Excerpt from American Family Physician article - Preventing Cardiovascular Disease in Women

[margaretandem]

This is an excerpt of the article, "Preventing Cardiovascular Disease in Women" by Sharonne N. Hayes MD, October 15, 2006, from the medical journal American Family Physician.  Hope you find it helpful.

Margaret Andem, LCSW
http://www.andemtherapy.com
http://www.andeminfodiabetesmellitus.com
http://www.andeminfobloodpressure.com
http://www.africanconexion.com



Final AHA Recommendations

The AHA CVD prevention recommendations for women are outlined in Tables 3 through 6.1 Interventions categorized as ineffective and potentially harmful, including prophylactic aspirin use in women at low risk, antioxidants,24 and hormone therapy, are listed in Table 7.1 A framework for applying the recommendations based on individual risk is given in Table 8,1 which lists the recommended interventions for each level of CVD risk.

table 3 Clinical Recommendations for Lifestyle Interventions for the Prevention of CVD in Women
Lifestyle intervention	AHA/ACC class, level	GI	References
Cigarette smoking
Consistently encourage women not to smoke and to avoid environmental tobacco.	I, B	1	21
Physical activity
Consistently encourage women to accumulate a minimum of 30 minutes of moderate- intensity physical activity (e.g., brisk walking) on most, and preferably all, days of the week.	I, B	1
Cardiac rehabilitation
Women with a recent acute coronary syndrome or coronary intervention, or new-onset or chronic angina should participate in a comprehensive risk-reduction regimen, such as cardiac rehabilitation or a physician-guided home- or community-based program.	I, B	2
Heart-healthy diet
Consistently encourage an overall healthy eating pattern including a variety of fruits, vegetables, grains, low-fat or nonfat dairy products, fish, legumes, and sources of protein low in saturated fat (e.g., poultry, lean meats, plant sources). Limit saturated fat intake to less than 10 percent of calories, limit cholesterol intake to less than 300 mg per day, and limit intake of trans-fatty acids.	I, B	1	18
Weight maintenance/reduction
Consistently encourage weight maintenance/reduction through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated to maintain or achieve a body mass index between 18.5 and 24.9 kg per m2 and a waist circumference less than 35 inches.	I, B	1	20
Psychosocial factors
Women with CVD should be evaluated for depression and referred or treated when indicated.	IIa, B	2	29
Omega-3 fatty acids
As an adjunct to diet, omega-3 fatty acid supplementation may be considered in women at high risk.	IIb, B	2
Folic acid
As an adjunct to diet, folic acid supplementation may be considered in women at high risk (except after revascularization procedure) if a higher-than-normal level of homocysteine has been detected.	IIb, B	2
CVD = cardiovascular disease; AHA = American Heart Association; ACC = American College of Cardiology; GI = generalizability index. note: For definitions of risk categories, see Table 2. Adapted with permission from Mosca L, Appel LJ, Benjamin EJ, Berra K, Chandra-Strobos N, Fabunmi RP, et al., for the American Heart Association. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004;109:676.

