Latest cardiovascular guidelines for women highlight "real world" strategies

Updated American Heart Association (AHA) guidelines for preventing cardiovascular disease in women emphasize advice that is likely to work in “real world” situations over recommendations based solely on clinical research findings, according to the AHA.

The guidelines, published in the Journal of the American College of Cardiology (2011;57[12]:1404-1423), focus on helping both physicians and patients understand the risks of cardiovascular disease and take effective steps to prevent it. They consider personal and socioeconomic impediments to effective prevention and treatment and call for a “renewed focus on health education, including systematic follow-up to assess effectiveness of medical and lifestyle therapies.”

“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,” says Lori Mosca, MD, MPH, PhD, chair of the guidelines writing committee. She notes that many women seen in physicians’ offices “are older, sicker, and experience more side effects than patients in research studies” and that barriers such as poverty, low literacy and English language skills, vision and hearing problems, and psychiatric illness can stand in the way of improving cardiovascular health.

The guidelines emphasize that when evaluating women for cardiovascular risk, the clinician needs to take into account illnesses that increase risk, including lupus erythmatosis, rheumatoid arthritis, and complications of pregnancy such as preeclampsia, gestational diabetes, and pregnancy-induced hypertension. They also emphasize the importance of recognizing the impact of racial and ethnic diversity on cardiovascular disease-hypertension in African American women and diabetes in Hispanic women, for example. Overall evaluation should include depression, the guidelines note, because of its potential negative effect on adherence to medical advice.

The guidelines specifically identify several preventive strategies as lacking strong clinical evidence of effectiveness or even having the potential to harm some women: hormone replacement therapy, antioxidant supplementation (such as vitamins E and C and beta carotene), folic acid supplementation, weight management, and routine use of aspirin in healthy women younger than 65 years of age.