Women less likely to receive optimum heart failure care than men
Women with heart failure are less likely to undergo assessment of left ventricular function and be treated with evidence-based drugs than their male counterparts, European investigators have discovered.
Heart 2008; 94: e10
Showing posts with label Cardiovascular Disease in Women. Show all posts
Showing posts with label Cardiovascular Disease in Women. Show all posts
Friday, February 15, 2008
Monday, February 11, 2008
Women less well managed than men with hypertension
Women less well managed than men with hypertension
By Caroline Price
11 February 2008
Hypertension 2008; Advance online publication
MedWire News: Two studies published in the journal Hypertension reveal gender disparities in the cardiovascular disease (CVD) management of patients with hypertension in the USA.
Indeed, one study found that women were significantly less likely than men to have their hypertension under control, as well as being less likely to receive CVD secondary prevention medications. In the second study, blood pressure (BP) control was not significantly inferior in women compared with men, but women had a higher prevalence of other concomitant CVD risk factors.
The studies are published in advance online to be included in a special edition of the journal highlighting women's unique risks for, and specific challenges in managing, hypertension.
Salomeh Keyhani (Mount Sinai School of Medicine, New York, USA) and colleagues examined data from the 2005 US National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, which included a total of 12,064 patient visits with a primary care provider, 7786 for women and 4278 for men.
Among patients with hypertension, women were significantly less likely than men to meet BP goal levels, at 54.0% versus 58.7% (p<0.01). This relationship was also seen among older patients aged 65 to 80 years, at corresponding rates of 53.4% versus 63.2% (p<0.005). The lower rate of hypertension control among women compared with men in this age group persisted in multivariable models, at an odds ratio (OR) of 0.62.
Women were less likely to receive ACE inhibitors to treat their hypertension than men (20.9% vs 28.7%, p<0.001) and more likely to receive diuretics (20.9% vs 16.9%, p=0.05). However, no associations were found between gender and use of antihypertensive medication or the initiation of a new hypertensive-lowering medication in patients with uncontrolled hypertension.
Meanwhile, among patients with diabetes and hypertension, just 38.4% of women compared with 46.6% of men received an ACE inhibitor or angiotensin receptor blocker (OR=0.71). Women with ischemic heart disease and cerebrovascular disease were also less likely to receive aspirin (OR=0.43) and those with ischemic heart disease less likely to receive a beta blocker (OR=0.60) than men with these conditions.
The authors emphasize that the study "reveals suboptimal treatment for both men and women in a national sample," with less than 60% of all hypertensive patients having controlled BP and fewer than half receiving recommended therapies for chronic conditions. Nevertheless, they conclude that there is a "need for increased awareness of the persistent gender disparities in CVD management."
In the second study, Bernard Cheung (University of Birmingham, UK) and colleagues studied control of BP and the prevalence of five other CVD risk factors among 3475 adults with diagnosed hypertension in the National Health and Nutrition Examination Survey conducted between 1999 and 2004.
The researchers report that the age-adjusted prevalence of uncontrolled BP was not significantly different between men and women, at 50.8% and 55.9%, respectively, and did not change significantly over the study period.
However, central obesity, elevated total cholesterol levels, and low high-density lipoprotein cholesterol levels were all significantly more common among men than women (all p<0.05).
Cheung et al conclude: "Although there is still room for improvement in BP control, our study has highlighted the importance of addressing other concomitant cardiovascular risk factors in women."
Journal
By Caroline Price
11 February 2008
Hypertension 2008; Advance online publication
MedWire News: Two studies published in the journal Hypertension reveal gender disparities in the cardiovascular disease (CVD) management of patients with hypertension in the USA.
Indeed, one study found that women were significantly less likely than men to have their hypertension under control, as well as being less likely to receive CVD secondary prevention medications. In the second study, blood pressure (BP) control was not significantly inferior in women compared with men, but women had a higher prevalence of other concomitant CVD risk factors.
The studies are published in advance online to be included in a special edition of the journal highlighting women's unique risks for, and specific challenges in managing, hypertension.
Salomeh Keyhani (Mount Sinai School of Medicine, New York, USA) and colleagues examined data from the 2005 US National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, which included a total of 12,064 patient visits with a primary care provider, 7786 for women and 4278 for men.
Among patients with hypertension, women were significantly less likely than men to meet BP goal levels, at 54.0% versus 58.7% (p<0.01). This relationship was also seen among older patients aged 65 to 80 years, at corresponding rates of 53.4% versus 63.2% (p<0.005). The lower rate of hypertension control among women compared with men in this age group persisted in multivariable models, at an odds ratio (OR) of 0.62.
Women were less likely to receive ACE inhibitors to treat their hypertension than men (20.9% vs 28.7%, p<0.001) and more likely to receive diuretics (20.9% vs 16.9%, p=0.05). However, no associations were found between gender and use of antihypertensive medication or the initiation of a new hypertensive-lowering medication in patients with uncontrolled hypertension.
