Heart guidelines revised to better reflect real life
February 15th, 2011
12:01 AM ET

Heart guidelines revised to better reflect real life

In an effort to combat heart disease, the No. 1 killer in women, the American Heart Association is re-tooling its prevention guidelines to reflect more of what doctors see in the real world, not in research trials.

Previous guidelines from 2007 leaned more on results from clinical trials but the patients doctors see in their practices are older, sicker and experience more side effects than patients in research studies. Doctors are being encouraged to tailor their treatment strategies to meet the needs of individual women and to talk with their patients about their risks. A healthy dialogue between patient and doctor is a critical first step in prevention.

Researchers also are looking at other diseases and conditions that may increase a woman's risk for heart disease. For the first time pregnancy complications are included as an indicator of future cardiovascular risk. Women with preeclampsia (high blood pressure during pregnancy), gestational diabetes (diabetes developed during pregnancy), or pre-term labor are at higher risk for heart problems 10 – 15 years later in life. Women with lupus and rheumatoid arthritis may also be at increased risk for stroke and heart disease. Experts hope that bringing attention to these groups of women will encourage health care providers and patients to take preventive action early.

The report finds that continued efforts at improving lifestyle habits are important in the prevention of heart disease and stroke in women. These include not smoking, getting exercise, eating well and maintaining a healthy weight. Taking certain medications to lower blood pressure, or cholesterol, for example, can also help with prevention. But women often have personal and socioeconomic issues that may keep them from following their doctors' medical advice or treatment. Factors such as poverty, low literacy levels, poor English skills, psychiatric illness, or hearing or vision problems may make it challenging.

"If we recommend that a patient get exercise to lower blood pressure and cholesterol but the woman is tied up at home 20 hours a day caretaking, it may not be a reasonable recommendation and we need to find alternative ways to help her meet the guidelines," says Dr. Lori Mosca, director of Preventive Cardiology at NY Presbyterian Hospital and chair of the expert panel for the new guidelines. "We want health care providers to assess barriers and address them. If we don't talk about the difficulties in meeting these guidelines we're never going to attain them," she adds.

Racial and ethnic diversity may also play a role in heart health and stroke. The prevalence of hypertension is particularly high in African American women and diabetes rates are a problem for Hispanic women. Greater education efforts are encouraged to address these issues.

The updated guidelines also point out that more women may be in the high risk group for heart attack and stroke than previously thought. Each year 55,000 more women die of stroke than men. Women at higher risk may need more aggressive treatment by health care providers.

"If women know what their risk factors are and they empower themselves to discuss with their doctor how they can best achieve the recommendations we have set out, women will go a long way to lead a long and healthy life free of cardiovascular disease," says Mosca.

soundoff (6 Responses)
  1. Dawn

    we are suppose to die of heart failure

    February 15, 2011 at 08:51 | Report abuse | Reply
  2. charles s

    See http://hp2010.nhlbihin.net/atpiii/calculator.asp to get some idea about your chances of having a heart attack.

    February 15, 2011 at 11:18 | Report abuse | Reply
  3. Andrea Scala

    I agree whole heartedly on not only delving into a woman's "issues," but also men's. Just yesterday, I was saying to a woman Cardiology patient of mine, that as providers, we need to ask the "why" questions, to find out perhaps, why a patient can't or isn't doing something (example, not exercising or eating healthier). It is then, I believe, that we will uncover those barriers, and if we work on those, we will have a greater, more beneficial impact on a patient's life. It isn't enough just to preach, "eat healthy and exercise!"


    March 15, 2011 at 12:21 | Report abuse | Reply
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