AHA updates CVD prevention guidelines for women

The American Heart Association (AHA) recently released its updated cardiovascular disease (CVD) prevention guidelines for women. The guidelines emphasize practical medical advice that works in the "real world" rather than on findings primarily observed in clinical research.

The 2011 guidelines:

• Incorporate personal and socioeconomic factors that keep women from following medical advice and treatment.

• Factor in consideration of illnesses that increase heart disease risk in women, such as lupus, rheumatoid arthritis, and pregnancy complications.

• Help women and their doctors understand risks and take practical steps that can be most effective in preventing heart disease and stroke.

 “These recommendations underscore the fact that benefits of preventive measures seen day-to-day in doctors’ offices often fall short of those reported for patients in research settings,” said Lori Mosca, MD, MPH, PhD, chair of the guidelines committee and a medical adviser for the AHA’s Go Red For Women movement. “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.”

Mosca added that the guidelines are a paradigm shift from evidence-based to effectiveness-based. Under the guidelines, women at high risk for CVD have 1 or more of the following conditions:

• Clinically established coronary heart disease (CHD), cerebrovascular disease, or peripheral artery disease

• End-stage or chronic kidney disease

• Diabetes mellitus

• Predicted 10-year CVD risk of 10% or more

The last of the criteria represents a change from how high risk was classified since 2007. Women were considered at high risk if their predicted 10-year risk was more than 20%.

Not everyone, however, believes the 2011 change to the guidelines is a change for the better.

“The definition of high risk for women … was not an evidence-based change,” said Rita Redberg, MD, MSc, director of women’s cardiovascular services at the University of California, San Francisco, and editor of the Archives of Internal Medicine. “That will lead to a lot more testing and a lot more medication use in women who will not benefit from it.”