Meanwhile, among patients with diabetes and hypertension, just 38.4% of women compared with 46.6% of men received an ACE inhibitor or angiotensin receptor blocker (OR=0.71). Women with ischemic heart disease and cerebrovascular disease were also less likely to receive aspirin (OR=0.43) and those with ischemic heart disease less likely to receive a beta blocker (OR=0.60) than men with these conditions.
The authors emphasize that the study "reveals suboptimal treatment for both men and women in a national sample," with less than 60% of all hypertensive patients having controlled BP and fewer than half receiving recommended therapies for chronic conditions. Nevertheless, they conclude that there is a "need for increased awareness of the persistent gender disparities in CVD management."
In the second study, Bernard Cheung (University of Birmingham, UK) and colleagues studied control of BP and the prevalence of five other CVD risk factors among 3475 adults with diagnosed hypertension in the National Health and Nutrition Examination Survey conducted between 1999 and 2004.
The researchers report that the age-adjusted prevalence of uncontrolled BP was not significantly different between men and women, at 50.8% and 55.9%, respectively, and did not change significantly over the study period.
However, central obesity, elevated total cholesterol levels, and low high-density lipoprotein cholesterol levels were all significantly more common among men than women (all p<0.05).
Cheung et al conclude: "Although there is still room for improvement in BP control, our study has highlighted the importance of addressing other concomitant cardiovascular risk factors in women."
Journal
Saturday, February 2, 2008
Diabetes Increases Risk Of Heart Disease Death For Women
Diabetes Increases Risk Of Heart Disease Death For Women
Medical News Today
02 Feb 2008
The word is out: women are at risk for heart disease, just like men. In fact, roughly twice as many women in this country will die of heart disease, stroke, and other cardiovascular diseases than from all forms of cancer combined, including breast cancer, according to the American Heart Association.
Risk factors for heart disease and stroke have long been identified. Several risk factors cannot be controlled by the individual, such as sex, increasing age and a family history of heart disease.
Others can be modified and include:
Smoking-- High blood pressure and cholesterol
Diabetes
Sedentary lifestyle
Body weight
Diabetes continues to be a growing problem in the United States for both men and women. A study published in the December 2007 issue of the European Heart Journal reveals that diabetes is a stronger risk factor for heart disease death in women than in men."The reason for the higher relative risk of coronary heart disease in women with diabetes than in men with diabetes is still unclear," explains Ane Cecilie Dale, M.D., the study's lead researcher and head of the Department of Circulation and Medical Imaging at the Norwegian University of Science and Technology in Trondheim. "But research in this field continues to go on."
According to the U.S. Food and Drug Administration, diabetes affects approximately 8.9 percent of American women. The occurrence of diabetes is significantly higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than in white women.
Women with diabetes have a two to four times higher risk of dying from heart disease and stroke compared to women without diabetes, according to data from the American Heart Association. Women with diabetes are often overweight and suffer from high blood pressure, also known as hypertension, and high cholesterol levels, which can add to the risk.
"Women with diabetes need to be aware of the associated risk of heart disease. The most important thing to do for all persons with diabetes to protect themselves from heart disease and other diabetes complications is to have a good glucometabolic control with a blood glucose as near normal as possible," Dale said. "They also need to control other risk factors like hypertension and blood cholesterol levels. In addition it is important to quit smoking, have a healthy diet and practice regularly exercise."
Considering how complex the management of diabetes and heart diseases risks are, women should talk to their health care providers to develop a plan of action.
Without the support of health care professionals, patients can easily feel overwhelmed.
February is American Heart Month.
For tips on reducing your heart disease risk, visit the American Heart Association Web site: http://http:/www.heart.org.
For diabetes information, visit the American Diabetes Association: http://www.diabetes.org.
WomenHeart, the National Coalition for Women with Heart Disease, provides patients with education and grassroots support networks. WomenHeart is online at http://www.womenshealthresearch.org.S
Society for Women's Health Research (SWHR)1025 Connecticut Ave. NW, Ste. 701Washington, DC 20036United Stateshttp://www.womenshealthresearch.org
Medical News Today
02 Feb 2008
The word is out: women are at risk for heart disease, just like men. In fact, roughly twice as many women in this country will die of heart disease, stroke, and other cardiovascular diseases than from all forms of cancer combined, including breast cancer, according to the American Heart Association.
Risk factors for heart disease and stroke have long been identified. Several risk factors cannot be controlled by the individual, such as sex, increasing age and a family history of heart disease.
Others can be modified and include:
Smoking-- High blood pressure and cholesterol
Diabetes
Sedentary lifestyle
Body weight
Diabetes continues to be a growing problem in the United States for both men and women. A study published in the December 2007 issue of the European Heart Journal reveals that diabetes is a stronger risk factor for heart disease death in women than in men."The reason for the higher relative risk of coronary heart disease in women with diabetes than in men with diabetes is still unclear," explains Ane Cecilie Dale, M.D., the study's lead researcher and head of the Department of Circulation and Medical Imaging at the Norwegian University of Science and Technology in Trondheim. "But research in this field continues to go on."
