdrew its arthritis drug Vioxx from the market, doubts are being raised about the safety of the two other approved medications in this class, Bextra and Celebrex.

In an article in the New England Journal of Medicine, an expert with a long history of research in the cox-2 inhibitor class of drugs says cardiovascular problems seen with Vioxx may yet surface with the other two medications.

The problem, says Dr. Garret A. FitzGerald, chairman of pharmacology at the University of Pennsylvania's Institute of Translational Medicine and Therapeutics, is that all cox-2 inhibitors suppress the production of a heart-protecting fat called prostaglandin I2.

"Vioxx, Celebrex, and Bextra all have the same effect on this biochemical system," Dr. FitzGerald says. 

"Therefore, until proven otherwise, evidence would suggest that this mechanism would involve all drugs in this class," explains Dr. FitzGerald.

After halting a study suggesting that long-term Vioxx users faced double the risk of heart attack or stroke compared to non-users, Merck announced recently it was pulling the medication from markets worldwide.

A day later, Pfizer Inc. issued a statement defending its biggest cox-2 drug, Celebrex.

Citing a number of ongoing, long-term studies, Pfizer's president of worldwide development, Dr. Joe Feczko, said, "The data we've accumulated over time demonstrate that Celebrex does not increase the risk of serious cardiovascular events in patients with arthritis and pain, even at higher-than-recommended doses."

One top US Food and Drug Administration (FDA) official echoed those sentiments. Dr. Steven Galson, acting director of the FDA's Center for Drug Evaluation and Research, says that cox-2 inhibitors other than Vioxx "do not have this same incidence of heart attack and stroke in clinical trials. There is a real difference in the data."

But Dr. FitzGerald says he remains uncertain.

"Back in 1999, we performed studies on Celebrex and Vioxx, and we showed that they had an effect on the same mechanism whereby they relieved pain and inflammation," he explains. That mechanism - inhibition of an enzyme called cyclooxygenase-2 - leads to reductions in lipids called prostaglandins.

These prostaglandins "are responsible for pain and inflammation, and they also protect the stomach" so Vioxx users got needed relief without the gastrointestinal upset often associated with other pain relievers, Dr. FitzGerald notes.

Prostaglandins, especially prostaglandin I2, "are also responsible for protecting the heart," he adds.

The bottom line, according to Dr. FitzGerald, is that as cox-2 drugs soothe arthritis pain and reduce risks for gastrointestinal symptoms, they may also raise cardiovascular risks over the long term. That turned out to be the case with Vioxx.

But what about long-term use of Celebrex, or the other Pfizer cox-2 inhibitor, Bextra?

"We just don't have a handle on 'how long is long'" Dr. FitzGerald says. "In the [Vioxx] trial, nothing much happened to patients for a year, and then things started to come apart. But maybe with other drugs, other circumstances, or in other types of patients, it may be two years, three years - who knows?"

Dr. FitzGerald believes that, given the failure of Vioxx, "the burden of proof has now shifted" to Pfizer and the FDA.

Always consult your physician for more information.