table 4 Clinical Recommendations for Major Risk Factor Interventions for Prevention of CVD in Women
Risk factor intervention	AHA/ACC class, level	GI	References
Blood pressure-lifestyle
Encourage an optimal blood pressure of less than 120/80 mm Hg through lifestyle approaches.	I, B	1	17
Blood pressure-drugs
Pharmacotherapy is indicated when blood pressure is 140/90 mm Hg or greater, or lower in patients with blood pressure-related target-organ damage or diabetes. Thiazide diuretics should be part of the drug regimen for most patients unless contraindicated.	I, A	1	17
Lipid, lipoproteins
Optimal levels of lipids and lipoproteins in women are LDL cholesterol less than 100 mg per dL (2.59 mmol per L), HDL cholesterol greater than 50 mg per dL (1.29 mmol per L), triglycerides less than 150 mg per dL (1.69 mmol per L), and non-HDL cholesterol (total cholesterol minus HDL cholesterol) less than 130 mg per dL (3.36 mmol per L); these should be encouraged through lifestyle approaches.	I, B	1	16
Lipids-diet therapy
In women at high risk or with elevated LDL cholesterol, saturated fat intake should be reduced to less than 7 percent of calories, cholesterol should be reduced to less than 200 mg per day, and trans-fatty acid intake should be reduced.	I, B	1	16
Lipids-pharmacotherapy-high risk
Initiate LDL cholesterol-lowering therapy (preferably a statin) simultaneously with lifestyle therapy in women at high risk with LDL cholesterol 100 mg per dL or greater.	I, A	1	16, 26
Initiate statin therapy in women at high risk with an LDL cholesterol less than 100 mg per dL unless contraindicated.	I, B	1	16, 26
Initiate niacin or fibrate therapy when HDL cholesterol is low, or non-HDL cholesterol is elevated in women at high risk.	I, B	1	16, 26
Lipids-pharmacotherapy-intermediate risk
Initiate LDL cholesterol-lowering therapy (preferably a statin) if LDL cholesterol level is 130 mg per dL or greater even with lifestyle therapy.	I, A	1	16
Initiate niacin or fibrate therapy when HDL cholesterol is low or non-HDL cholesterol elevated after LDL cholesterol goal is reached.	I, B	1	16
Lipids-pharmacotherapy-lower risk
Consider LDL cholesterol-lowering therapy in women at low risk with no more than one risk factor when LDL cholesterol level is 190 mg per dL (4.91 mmol per L) or greater, and in women with multiple risk factors when LDL cholesterol is 160 mg per dL (4.14 mmol per L) or greater; consider niacin or fibrate therapy when HDL cholesterol is low or non-HDL cholesterol elevated after LDL cholesterol goal is reached.	IIa, B	1	16
Diabetes
Lifestyle and pharmacotherapy should be used to achieve near-normal A1C levels (i.e., less than 7 percent) in women with diabetes.	I, B	1	19
CVD = cardiovascular disease; AHA = American Heart Association; ACC = American College of Cardiology; GI = generalizability index; LDL = low-density lipoprotein; HDL = high-density lipoprotein. note: For definitions of risk categories, see Table 2. Adapted with permission from Mosca L, Appel LJ, Benjamin EJ, Berra K, Chandra-Strobos N, Fabunmi RP, et al., for the American Heart Association. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004;109:676-7.

table 5 Clinical Recommendations for Pharmacologic Interventions for Prevention of CVD in Women
Pharmacologic intervention	AHA/ACC class, level	GI	References
Aspirin-high risk
Aspirin (75 to 162 mg per day), or clopidogrel (Plavix) if intolerant to aspirin, should be used in women at high risk unless contraindicated.	I, A	1	33
Aspirin-intermediate risk
Consider aspirin therapy (75 to 162 mg per day) in women at intermediate risk if blood pressure is controlled and benefit is likely to outweigh the risk of gastrointestinal side effects.	IIa, B	2	33
Beta blockers
Beta blockers should be used indefinitely in all women who have had a myocardial infarction or who have chronic ischemic syndromes unless contraindicated.	I, A	1
ACE inhibitors
ACE inhibitors should be used in women at high risk unless contraindicated.	I, A	1	31
ARBs
ARBs should be used in women at high risk with clinical evidence of heart failure or an ejection fraction less than 40 percent who are intolerant of ACE inhibitors.	I, B	1	32
CVD = cardiovascular disease; AHA = American Heart Association; ACC = American College of Cardiology; GI = generalizability index; ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker. note: For definitions of risk categories, see Table 2. Adapted with permission from Mosca L, Appel LJ, Benjamin EJ, Berra K, Chandra-Strobos N, Fabunmi RP, et al., for the American Heart Association. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004;109:677.