According to the U.S. Food and Drug Administration, diabetes affects approximately 8.9 percent of American women. The occurrence of diabetes is significantly higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than in white women.
Women with diabetes have a two to four times higher risk of dying from heart disease and stroke compared to women without diabetes, according to data from the American Heart Association. Women with diabetes are often overweight and suffer from high blood pressure, also known as hypertension, and high cholesterol levels, which can add to the risk.
"Women with diabetes need to be aware of the associated risk of heart disease. The most important thing to do for all persons with diabetes to protect themselves from heart disease and other diabetes complications is to have a good glucometabolic control with a blood glucose as near normal as possible," Dale said. "They also need to control other risk factors like hypertension and blood cholesterol levels. In addition it is important to quit smoking, have a healthy diet and practice regularly exercise."
Considering how complex the management of diabetes and heart diseases risks are, women should talk to their health care providers to develop a plan of action.
Without the support of health care professionals, patients can easily feel overwhelmed.
February is American Heart Month.
For tips on reducing your heart disease risk, visit the American Heart Association Web site: http://http:/www.heart.org.
For diabetes information, visit the American Diabetes Association: http://www.diabetes.org.
WomenHeart, the National Coalition for Women with Heart Disease, provides patients with education and grassroots support networks. WomenHeart is online at http://www.womenshealthresearch.org.S
Society for Women's Health Research (SWHR)1025 Connecticut Ave. NW, Ste. 701Washington, DC 20036United Stateshttp://www.womenshealthresearch.org
Tuesday, December 11, 2007
Symptom Presentation of Women With Acute Coronary Syndromes - Myth vs Reality
Symptom Presentation of Women With Acute Coronary Syndromes
Myth vs Reality
John G. Canto, MD, MSPH; Robert J. Goldberg, PhD; Mary M. Hand, MSPH, RN; Robert O. Bonow, MD; George Sopko, MD, MPH; Carl J. Pepine, MD; Terry Long, BA
Arch Intern Med. 2007;167(22):2405-2413.
Background Optimal diagnosis and timely treatment of patients with an acute coronary syndrome (ACS) depends on distinguishing differences between popular "myths" about ischemic symptoms in women and men. Chest pain or discomfort is regarded as the hallmark symptom of ACS, and its absence is regarded as "atypical" presentation. This review describes the presenting symptoms of ACS in women compared with men and ascertains whether women should have a symptom message that is separate or different from that for men.
Methods MEDLINE (1970-2005), bibliographies of articles, and pertinent abstracts were reviewed, focusing on studies of ACS presentation, especially those reporting differences in symptoms by sex. This analysis included 69 of 361 possible studies. Data regarding symptom presentation were recorded.
Results The published literature lacks standardization in characterizing ACS presentation, data collection, and reporting of symptoms. Approximately one-third of patients in the large cohort studies and one-quarter of patients in the smaller reports and direct patient interviews presented without chest pain or discomfort. The absence of chest pain or discomfort with ACS was noted more commonly in women than in men in both the cumulative summary from large cohort studies (37% vs 27%) and the single-center and small reports or interviews (30% vs 17%).
Conclusions Women are significantly less likely to report chest pain or discomfort compared with men. These differences, however, are not likely large enough to warrant sex-specific public health messages regarding the symptoms of ACS at the present time. Further research must systematically investigate sex differences in the clinical presentation of ACS symptoms and must include standardized data collection efforts.
Myth vs Reality
John G. Canto, MD, MSPH; Robert J. Goldberg, PhD; Mary M. Hand, MSPH, RN; Robert O. Bonow, MD; George Sopko, MD, MPH; Carl J. Pepine, MD; Terry Long, BA
Arch Intern Med. 2007;167(22):2405-2413.
Background Optimal diagnosis and timely treatment of patients with an acute coronary syndrome (ACS) depends on distinguishing differences between popular "myths" about ischemic symptoms in women and men. Chest pain or discomfort is regarded as the hallmark symptom of ACS, and its absence is regarded as "atypical" presentation. This review describes the presenting symptoms of ACS in women compared with men and ascertains whether women should have a symptom message that is separate or different from that for men.
Methods MEDLINE (1970-2005), bibliographies of articles, and pertinent abstracts were reviewed, focusing on studies of ACS presentation, especially those reporting differences in symptoms by sex. This analysis included 69 of 361 possible studies. Data regarding symptom presentation were recorded.
Results The published literature lacks standardization in characterizing ACS presentation, data collection, and reporting of symptoms. Approximately one-third of patients in the large cohort studies and one-quarter of patients in the smaller reports and direct patient interviews presented without chest pain or discomfort. The absence of chest pain or discomfort with ACS was noted more commonly in women than in men in both the cumulative summary from large cohort studies (37% vs 27%) and the single-center and small reports or interviews (30% vs 17%).
