Preventing CVD in women: updates focus on real-world advice

In 2004, the American Heart Association (AHA) sponsored the Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women. These guidelines were updated in 2007, and have been updated again in 2011.1 The updated guidelines focus on what works best in the real-world; considering personal and socioeconomic factors that keep women from adhering to lifestyle and medical recommendations.2

In an accompanying editorial, Dr Lori Mosca, chair of the guidelines writing committee, says, "Many women seen in provider practices are older, sicker, and experience more side effects than patients in research studies. Factors such as poverty, low literacy level, psychiatric illness, poor English skills, and vision and hearing problems can also challenge clinicians trying to improve their patients' cardiovascular health."2 The 2011 guidelines outline key strategies for addressing these obstacles.

While coronary heart disease accounts for a greater proportion of cardiovascular disease (CVD) events in men than stroke, the ratio is the opposite for women.1 In the US, 55 000 more women die of stroke each year than men. Since atrial fibrillation is an independent risk factor for stroke, the expert panel voted to include recommendations for the prevention of stroke among women with atrial fibrillation.

Women have a greater prevalence of hypertension at older age than men, and undertreatment with anticoagulants has been shown to double the risk of recurrent stroke.1 Women also have unique risk factors for stroke, such as pregnancy and hormone therapy. Pregnancy complications such as preeclampsia, gestational diabetes and pregnancy-induced hypertension, along with other illnesses such as lupus and rheumatoid arthritis, have been incorporated into the guidelines as risk factors for CVD in women.2 Also, some commonly considered therapies for preventing CVD in women are specifically noted in the guidelines as lacking strong clinical evidence and, in fact, being potentially harmful to some women. These include hormone replacement therapy, antioxidants and folic acid.2

A comprehensive review of current literature on the cost effectiveness of interventions has been added, recognising that cost effectiveness may differ by sex. However, the expert panel emphasises that more cost-effective analyses need to be conducted according to gender.1 The guidelines continue to prioritise lifestyle approaches for the prevention of CVD, since these are likely to be the most cost-effective strategies.

[Reference]

1. Executive Writing Committee, Expert Panel Members.Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women 2011 Update: a Guideline from the American Heart Association. Internet Document: [21 pages], 16 Feb 2011. Available from: URL: http://dx.doi.org/10.1161/cir.0b013e31820faaf8. .

2. American Heart Association.Updated Heart Disease Prevention Guidelines for Women Focus More on 'Real-World' Recommendations Than Clinical Research. Media Release: 15 Feb 2011. Available from: URL: http://www.prnewswire.com. .