CVD in Women

Posted on Feb 22, 2011 in Clinical Updates | 1 comment

Updated Guidelines for Preventing Cardiovascular Disease in Women

Practical medical advice that works in the “real world” may more effectively prevent cardiovascular disease in women than recommendations based only on findings in clinical research settings, according to the 2011 update to the American Heart Association’s cardiovascular disease prevention guidelines for women.[1]

First published in 1999, the guidelines, until now, have been primarily based on findings observed in clinical research. That alone often doesn’t consider the personal and socioeconomic factors that can keep women from following medical advice and treatment. 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.

The 2011 update identifies barriers that hinder both patients and doctors from following guidelines, while outlining key strategies for addressing those obstacles.

Getting a dialogue started between you and your female patients is a critical first step. If you don’t ask them if they’re taking medicines regularly, if they’re having any side effects, or if they’re following recommended lifestyle behaviors, the problems may remain undetected.

To evaluate patient risk, the guidelines incorporate illnesses linked to higher risk of cardiovascular disease in women, including lupus and rheumatoid arthritis, and pregnancy complications such as preeclampsia, gestational diabetes, or pregnancy-induced hypertension. According to an AHA spokesperson, women with a history of preeclampsia face double the risk of stroke, heart disease, and dangerous clotting in veins during the five to 15 years after pregnancy. Essentially, having pregnancy complications can now be considered equivalent to having failed a stress test.

The updated guidelines also emphasize the importance of recognizing racial and ethnic diversity and its impact on cardiovascular disease. For example, hypertension is a particular problem among African American women and diabetes among Hispanic women.

Although putting clinical research into practical, everyday adherence can be challenging, solid scientific evidence is still the basis for many of the guidelines. Some commonly considered therapies for women are specifically noted in the guidelines as lacking strong clinical evidence in their effectiveness for preventing cardiovascular disease and, in fact, may be harmful to some women, including the use of hormone replacement therapy, antioxidants, and folic acid.

Multicultural Resources

• American Heart Association’s Go Red For Women
• Hispanic Heart Health Toolkit
• African American Heart Health Toolkit

Published February 22, 2011

Reference

1. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association [published online ahead of print February 18, 2011]. Circulation. 2011;123. DOI: 10.1161/CIR.0b013e31820faaf8.