Conclusions Women are significantly less likely to report chest pain or discomfort compared with men. These differences, however, are not likely large enough to warrant sex-specific public health messages regarding the symptoms of ACS at the present time. Further research must systematically investigate sex differences in the clinical presentation of ACS symptoms and must include standardized data collection efforts.
Among the findings:
In nine large cohort studies, 27.4% of men with ACS had no chest pain at presentation; 37.5% of women had no pain.
In the single-center and small reports or interviews, 30% of women and 17% of men did not have chest pain.
In the setting of acute MI, women are more likely to have ST-elevation MI than non-STEMI.
Women are less likely to have obstruction of coronary vessels and more likely to have Prinzmetal angina, syndrome X, and mitral valve prolapse.
Even in the presence of ischemic damage, women are likely to have normal findings on angiography.
Friday, November 23, 2007
Do Diet, Folic Acid, and Vitamins Matter?
Title
Do Diet, Folic Acid, and Vitamins Matter?: What Did We Learn From The Women's Health Initiative, The Women's Health Study, The Women's Antioxidant and Folic Acid Cardiovascular Study, and Other Clinical Trials?[Review]
Author
Wenger, Nanette K. MD
Institution
From the Department of Medicine, Division of Cardiology, Emory University School of Medicine; the Division of Cardiology, Grady Memorial Hospital; and the Emory Heart and Vascular Center, Atlanta, Georgia.
Source
Cardiology in Review. 15(6):288-290, November/December 2007.
Abstract
Data from recent randomized clinical trials have contributed substantially to our understanding of appropriate interventions for coronary heart disease in women. Addressed in this monograph are issues of diet, folic acid, and antioxidant vitamins. Importantly, these randomized clinical trials have helped to clarify conflicting information from observational data, and to aid clinicians and their women patients in making appropriate choices of coronary and cardiovascular preventive therapy.
The 2007 update to the AHA women's prevention guidelines concludes that antioxidant vitamin supplements (eg, vitamins C, E, and beta carotene) should not be used for the primary or secondary prevention of CVD, a class III recommendation.
Do Diet, Folic Acid, and Vitamins Matter?: What Did We Learn From The Women's Health Initiative, The Women's Health Study, The Women's Antioxidant and Folic Acid Cardiovascular Study, and Other Clinical Trials?[Review]
Author
Wenger, Nanette K. MD
Institution
From the Department of Medicine, Division of Cardiology, Emory University School of Medicine; the Division of Cardiology, Grady Memorial Hospital; and the Emory Heart and Vascular Center, Atlanta, Georgia.
Source
Cardiology in Review. 15(6):288-290, November/December 2007.
Abstract
Data from recent randomized clinical trials have contributed substantially to our understanding of appropriate interventions for coronary heart disease in women. Addressed in this monograph are issues of diet, folic acid, and antioxidant vitamins. Importantly, these randomized clinical trials have helped to clarify conflicting information from observational data, and to aid clinicians and their women patients in making appropriate choices of coronary and cardiovascular preventive therapy.
The 2007 update to the AHA women's prevention guidelines concludes that antioxidant vitamin supplements (eg, vitamins C, E, and beta carotene) should not be used for the primary or secondary prevention of CVD, a class III recommendation.
Wednesday, November 21, 2007
Heart Disease Deaths Among Younger Women Might Be on the Rise
Heart Disease Deaths Among Younger Women Might Be on the Rise
After decades of steady decline, deaths from coronary heart disease in women under 54 may be increasing, according to findings published in the Journal of the American College of Cardiology.
Using CDC and U.S. Census data, researchers found that from 2000 to 2002, the death rate due to CHD in women aged 35 to 54 increased by 1.5% annually. Among the youngest of these women (aged 35-44), the mortality rate had begun to rise in 1997 — averaging a 1.3% increase each year.
In addition, the decline in the CHD death rate among men under 54 appeared to slow — from 2000 to 2002, the rate decreased by only 0.5% annually.
The authors remind physicians to use prevailing guidelines to prevent CHD in patients with one or more risk factors. They conclude, "Complacency runs a high risk: mortality rates among younger adults may represent the leading edge of a brewing storm."
LINK(S):
Journal of the American College of Cardiology article (Free PDF)
Journal of the American College of Cardiology editorial (Subscription required)
Published in Physician's First Watch November 21, 2007
After decades of steady decline, deaths from coronary heart disease in women under 54 may be increasing, according to findings published in the Journal of the American College of Cardiology.
Using CDC and U.S. Census data, researchers found that from 2000 to 2002, the death rate due to CHD in women aged 35 to 54 increased by 1.5% annually. Among the youngest of these women (aged 35-44), the mortality rate had begun to rise in 1997 — averaging a 1.3% increase each year.
In addition, the decline in the CHD death rate among men under 54 appeared to slow — from 2000 to 2002, the rate decreased by only 0.5% annually.
