Patient Care Endocrinology & Cardiology - December 2007 - (Page 14)

I Preventing CHD in women become intermediate- or high-risk individuals with aging and would presumably have benefited from earlier institution of preventive measures. The panel places emphasis on lifetime risk by relying less heavily on the Framingham risk score, which focuses on 10-year end points of MI or cardiovascular death. Moreover, there are increasing concerns that the Framingham risk score misses subclinical CHD in women, especially in the young and middle-aged female population. Furthermore, the Framingham risk score may underestimate or overestimate risk when applied to different racial groups.7 High-risk women are now defined by the presence of established CHD, cerebrovascular disease, peripheral arterial disease, abdominal aortic aneurysm, end-stage or chronic renal disease, diabetes mellitus, or a 10-year Framingham risk of greater than 20%. At-risk women are those who have one or more major risk factors for CHD, evidence of subclinical vascular disease (such as coronary calcification), metabolic syndrome, or poor exercise capacity. Finally, those at optimal risk have both a Framingham risk of less than 10% and a healthy lifestyle with no risk factors. Lifestyle modification In June 2006, the AHA issued dietary and lifestyle recommendations aimed at the prevention of CVD.8 These recommendations have largely been reaffirmed in the present guidelines for the prevention of CVD in women. The following lifestyle modifications are recommended for women in all 3 risk categories, except as noted. Smoking cessation As physicians, we need to continue emphasizing smoking cessation at each patient encounter with each woman who still smokes. It is thought that smoking increases the risk for CHD by impairing vasodilation, increasing inflammatory markers, and worsening lipid profiles. Women who stop smoking decrease their chance of dying from CHD by 30%, compared with those who continue to smoke.9 Given the increased effectiveness of nicotine replacement and counseling in achieving continued smoking cessation, the recent guidelines now include a new recommendation for these measures.10 Women should also continue to avoid secondhand smoke, which has been shown to increase CHD risk even more strongly than it does the risk for respiratory diseases.11 Physical activity This intervention improves glucose tolerance and sensitivity, increases HDL cholesterol (HDL-C), improves cardiac oxygen delivery and uptake, and decreases resting heart rate and BP . While vigorous activity confers the greatest decrease in CHD among women, even light activity has been shown to be beneficial.12,13 As before, exercising for 30 minutes on all or most days of the week is advised. However, as a new recommendation, 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. Unfortunately, in 2003, only 28% of women reported exercising more than 3 times weekly, thus highlighting another area that needs significant improvement. Diet A healthy diet has been shown to decrease the risk of CHD in women, independent of variables frequently associated with dietary choices, such as weight.14 The current dietary recommendations are similar to those recommended in 2004 but in several cases have become more specific and are worthy of note. Fruits and vegetables should be eaten in abundance, and protein should come from fish, lean meats, and legumes. Women are now also encouraged to consume oily fish at least twice a week, although pregnant women are cautioned to avoid fish high in mercury content such as shark, swordfish, king mackerel, and tile fish. The recommendation that saturated fat make up less than 10% of caloric intake is reiterated, but now women are encouraged to lower their intake to less than 7% when possible. High-risk women and those with hypercholesterolemia should aim for saturated fat intakes of less than 7%. A new recommendation that trans fatty acid consumption be as low as possible reflects the growing understanding of its harmful effects on cholesterol.15 A woman’s cholesterol intake still should not exceed 300 mg/d and, if she has hypercholesterolemia, cholesterol intake should not exceed 200 mg/d. The recommendation that women not consume 14 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY www.patientcareonline.com http://www.patientcareonline.com

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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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