Raising awareness of heart disease in women

Cardiovascular disease (CVD) is the No. 1 killer of women in the United States and most developed countries. Every year, 250,000 American women die from CVD. "Almost every minute a woman dies of cardiovascular disease," said Nanette Wenger, M.D., professor of medicine in the Division of Cardiology at Emory University School of Medicine in Atlanta and chief of cardiology at Grady Memorial Hospital.

The American Heart Association (AHA) recently launched its Go Red For Women! campaign to educate women about their CVD risk factors. The launch occurred in conjunction with the publication of new Evidence-based Guidelines for Cardiovascular Disease Prevention in Women, also sponsored by AHA in collaboration with 11 other professional and governmental organizations. The simultaneous launch of the educational campaign and publication of the guidelines were announced at a recent press conference held in New York City.

Although a recent AHA survey of more than 1,000 women found improvement in women's understanding of CVD as a major cause of mortality, lower rates of awareness exist among older women and women with ethnic backgrounds. Furthermore, while most women can recite their risk factors for heart disease, most have done nothing about it, noted Wenger, who is also a coauthor of the AHA guidelines. The guidelines and survey findings were published in the Feb. 10, 2004, issue of Circulation.

The new guidelines take a personalized approach to CVD prevention in women. Each woman is placed in one of three risk categories—high, intermediate, or low—based on Framingham Global Risk scores. Over the next decade, high-risk women will have a greater than 20% chance of a cardiovascular event; those of intermediate risk a 10% to 20% chance of CVD; and those at low risk less than a 10% chance of CVD. As Sallie Young, Pharm.D., clinical pharmacy specialist in cardiology at the Penn State Milton S. Hershey Medical Center in Hershey, Pa., pointed out, instead of cardiovascular disease being an all-or-none situation, the new guidelines help reinforce the continuum of CVD, which will help determine individualized therapy

According to the guidelines, all women, regardless of their risk factors for CVD, should practice lifestyle modifications. Smoking cessation, at least 30 minutes of moderate physical activity daily, a heart-healthy diet, and weight loss are listed as Class I recommendations, indicating that these lifestyle changes are useful and effective in reducing existing CVD risk and preventing major risks.

Weight management is of utmost importance. But, Wenger noted, many obese women have never been checked for other risk factors, and they may have hypertension and diabetes without knowing it. In addition to lifestyle modifications for women at intermediate risk, blood pressure (BP) management and lipid control are included as Class I recommendations.

For women at high risk of CVD, statins should be prescribed even if LDL cholesterol levels are less than 100 mg/dL. Routine statin therapy was not always recommended for this group, but recent studies suggest the benefits outweigh the risks. Blood pressure reduction should be initiated even when BP is lower than 140/90 mm Hg if there is evidence of target-organ damage or diabetes. According to Wenger, a woman with diabetes is at the same risk of a heart attack as a woman who has already had one.

Beta-blockers, ACE inhibitors (or angiotensin receptor blockers, if ACE inhibitors are contraindicated), aspirin, and adequate glycemic control are also recommended as preventative interventions for high-risk women. And, unless contraindicated, thiazide diuretics should be part of the regimen to reduce hypertension.

Based on data from the Women's Health Initiative, three interventions are labeled as Class III (ineffective, not useful, and possibly even harmful): hormone therapy, antioxidant vitamin supplements, and aspirin therapy. Although aspirin is recommended for high-risk women, it should be avoided in low-risk women because the risks of bleeding events and gastrointestinal complications may outweigh the heart benefits.

Wenger said one positive outcome of the simultaneous launch of the new campaign and publication of the guidelines is that women and clinicians are targeted at the same time. Women need a partnership with their healthcare providers to prevent CVD. "Prevention is key," Wenger said. She would like to see all doctors who treat women—general practitioners, internists, obstetricians, gynecologists, family practitioners—to use the new guidelines to "refocus patterns of risk assessment for all women."

These sentiments were echoed by Young. "The guidelines will expand areas of awareness of CVD in women for all healthcare practitioners—physicians, nurses, and pharmacists." However, Young believes "there's a lot more we can do to increase awareness in women."

Pharmacists are often the first-line individuals in terms of counseling women when they get prescriptions filled," said Wenger. "They can provide women educational materials from the Go Red for Women! campaign."

"Patients often perceive that more adverse effects are associated with antihypertensive and lipid-lowering medications than actually exist," said Lori Mosca, M.D., MPH, Ph.D., director of the Columbia Weill Cornell Preventive Cardiology Program at New York-Presbyterian Hospital in New York City, and lead author of both the survey findings and the guidelines. "Pharmacists can reinforce for women the importance of compliance with the therapeutic regimen, and put the adverse effects associated with these medications into perspective."

Go Red For Women! materials and information about the campaign are available from AHA at www.americanheart.org . Women can call (888) MY-HEART (694-3278) for AHA's red dress pin, symbolizing awareness of heart disease in women, along with a brochure and wallet card to track their cholesterol, blood pressure, and weight.

Charlotte LoBuono

Warning signs of myocardial infarction

Shortness of breath

Chest discomfort

Discomfort elsewhere in upper body

Other signs may include nausea, lightheadedness, and breaking out in a cold sweat

Source: American Heart Association

Warning signs of stroke

Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body

Sudden confusion, or trouble speaking or understanding

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, or loss of balance or coordination

Sudden severe headache with no known cause

Source: American Stroke Association

Minorities and CVD/stroke

The prevalence of heart disease and stroke in black women is 39.6%, in contrast to 23.8% in white women.

Cardiovascular disease, venereal disease, and stroke are the leading causes of death among Hispanics and are responsible for 33% of deaths among Hispanic women.

Stroke is the third leading cause of death for Hispanic women, behind CVD and cancer.

The prevalence of CVD among Mexican-American women aged 20 years and older is 26.6%.

Source: American Heart Association Heart Disease and Stroke Statistics-2003 Update

 

Charlotte LoBuono. Raising awareness of heart disease in women. Drug Topics May 2, 2004;148:7s.