The authors remind physicians to use prevailing guidelines to prevent CHD in patients with one or more risk factors. They conclude, "Complacency runs a high risk: mortality rates among younger adults may represent the leading edge of a brewing storm."
LINK(S):
Journal of the American College of Cardiology article (Free PDF)
Journal of the American College of Cardiology editorial (Subscription required)
Published in Physician's First Watch November 21, 2007
Monday, September 17, 2007
Most American Women Don't Know Their Cholesterol Level
Most American Women Don't Know Their Cholesterol Level
Medical News today
17 Sep 2007
80 per cent of women in the US between 18 and 44 don't know their cholesterol level, despite the fact that cholesterol is a major risk factor for the biggest killer of American women, heart disease.
Most women don't understand about cholesterol, concluded a recent survey by the Society for Women's Health Research (SWHR), an advocacy organization based in Washington DC.
President and CEO of the SWHR, Phyllis Greenberger, said:
"Heart disease is a serious threat to women. That fact that only one in five women surveyed knew their cholesterol level shows how much work remains to be done."
"You can't wait until mid-life or later to monitor or manage your cholesterol, which is a major risk factor for heart disease in both women and men," she explained.
A spokeswoman for the American Heart Association, Dr Mary Ann Bauman, who is an internal medicine specialist said:
"For the most part, women do not believe that heart disease risk pertains to them."
"They are often aware of the risk factors, but underestimate their own personal risk," she added.
Bauman suggested the reason was women tended to ignore themselves and focused on looking after others.
She added that despite many public health campaigns, women were still more concerned about other diseases such as breast cancer.
"Most women do not have a fear of heart disease, so it is easy to ignore the risks or warning signs," said Bauman.
Over 50 per cent of the women surveyed aged between 18 and 44 were concerned about cholesterol in general but only one in 5 knew what her personal cholesterol count was. 25 per cent did not even know how cholesterol is tested.
High cholesterol raises the risk of angina, stroke, heart disease and heart attack.
About half of American adults have high cholesterol, according to statistics from the National Heart, Lung, and Blood Institute's (NHLBI) National Cholesterol Education Program.
A person's cholesterol count is made up of three things: low density lipoprotein (LDL or "bad" cholesterol), high density lipoproteins (HDL or "good" cholesterol) and triglycerides, a type of blood fat.
According to the American Heart Association, you should aim for a "desirable" total cholesterol count that is under 200 mg per decilitre or less than 5.2 millimoles per litre.
High LDL increases risk of heart disease and stroke because it promotes deposits of plaque that make blood vessels narrower. An optimum LDL count should be no higher than 100.
Low HDL is linked to increased risk of cardiovascular disease, and an optimum level for women says the SWHR is 50 and above.
Some risk factors for heart disease are controllable and some are uncontrollable, like family history, age and being post menopausal.
Apart from cholesterol, the controllable risk factors for heart disease include: smoking, high blood pressure, obesity, diabetes and a sedentary lifestyle.
Bauman said the good news is there are several ways a woman can control cholesterol and reduce her risk of heart disease:
Take regular exercise.
Maintain a healthy weight.
Eat lots of fruit and vegetables.
Keep to a diet low in saturated fats and cholesterol.
Go for regular health screening, and check cholesterol every 5 years say the AHA and the NHLBI.
Giving up smoking and tobacco also reduces heart disease risk.
People with a family history of heart disease or high cholesterol should probably start regular health screening earlier than the recommended age of 20. Bauman said that lifestyle changes at a young age make a difference later in life:
"I think of heart disease as a disease of adolescence which manifests itself in adulthood," said Bauman.
"We must start early!" she urged.
Click here for Society for Women's Health Research (SWHR).
Medical News today
17 Sep 2007
80 per cent of women in the US between 18 and 44 don't know their cholesterol level, despite the fact that cholesterol is a major risk factor for the biggest killer of American women, heart disease.
Most women don't understand about cholesterol, concluded a recent survey by the Society for Women's Health Research (SWHR), an advocacy organization based in Washington DC.
President and CEO of the SWHR, Phyllis Greenberger, said:
"Heart disease is a serious threat to women. That fact that only one in five women surveyed knew their cholesterol level shows how much work remains to be done."
"You can't wait until mid-life or later to monitor or manage your cholesterol, which is a major risk factor for heart disease in both women and men," she explained.
A spokeswoman for the American Heart Association, Dr Mary Ann Bauman, who is an internal medicine specialist said:
"For the most part, women do not believe that heart disease risk pertains to them."
"They are often aware of the risk factors, but underestimate their own personal risk," she added.
Bauman suggested the reason was women tended to ignore themselves and focused on looking after others.
She added that despite many public health campaigns, women were still more concerned about other diseases such as breast cancer.
"Most women do not have a fear of heart disease, so it is easy to ignore the risks or warning signs," said Bauman.
