New Guidelines For Heart Disease Prevention In Women

The Heart Truth Road Show Takes The "Red Dress" To Women

The American Heart Association recently announced new guidelines for preventing heart disease and stroke in women based on a woman’s individual cardiovascular health. 

The guidelines are published in Circulation: Journal of the American Heart Association.

Cardiovascular disease is the leading cause of death for men and women in the US. Nearly 500,000 women die from cardiovascular disease each year.

“For the first time we are giving clarity about how much we know and how much we don’t know,” said Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center. 

“The concept of cardiovascular disease (CVD) as a ‘have-or-have-not’ condition has been replaced with the idea that CVD develops over time and every woman is somewhere on the continuum,” Dr. Mosca says.

The guidelines are based on the highest-quality evidence from all the available research related to CVD prevention, according to the American Heart Association.

The new recommendations say that the aggressiveness of treatment should be linked to whether a woman has low, intermediate, or high risk of having a heart attack in the next 10 years, based on a standardized scoring method developed by the Framingham Heart Study. 

“This provides a very individual approach to preventing CVD throughout the population,” Dr. Mosca said.

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.

Aspirin recommendations illustrate how recommended therapy varies across three levels of risk. For all high-risk women and for those who have documented cardiovascular disease, aspirin is recommended, but is not recommended for low-risk women. 

Among intermediate-risk women, aspirin can be considered as long as blood pressure is controlled and the benefit is likely to outweigh the risk of side effects such as gastrointestinal bleeding or hemorrhagic stroke.

Lifestyle interventions such as smoking cessation, regular physical activity, heart-healthy diet, and weight maintenance were given a strong priority in all women, not only because of their potential to reduce existing CVD, but also because heart-healthy lifestyles may prevent major risk factors from developing.

Medications including ACE inhibitors and beta-blockers are recommended for all high-risk women.

The guidelines also include a strong recommendation that high-risk women, even those with low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, should receive cholesterol-lowering drugs, preferably medications called statins. 

Routine statin therapy has not previously been recommended for these women, but recent studies have shown a benefit in this subgroup. Other cholesterol-lowering drugs of particular benefit in specific cases, such as niacin and fibrates, also are discussed.

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.

Physicians are provided prevention measurements, both lifestyle and medical, that are divided into classes based on the strength of the recommendation for each level of risk. 

Class I is the most strongly recommended intervention, followed by Class IIa and IIb. The guidelines also provide guidance on what not to do, with certain interventions labeled Class III - indicating that an intervention is either not useful or could be harmful, or both.

“The Class III category is important, especially in areas where there has been a lot of confusion, such as hormone therapy and antioxidant supplements," Dr. Mosca says.  "Research has shown that these interventions have no benefit for preventing CVD in women."

Another example is aspirin use, which is Class III for low-risk women because the side effects may outweigh benefits. Until more research is available, Dr. Mosca said it is more prudent for physicians to wait before recommending aspirin therapy in this group of women.

“Overwhelming evidence suggests that CVD can be prevented in both women and men,” she said.  “These recommendations should help healthcare providers and the public avoid initial or recurrent heart attacks and strokes.”

The guidelines represent a major collaborative effort by representatives of the American Heart Association and 11 other professional and governmental co-sponsoring organizations.  Another 22 organizations, including some lay organizations, endorsed the guidelines.

Always consult your physician for more information.

Watch for the "Red Dress" Campaign

The National Heart, Lung, and Blood Institute (NHLBI), one of the National Institutes of Health (NIH), announced recently at an American Heart Month program in Washington DC, its plans for a traveling exhibit on heart health.

From March through April 2004, The Heart Truth Road Show, sponsored by NHLBI and presented by Johnson & Johnson, will bring important information to women across the US to urge them to take their heart health seriously and personally.

Complete with free risk factor screenings and educational materials, the traveling exhibit will feature a stunning display of dresses from The Heart Truth’s Original Red Dress Collection 2003 - including designs from Donna Karan, Michael Kors, Oscar de la Renta, and Calvin Klein. The Road Show will visit shopping malls in the following five cities: Chicago, Dallas, Miami, Philadelphia, and San Diego.

The Heart Truth’s Red Dress is the national symbol for women and heart disease awareness. It is a red alert that heart disease is the leading cause of death in women, and an urgent reminder to every woman to care for her heart.

Research shows that women are more worried about cancer than heart disease - especially breast cancer.

According to a survey commissioned by the National Council on the Aging, only 9 percent of women ages 45 to 64 name heart disease as the condition they most fear - while 61 percent name breast cancer.

Yet, heart disease, which includes coronary artery disease, congestive heart failure, angina, and other conditions, is the leading cause of death in American women.

“The Heart Truth Road Show takes these important messages about heart health directly to women in local communities so they can learn about their personal risk
factors for heart disease - and understand that heart disease is a woman's number one health threat," said US Health and Human Services (HHS) Director Secretary Tommy G. Thompson.

“We want to encourage every woman to talk to her doctor about her risks for heart disease and to start taking action to lead a heart healthy life,” said NIH Director Elias A. Zerhouni.

