AHA: 2011 guidelines focus on preventing CVD in women
A stronger focus should be placed on preventive medicine and recognizing racial and ethnic disparities within medical care to better prevent cardiovascular disease in women, according to new American Heart Association (AHA) evidence-based guidelines published in the Feb. 15 issue of Circulation.

Lori Mosca, MD, PhD, MPH, chair of the guidelines writing committee and a medical advisor for AHA’s Go Red for Women movement, and colleagues put forth the updated 2011 guidelines that outline proper preventive care and treatment strategies for women.

"The myth that heart disease is a 'man’s disease' has been debunked; the rate of public awareness of CVD as the leading cause of death among U.S. women has increased from 30 percent in 1997 to 54 percent in 2009," the authors wrote. Despite gains in the rates of death from CV disease, in 2007 CVD caused almost one death per minute among women in the U.S.

Within the guidelines, the AHA panel outlines a concept of "ideal cardiovascular health," which is the presence of all ideal levels of total cholesterol (<200 mg/dL), blood pressure (<120/80 mmHg) and fasting blood glucose (<100 mg/dL), in addition to healthy behaviors including body mass index that is lower than 25 kg/m2, not smoking and daily physical activity.

Additionally, the researchers outlined the importance of including depression screening in women’s evaluation for CV risk, because the condition could have the potential to affect whether women will follow a doctor’s advice.

The panel also wrote that on top of understanding racial and ethnic disparities within outcomes, one must take into account socioeconomic status and age.

Mosca and colleagues noted that future studies should analyze interventions during puberty, pregnancy and menopause to help better determine risk factors and prevention strategies to thwart CV disease. In addition, more studies should outline the differences between the sexes and also perform cost-effective analysis of preventive strategies.

"[T]he recognition of all aspects of diversity and the delivery of culturally sensitive care must guide clinicians to apply these guidelines broadly to match the diversity of women patients they treat, avoiding disparity of care," the authors wrote.

While the panel said a greater emphasis should be placed on finding optimal treatment strategies to improve CVD preventive care, they noted that many patient, clinician and systemic barriers can limit adherence to the recommended guidelines.

"If the doctor doesn't ask the woman if she's taking her medicine regularly, if she's having any side effects or if she's following recommended lifestyle behaviors, the problems may remain undetected," said Mosca. "Improving adherence to preventive medications and lifestyle behaviors is one of the best strategies we have to lower the burden of heart disease in women."

The researchers noted that while medication adherence can be challenging, more evidence is necessary to outline the effectiveness of therapies such as hormone replacement therapy, antioxidants and folic acid to prevent CV disease in women.

Because the average person with a chronic illness may see up to 16 physicians per year, adherence is often very challenging. The panel noted that a team-based approach to education that includes the patient, their family and healthcare professionals may be most beneficial and help improve outcomes.

"These guidelines are a critical weapon in the war against heart disease, the leading killer of women," Mosca said. "They are an important evolution in our understanding of women and heart disease. And I cannot stress personal awareness and education enough. Initiatives such as Go Red For Women give women access to the latest information and real-life solutions to lower their risk of heart disease."