Over 50 per cent of the women surveyed aged between 18 and 44 were concerned about cholesterol in general but only one in 5 knew what her personal cholesterol count was. 25 per cent did not even know how cholesterol is tested.
High cholesterol raises the risk of angina, stroke, heart disease and heart attack.
About half of American adults have high cholesterol, according to statistics from the National Heart, Lung, and Blood Institute's (NHLBI) National Cholesterol Education Program.
A person's cholesterol count is made up of three things: low density lipoprotein (LDL or "bad" cholesterol), high density lipoproteins (HDL or "good" cholesterol) and triglycerides, a type of blood fat.
According to the American Heart Association, you should aim for a "desirable" total cholesterol count that is under 200 mg per decilitre or less than 5.2 millimoles per litre.
High LDL increases risk of heart disease and stroke because it promotes deposits of plaque that make blood vessels narrower. An optimum LDL count should be no higher than 100.
Low HDL is linked to increased risk of cardiovascular disease, and an optimum level for women says the SWHR is 50 and above.
Some risk factors for heart disease are controllable and some are uncontrollable, like family history, age and being post menopausal.
Apart from cholesterol, the controllable risk factors for heart disease include: smoking, high blood pressure, obesity, diabetes and a sedentary lifestyle.
Bauman said the good news is there are several ways a woman can control cholesterol and reduce her risk of heart disease:
Take regular exercise.
Maintain a healthy weight.
Eat lots of fruit and vegetables.
Keep to a diet low in saturated fats and cholesterol.
Go for regular health screening, and check cholesterol every 5 years say the AHA and the NHLBI.
Giving up smoking and tobacco also reduces heart disease risk.
People with a family history of heart disease or high cholesterol should probably start regular health screening earlier than the recommended age of 20. Bauman said that lifestyle changes at a young age make a difference later in life:
"I think of heart disease as a disease of adolescence which manifests itself in adulthood," said Bauman.
"We must start early!" she urged.
Click here for Society for Women's Health Research (SWHR).
Wednesday, August 22, 2007
Lessons from hormone replacement therapy trials for primary prevention of cardiovascular disease.[Miscellaneous]
Author
Mohandas, Bhavna; Mehta, Jawahar L
Institution
Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Title
Lessons from hormone replacement therapy trials for primary prevention of cardiovascular disease.[Miscellaneous]
Source
Current Opinion in Cardiology. 22(5):434-442, September 2007.
Abstract
Purpose of review: Coronary heart disease in women is a common cause of morbidity and mortality, particularly after menopause. It was thought that estrogen and progesterone protected women from coronary heart disease. The recommendations of the recent Women's Health Initiative, however, are that hormone replacement therapy should not be used for primary prevention of coronary heart disease in women.
Here, we have made a comprehensive review of major studies and comment on the validity of this recommendation.
We have also analyzed the importance of dietary modification in primary prevention. In addition, we have delineated the important predictors of cardiovascular disease in women from prior observational and clinical studies.
Recent findings: Recent major studies, including the Women's Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS), studied the role of hormone replacement therapy in protecting women from coronary heart disease. These studies showed no significant reduction in coronary heart disease events. In addition, the dietary modification component of the Women's Health Initiative did not show any significant reduction in the incidence of coronary heart disease.
Summary: It can be summarized that hormone replacement is not generally recommended in postmenopausal women for primary prevention of coronary heart disease.
Although the dietary modification trials did not show any significant reduction in the incidence of coronary heart disease, it is currently recommended to continue using a heart-healthy diet.
Mohandas, Bhavna; Mehta, Jawahar L
Institution
Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Title
Lessons from hormone replacement therapy trials for primary prevention of cardiovascular disease.[Miscellaneous]
Source
Current Opinion in Cardiology. 22(5):434-442, September 2007.
Abstract
Purpose of review: Coronary heart disease in women is a common cause of morbidity and mortality, particularly after menopause. It was thought that estrogen and progesterone protected women from coronary heart disease. The recommendations of the recent Women's Health Initiative, however, are that hormone replacement therapy should not be used for primary prevention of coronary heart disease in women.
Here, we have made a comprehensive review of major studies and comment on the validity of this recommendation.
We have also analyzed the importance of dietary modification in primary prevention. In addition, we have delineated the important predictors of cardiovascular disease in women from prior observational and clinical studies.
Recent findings: Recent major studies, including the Women's Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS), studied the role of hormone replacement therapy in protecting women from coronary heart disease. These studies showed no significant reduction in coronary heart disease events. In addition, the dietary modification component of the Women's Health Initiative did not show any significant reduction in the incidence of coronary heart disease.
Summary: It can be summarized that hormone replacement is not generally recommended in postmenopausal women for primary prevention of coronary heart disease.
Although the dietary modification trials did not show any significant reduction in the incidence of coronary heart disease, it is currently recommended to continue using a heart-healthy diet.
