Wednesday, February 4, 2004

AHA Releases Preventive Guidelines for Women
By Mike Upchurch

The American Heart Association (AHA), with help from DCRI faculty and fellows, has released the first guidelines for the prevention of cardiovascular disease in women. The measures are based on evidence from hundreds of clinical studies and will appear in a special issue of the AHA’s journal, Circulation, on February 10.

Heart disease is the leading killer of women in the U.S. According to AHA estimates, 500,000 women die of heart disease or stroke in the U.S. each year, more than the next 7 leading causes of death combined. Though women are more likely to die within a year of a heart attack or bypass surgery than men, heart attacks continue to be thought of as a male problem.

"Women just don't expect to have a heart attack. They think heart attacks are for men," said first lady Laura Bush in a ceremony kicking off American Heart Month. "So women seek help a lot later than men do. ... And because of that, they suffer more damage because they get to the hospital later when they are having a heart attack than most men do."

Heart disease can produce different signs and symptoms in women than in men and be more difficult to diagnose accurately. Though more women than men die of heart disease each year, according to the National Coalition for Women with Heart Disease, women undergo just 36% of open-heart surgeries and a third of all angioplasties.

The expert panel, selected by the heads of the AHA’s 13 scientific councils, which wrote the recommendations chose 399 articles reporting the results of clinical research, out of an initial pool of more than 7000. A systematic search and summarization of these studies was conducted by faculty at the Duke Center for Health Policy Research, many of whom are also DCRI researchers.

The guidelines covered both lifestyle modification and changes in preventive medication regimens for at-risk women.

One of the most anticipated guidelines in the new document warned against hormone replacement therapy (HRT) for preventive purposes. Research released in 2002 and 2003 showed that HRT, once thought to prevent heart disease, actually raised the risk of heart attack and possibly other diseases, such as breast cancer. The new AHA guidelines used the cumulative evidence to close the case officially on HRT for preventing heart disease.

Some of the chief lifestyle recommendations were:

• Physicians should counsel all women to quit smoking and avoid secondhand smoke.
• Encourage at least 30 minutes of moderate exercise on “most, and preferably all, days of the week.”
• Women with known cardiovascular disease should be evaluated for depression and treated if appropriate. Depression has been shown recently to have a significant affect how heart patients fare.
• The maintenance of a healthy weight should be part of any woman’s health plan. The guidelines say that a body mass index (BMI) between 18.5 and 24.9 is acceptable. BMI is a measure of weight in proportion to height. The guidelines also say that women should strive to keep a waist measurement below 35 inches.
• A heart-healthy diet that consists of low-fat, low-cholesterol foods was recommended. Trans-fatty acids, found in commercially fried foods and most partially hydrogenated cooking oils, are specifically to be avoided.
• Omega-3 fatty acids, found primarily in fish, received a moderately strong recommendation as well. Though the guidelines emphasize adding fish to a woman’s heart-healthy diet, they also suggest that an omega-3 supplement could be helpful.
• The guidelines also set new levels for low-, moderate- and high-risk blood pressure and cholesterol for women.

The AHA stopped short of recommending daily aspirin for all women, but said that those who are at intermediate or high risk for heart disease should take a low dose of aspirin every day.

Other medication guidelines included the indefinite use of beta-blockers for all women who had suffered a heart attack or had chronic blood vessel blockages, as well as the use of ACE inhibitors in all high-risk patients.

Periodically, the AHA, in conjunction with other major sponsors such as the American College of Cardiology and the National Heart, Lung and Blood Institute, revamps its treatment and prevention guidelines for various cardiovascular diseases. The revisions are done through review of the best and most current evidence from clinical research by experts in the field. The recommendations released today are the first completely new set of guidelines issued in 2004.

The publication of the guidelines coincides with the launch of the AHA’s “Go Red For Women” campaign, aimed at boosting awareness of heart-disease risk and the best means of prevention for women.

DCRI faculty and fellows made an integral contribution to these first-ever guidelines for the prevention of cardiovascular disease in women. As part of the Duke Center for Health Policy Research team, they searched and summarized the sum of the existing research in order to provide the expert panel the evidence on which these new guidelines were based.

DCRI researchers on the literature search team were: Rowena Dolor, Kristin Newby, Ken Mahaffey, Mimi Biswas, Svati Shah, John Petersen, Jonathan Yager, Jean-Pierre Dery, and Camille G. Frazier.