Patient Care Endocrinology & Cardiology - December 2007 - (Page 13)

Now that the American Heart Association has issued its new guidelines, we need to carefully consider each woman’s risk for coronary heart disease (CHD). Educating women today about their lifetime risk for CHD and working with every patient to implement the guidelines for CHD risk prevention may have a significant impact on women’s health for the future. disease (CVD) in women in the Journal of the American College of Cardiology and Circulation, revising guidelines that had been published in 2004.4-6 As in 2004, the current guidelines address the topics of lifestyle modification, risk factor intervention, preventive pharmacotherapy, and interventions not recommended for the prevention of CHD. This article will address the major recommendations in these new guidelines, highlighting changes from the previous 2004 document. Article at a glance I I I I I Risk stratification An important change in the most recent guidelines is the panel’s modification of risk groups. In 2004, women were categorized as at high, intermediate, lower, or optimal risk, based solely on the Adult Treatment Panel III (ATP-III) adapted Framingham 10-year risk score for developing MI or death due to CHD. The new guidelines, while incorporating the Framingham risk score, use it as only one of a number of criteria that classify women as at high risk, risk, or optimal risk. Thus, the earlier intermediate- and lower-risk groups from the 2004 guidelines are now combined into the broader “at risk” designation. This change recognizes the high lifetime prevalence of CHD in women. Many women who fell into the 2004 low-risk group would I I I In March of this year, the American Heart Association published updated guidelines for the prevention of cardiovascular disease in women. The new guidelines, while incorporating the Framingham risk score, use it as only one of a number of criteria that classify women as at high risk, risk, or optimal risk. Women who stop smoking decrease their chance of dying from coronary heart disease (CHD) by 30%, compared with those who continue to smoke. Women who need to lose weight are now advised to prolong their exercise to 60 to 90 minutes on all or most days of the week. High-risk women and those with hypercholesterolemia should aim for saturated fat intake of less than 7% of caloric intake. In high-risk women, the reduction of LDL cholesterol to less than 70 mg/dL is now considered reasonable. Aspirin use continues to be recommended in women who are at high risk, with the recommended upper dosage of aspirin now being 325 mg/d versus the previous recommendation of 162 mg/d. The current guidelines advise against the use of folic acid and vitamin B12 supplementation for the prevention of CHD. DECEMBER 2007 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY 13

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Patient Care Endocrinology & Cardiology - December 2007 Research Digest Contents Medicine in the News Options for Managing Diabetes: Three Types of Basal Insulin Therapy Using the New AHA Guidelines for Preventing Coronary Heart Disease in Women Cardiovascular and Metabolic Implications of Polycystic Ovary Syndrome Case & Comment Classified Advertising Clinical Clips

Patient Care Endocrinology & Cardiology - December 2007

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