Wednesday, July 11, 2007
HRT and Cardiac Risk - Debate
Medical News Today News Article
Wall Street Journal Examines Women's Health Initiative Findings On HRT's Effect On Heart Attack Risk
11 Jul 2007
The Wall Street Journal on Monday examined findings from the 15-year, $725 million NIH-sponsored Women's Health Initiative on hormone replacement therapy's effects on heart attack risk. According to the Journal, in the five years since the study was released, many in the medical community have said "some aspects" of the initial findings "were either misleading" or "overgeneralized in large part because they excluded many of the study's own investigators and physicians from the first review" (Parker-Pope, Wall Street Journal, 7/9).
NIH researchers in July 2002 ended the WHI study on combination HRT three years early because they determined that the treatment might increase the risk for heart disease, invasive breast cancer and other health problems. A later WHI analysis, published in the April 4 issue of the Journal of the American Medical Association, found that HRT use among women in their 50s does not increase their risk for heart attack (Kaiser Daily Women's Health Policy Report, 4/4).
In addition, a study published last month in the New England Journal of Medicine found that women in their 50s who took estrogen on a regular basis were 60% less likely than those who took a placebo to have large amounts of plaque in their arteries, an indicator of heart attack risk. Participants who took estrogen were 30% to 40% less likely than those who took a placebo to have large amounts of plaque in their arteries. However, participants who took estrogen had a higher risk for stroke than those who took a placebo, according to the study (Kaiser Daily Women's Health Policy Report, 6/22).
According to the Journal, the WHI's 40 researchers in 2002 were told 11 days before the initial WHI study report in JAMA was released that it had been halted early. Although some of them were concerned that the results were "too broadly interpreted," it was "too late to make meaningful changes" to the JAMA article, the Journal reports. Two ongoing studies are examining the role of estrogen in the development of heart disease, the Journal reports. Both studies also will examine whether using natural progesterone, instead of synthetic progestin used in WHI, reduces or eliminates breast cancer risk.
Comments
Jacques Rossouw, a physician with the National Heart Lung and Blood Institute who had overseen the WHI since its inception, said it was an "NIH decision supported by the WHI executive committee to keep it to a small group because we realized it was a sensitive paper." He said that the handling of the study's results was "based on what we knew at the time," adding, "Our main job ... was to turn around the prevailing notion that hormones would be useful for a long-term prevention of heart disease." It was a "worthy objective, which we achieved," Rossouw said.
Robert Langer -- former principal investigator for WHI's clinical center at the University of California-San Diego, who has since spoken as a witness for HRT maker Wyeth -- said, "I think that had the initial report been written by a broader group, as almost all of our later papers have been, it would have been framed differently."
According to the Journal, key questions about long-term use of HRT are "far from resolved." Most experts agree that HRT is a reasonable option for women to treat menopausal symptoms, but the "bigger question" is whether the drugs should be used to prevent heart-related conditions, the Journal reports. NHLBI says that HRT should not be used to prevent heart disease because of its potential to increase risk for breast cancer, blood clots and strokes. According to the health care information company IMS Health, HRT sales have declined 30% since the WHI results were published in 2002 (Wall Street Journal, 7/9).
Wall Street Journal Examines Women's Health Initiative Findings On HRT's Effect On Heart Attack Risk
11 Jul 2007
The Wall Street Journal on Monday examined findings from the 15-year, $725 million NIH-sponsored Women's Health Initiative on hormone replacement therapy's effects on heart attack risk. According to the Journal, in the five years since the study was released, many in the medical community have said "some aspects" of the initial findings "were either misleading" or "overgeneralized in large part because they excluded many of the study's own investigators and physicians from the first review" (Parker-Pope, Wall Street Journal, 7/9).
NIH researchers in July 2002 ended the WHI study on combination HRT three years early because they determined that the treatment might increase the risk for heart disease, invasive breast cancer and other health problems. A later WHI analysis, published in the April 4 issue of the Journal of the American Medical Association, found that HRT use among women in their 50s does not increase their risk for heart attack (Kaiser Daily Women's Health Policy Report, 4/4).
In addition, a study published last month in the New England Journal of Medicine found that women in their 50s who took estrogen on a regular basis were 60% less likely than those who took a placebo to have large amounts of plaque in their arteries, an indicator of heart attack risk. Participants who took estrogen were 30% to 40% less likely than those who took a placebo to have large amounts of plaque in their arteries. However, participants who took estrogen had a higher risk for stroke than those who took a placebo, according to the study (Kaiser Daily Women's Health Policy Report, 6/22).
According to the Journal, the WHI's 40 researchers in 2002 were told 11 days before the initial WHI study report in JAMA was released that it had been halted early. Although some of them were concerned that the results were "too broadly interpreted," it was "too late to make meaningful changes" to the JAMA article, the Journal reports. Two ongoing studies are examining the role of estrogen in the development of heart disease, the Journal reports. Both studies also will examine whether using natural progesterone, instead of synthetic progestin used in WHI, reduces or eliminates breast cancer risk.