Johnson & Johnson is the presenting sponsor of The Heart Truth Road Show. The Heart Truth Road Show community partners include: American College of Cardiology, the American Heart Association, the Office on Women’s Health (Department of Health and Human Services), and WomenHeart: the National Coalition for Women with Heart Disease. National sponsors include: LifeWise by RadioShack, Johnson & Johnson Reach Dental Floss, Cordis Corporation, and Albertsons.

The Heart Truth is a national awareness campaign for women about heart disease, sponsored by the NHLBI and  HHS. The campaign first introduced the Red Dress as the national symbol for women and heart disease awareness during American Heart Month at Fashion Week in February 2003.

Always consult your physician for more information.

Online Resources

American Heart Association

Centers for Disease Control and Prevention (CDC) 

HealthierUS.Gov

National Heart, Lung, and Blood Institute (NHLBI) 

National Institutes of Health (NIH)

The Heart Truth National Awareness Campaign

March 2004

New Guidelines For Heart Disease Prevention In Women

Watch for the "Red Dress" Campaign

Heart Fitness for Young Adults Supports Prevention

The Role of Fitness

Women and Men Fared the Same

Online Resources

Heart Fitness for Young Adults Supports Prevention

In other recent heart news, researchers found that cardiorespiratory fitness in early adulthood significantly decreases the chance of developing high blood pressure and diabetes - both major risk factors for heart disease and stroke - in middle age, according to a new study reported in the Journal of the American Medical Association.

Heart disease and stroke are the first and third leading causes of death for Americans. Nearly 13 million Americans have heart disease and nearly 5 million have had a stroke.

Fitness also reduces the risk for the metabolic syndrome, a constellation of factors that includes excess abdominal fat, elevated blood pressure, and triglycerides, and low levels of the high-density lipoprotein, the “good” cholesterol.

Further, improving fitness in healthy young adults can cut by as much as 50 percent the risk for diabetes and the metabolic syndrome.

The Role of Fitness

The research is the first, large observational study to look at the role of fitness on healthy young adults’ development of risk factors for heart disease. Prior studies had examined the relationship between fitness and death from heart disease and stroke.

The study was supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH).

The study was conducted by researchers at Northwestern University, Nemours Cardiac Center, the Kaiser Permanente Division of Research, the University of Minnesota School of Public Health, and the University of Alabama Birmingham.

“This study underscores the importance of both fitness and maintaining a healthy weight in the fight against heart disease and stroke and their risk factors,” said Dr. Barbara Alving, NHLBI acting director. “Americans need to become physically active early in life and continue to be active as they age in order to remain as healthy as possible.”

“Given the epidemic of obesity in the United States and the decline in people’s physical activity, it’s important that Americans take steps to improve their physical fitness,” cautioned Dr. Mercedes Carnethon, Department of Preventive Medicine at Northwestern University.

“If all the young adults in our study had been fit, there would have been nearly a third fewer cases of high blood pressure, diabetes, and metabolic syndrome,” she says.

Data came from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which began in January 1984 and ended in December 2001. The fitness study involved 4,487 African-American and Caucasian men and women, who were ages 18 to 30 at the time of their enrollment. They participated through four clinical centers - in Birmingham, Chicago, Minneapolis, and Oakland.

All participants were followed for 15 years, but 2,478 of them had their cardiopulmonary fitness tested again after seven years in order to measure changes in fitness.

Cardiopulmonary fitness was measured with an exercise treadmill test, which included up to nine, two-minute stages of progressive difficulty.

Women were classified as “low” in fitness if they completed less than six minutes of exercise and men if they completed less than 10 minutes. Women who completed six to nine minutes of exercise were classified as “moderately” fit and men if they completed 10 to 12 minutes. Those who completed more exercise were classified as “highly” fit.

Women and Men Fared the Same

Results were the same for African-American and Caucasian adults, as well as men and women.

Those who were low or moderately fit had twice the risk of high blood pressure, diabetes, and metabolic syndrome as those who were highly fit.

Moreover, the risk increased directly as fitness level dropped.
Weight gain was inversely related to fitness over the course of the study.

Of those who retook the treadmill test after seven years, the average weight gain was about 15 pounds. The average weight gain after 15 years was about 28 pounds.

Those who were obese tended to be less fit: Of those who were obese, 68 percent were low in fitness, 29 percent were moderately fit, and 4 percent were highly fit.

Of those who were not obese, 13 percent were low in fitness, 36 percent were moderately fit, and 51 percent were highly fit.

Fitness did not protect those who were highly fit and obese at the start of the study from developing diabetes or the metabolic syndrome later in life.

“The key point from this study is that the development of risk factors for heart disease and stroke isn’t just the natural result of aging,” said Dr. Carnethon. “All Americans - including women and minorities -can protect themselves against those risks by maintaining their physical fitness."

Cheryl Nelson, NHLBI project officer for the study, says  “Americans don’t have to run marathons to improve their physical fitness. They should try to engage in at least 30 minutes of a moderate-intensity physical activity such as brisk walking on most and, preferably, all days of the week. Being physically active will not only improve their fitness but also help them maintain a healthy weight, which in turn will protect their heart health.”

Always consult your physician for more information.