The AHA Guidelines and Scientific Statements Handbook

Cardiovascular Disease Prevention

in Women

Kathy Berra and Nanette Kass Wenger

12

Introduction

Summary of key changes

European Guidelines for Cardiovascular Disease

Prevention in Clinical Practice

Future directions

Introduction

The American Heart Association (AHA) statistics

have, for a number of years, highlighted cardiovas-

cular disease (CVD) as leading cause of death for

American women: Hispanic, Black, Asian/Pacifi c

Islander, American Indian/Alaska native and White

women. It is well known that, in the United States,

more women than men die annually from heart-

related illnesses. Women are at great risk both for

death and for disability from heart and other dis-

eases of the vascular system [1]. The economic and

social costs of heart disease in women are enormous.

In the United States, the estimated cost associated

with CVD was $448.5 billion, including health-

care and lost productivity in 2008. It is estimated

that preventive efforts worldwide would result in

36 million fewer total lives lost due to

CVD [2].

The American Heart Association published 2007

updated guidelines for the prevention of CVD in

Women, representing the ongoing accumulation of

scientifi c evidence that supports the importance of

preventive efforts to reduce death and disability

from CVD in women [3]. These new guidelines

provide evidence-based practice recommendations

to guide appropriate lifestyle and pharmacological

interventions for women at all levels of risk.

The risks for developing heart attack and stroke

for both women and men are closely related to well-

documented cardiovascular risk factors. These

include cigarette smoking, abnormal blood lipid

levels, hypertension, diabetes, physical inactivity,

obesity, unhealthy diet, and depression [1,3–6].

Certain CVD risk factors appear to impart increased

risk for women. For example, women with diabetes

develop CVD at an earlier age than non-diabetic

women and sustain increased morbidity and mor-

tality compared to diabetic men [7,8].

Although CVD predominately affects women

over 60 years of age, the risk for developing CVD

should be addressed in women of all ages; CVD

remains a signifi cant threat for high-risk younger

women. Because of this, the new guidelines address

the importance of a woman’s “lifetime risk” which

is greatly infl uenced by well known CVD risk factors,

ethnic diversity and family history. Age plays a major

role in the Framingham short-term (10-year) risk

calculation for women, which may underestimate

risk and thereby disadvantage younger women and

women with multiple elevated CVD risk factors.

There also may be overestimation or under-

estimation of risk in non-white populations and

an underestimation of younger women with

known sub-clinical disease by the Framingham

risk score [3].

The Reynolds Risk Score, an algorithm for the

calculation of risk CVD in women, has been devel-

oped and compared to the traditional Framingham

risk score. The Reynolds Risk Score classifi ed

40–50% of all women into higher or lower risk

The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978-1-405-18463-2