Comments
Jacques Rossouw, a physician with the National Heart Lung and Blood Institute who had overseen the WHI since its inception, said it was an "NIH decision supported by the WHI executive committee to keep it to a small group because we realized it was a sensitive paper." He said that the handling of the study's results was "based on what we knew at the time," adding, "Our main job ... was to turn around the prevailing notion that hormones would be useful for a long-term prevention of heart disease." It was a "worthy objective, which we achieved," Rossouw said.
Robert Langer -- former principal investigator for WHI's clinical center at the University of California-San Diego, who has since spoken as a witness for HRT maker Wyeth -- said, "I think that had the initial report been written by a broader group, as almost all of our later papers have been, it would have been framed differently."
According to the Journal, key questions about long-term use of HRT are "far from resolved." Most experts agree that HRT is a reasonable option for women to treat menopausal symptoms, but the "bigger question" is whether the drugs should be used to prevent heart-related conditions, the Journal reports. NHLBI says that HRT should not be used to prevent heart disease because of its potential to increase risk for breast cancer, blood clots and strokes. According to the health care information company IMS Health, HRT sales have declined 30% since the WHI results were published in 2002 (Wall Street Journal, 7/9).
Wednesday, April 18, 2007
Cardiovascular Disease Prevention in Women: Evidence-Based Guidelines for: 2007 Update
http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.181546
Updated guidelines advise focusing on women's lifetime heart risk
Update gives definitive answers on HRT, aspirin, supplements
DALLAS, Feb. 20, 2007 – Healthcare professionals should focus on women’s lifetime heart disease risk, not just short-term risk, according to updated American Heart Association guidelines.
The 2007 Guidelines for Preventing Cardiovascular Disease in Women – published today in a special women’s health issue of Circulation: Journal of the American Heart Association – also include new directions for using aspirin, hormone therapy and vitamin and mineral supplements in heart disease and stroke prevention in women.
Highlights of the changes include:
This 2007 update provides the most current clinical recommendations for preventing CVD in women 20 and older and are based on a systematic search of the highest quality science interpreted by experts in the fields of cardiology, epidemiology, family medicine, gynecology, internal medicine, neurology, nursing, public health, statistics and surgery.
The authors note that these guidelines cover the primary and secondary prevention of chronic atherosclerotic vascular diseases.
Updated guidelines advise focusing on women's lifetime heart risk
Update gives definitive answers on HRT, aspirin, supplements
DALLAS, Feb. 20, 2007 – Healthcare professionals should focus on women’s lifetime heart disease risk, not just short-term risk, according to updated American Heart Association guidelines.
The 2007 Guidelines for Preventing Cardiovascular Disease in Women – published today in a special women’s health issue of Circulation: Journal of the American Heart Association – also include new directions for using aspirin, hormone therapy and vitamin and mineral supplements in heart disease and stroke prevention in women.
Highlights of the changes include:
Recommended lifestyle changes to help manage blood pressure include weight control, increased physical activity, alcohol moderation, sodium restriction, and an emphasis on eating fresh fruits, vegetables and low-fat dairy products.
Besides advising women to quit smoking, the 2007 guidelines recommend counseling, nicotine replacement or other forms of smoking cessation therapy.
Physical activity recommendations for women who need to lose weight or sustain weight loss have been added – minimum of 60–-90 minutes of moderate-intensity activity (e.g., brisk walking) on most, and preferably all, days of the week.
The guidelines now encourage all women to reduce saturated fats intake to less than 7 percent of calories if possible.
Specific guidance on omega-3 fatty acid intake and supplementation recommends eating oily fish at least twice a week, and consider taking a capsule supplement of 850–1000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) in women with heart disease, two to four grams for women with high triglycerides.
Hormone replacement therapy and selective estrogen receptor modulators (SERMs) are not recommended to prevent heart disease in women.
Antioxidant supplements (such as vitamin E, C and beta-carotene) should not be used for primary or secondary prevention of CVD.
Folic acid should not be used to prevent CVD – a change from the 2004 guidelines that did recommend it be considered for use in certain high-risk women.
Routine low dose aspirin therapy may be considered in women age 65 or older regardless of CVD risk status, if benefits are likely to outweigh other risks. (Previous guidelines did not recommend aspirin in lower risk or healthy women.)
The upper dosage of aspirin for high-risk women increases to 325 mg per day rather than 162 mg. This brings the women’s guidelines up to date with other recently published guidelines.
Consider reducing LDL cholesterol to less than 70 mg/dL in very high-risk women with heart disease (which may require a combination of cholesterol-lowering drugs).
This 2007 update provides the most current clinical recommendations for preventing CVD in women 20 and older and are based on a systematic search of the highest quality science interpreted by experts in the fields of cardiology, epidemiology, family medicine, gynecology, internal medicine, neurology, nursing, public health, statistics and surgery.
The authors note that these guidelines cover the primary and secondary prevention of chronic atherosclerotic vascular diseases.
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