American Heart Association Women-Themed Issue Rapid Access Journal Report: Prevention Guidelines Help Predict Women's Cardiovascular Risk

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Feb 17, 2010, 11:02 ET

Themed issue highlights:

-- A special-themed issue of Circulation: Cardiovascular Quality and Outcomes highlights studies about women and cardiovascular disease. In an editorial, researchers wrote that the pool of data on the topic is still limited and has left “more questions than answers.”

-- Researchers in one featured study found women are underrepresented in research areas cited in the American Heart Association’s prevention guidelines for women.

-- Another study found that after a heart attack, low social support is tied to poorer health outcomes, particularly among women.

DALLAS, Feb. 17 /PRNewswire-USNewswire/ -- A simplified strategy for assessing cardiovascular disease risk can predict women's odds of heart attack, stroke or other cardiovascular events in the following 10 years, according to new research in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.

The strategy, outlined in the 2007 update to the American Heart Association Guidelines for Cardiovascular Disease Prevention in Women, was tested using the Women's Health Initiative (WHI) study. In the WHI, researchers followed an ethnically diverse population of 161,808 women, ages 50 to 79, for nearly eight years. Using known cardiovascular risk factors as recommended in the 2007 association guidelines, researchers classified 11 percent as high risk, 72 percent as at risk and 4 percent as optimal (low) risk.

An additional 13 percent didn't fit into any of the categories — they lacked risk factors but didn't have the good health habits required for the optimal category. These women warrant further consideration and future versions of the guidelines will need to address them, said Judith Hsia, M.D., a cardiologist who led the research.

The researchers found that the higher the risk categorization, the higher the odds of a cardiovascular event in the subsequent decade in both white and non-white populations. Among the high-risk women, the chance of heart attack or coronary death over 10 years was 12.5 percent, compared with 3.1 percent among the at-risk women and 1.1 percent among the optimal-risk group.

The association's guidelines may provide a way for physicians to assess risk and for patients to grasp how to improve their health that's easier than a commonly used approach from the Framingham Heart Study, Hsia said. That approach incorporates seven variables — such as age, smoking status and cholesterol levels — into a formula to derive a risk score, a process Hsia said can be time-consuming for doctors and confusing to patients.

In contrast, using the American Heart Association's strategy, researchers labeled those with diabetes or known cardiovascular disease as high risk. They determined the next two levels of risk by number of risk factors, diet and physical activity level. People with one or more major risk factors — including smoking, hypertension, obesity, cholesterol problems, physical inactivity and/or a diet high in saturated fats — were at risk. People with optimal risk had no risk factors and prudent lifestyle, defined in this analysis as eating less than 7 percent of their calories in saturated fats, and exercising the equivalent of 30 minutes of brisk walking six times a week.

Because it pinpoints the most relevant risk factors, the association's strategy "intrinsically conveys to patients why they are at risk, so what they have to do to reduce their risk is clearer," said Hsia, who began the study as a professor of medicine at George Washington University in Washington, D.C., and is now with pharmaceutical company AstraZeneca.

This analysis simplified the assessment of diet by using only the saturated fat standard of less than 7 percent of daily calories — "which saves having to also track daily cholesterol, sodium, trans fat and other nutrient intake," Hsia said. WHI researchers have previously found that consumption of a diet with less than 6.1 percent of daily calories from saturated fats correlated with lower cardiovascular risk, and people consuming this low saturated fat diet were likely to meet other specific dietary guidelines.

Minorities made up about 20 percent of the study population. As with the overall population, minorities classified at higher risk were more likely than others to have cardiovascular troubles in the next decade. But actual rates of cardiovascular events for each group varied. For instance, in subjects with optimal risk, Asians had the lowest risk, with a 1 percent rate of cardiovascular events, compared with 4 percent for blacks, 3.6 percent for whites and 2.2 percent for Hispanics.

One limitation of the study is that it included only women ages 50 to 79, Hsia said; however, cardiovascular events are infrequent in younger women.

Noting that coronary heart disease is the leading cause of death worldwide for women and men, Hsia urges doctors and patients to focus on treating risk factors, improving exercise levels and diet and addressing obesity.

Co-authors are Rebecca J. Rodabough, M.S.; JoAnn E. Manson, M.D., Dr.P.H.; Simin Liu, M.D., Sc.D.; Matthew S. Freiberg, M.D., M.Sc.; William Graettinger, M.D.; Milagros C. Rosal, Ph.D.; Barb Cochrane, Ph.D.; Donald Lloyd-Jones, M.D., Dr.P.H.; Jennifer G. Robinson, M.D., M.P.H.; and Barbara V. Howard, Ph.D. Author disclosures are on the manuscript.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

SOURCE American Heart Association