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Updated guidelines for CVD prevention in women encompass clinical practice findings
Mosca L. Circulation. 2011;doi:10.1161/CIR.0b013e31820faaf8
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The 2011 update to the American Heart Association’s guidelines for the prevention of CVD in women has incorporated benefits and risks associated with clinical practice findings, besides those observed in clinical research. Further, the guidelines also feature changes regarding the CVD risk classification threshold.
The AHA first published women-specific clinical recommendations for prevention of CVD in 1999. One of the major changes with the present guidelines compared with earlier ones, executive writing committee and expert panel members of the guidelines wrote, was that the benefits and risks observed in clinical practice of preventive therapies were strongly considered, and recommendations were not limited to evidence of benefits observed in clinical research.
“Hence, in the transformation from ‘evidence-based’ to ‘effectiveness-based’ guidelines for the prevention of CVD in women, the panel voted to update recommendations to those therapies that have been shown to have sufficient evidence of clinical benefit for CVD outcomes,” the writing committee and panel members wrote.
The updated guidelines now include modifications to the risk classification algorithm that acknowledge several 10-year risk equations for predicting 10-year global CVD risk, such as the updated Framingham CVD risk profile and Reynolds risk score for women. The new threshold for defining high risk is at least a 10% 10-year risk of all CVD, instead of an at least 20% Framingham 10-year predicted risk for CHD alone, which had previously identified women at high risk in the 2007 update.
“Indeed, it is difficult for a woman<75 years of age, even with several markedly elevated risk factors, to exceed a 10% (let alone a 20%) 10-year predicted risk for CHD with the Adult Treatment Panel III risk estimator,” the guideline authors wrote.
Besides recognizing the importance of racial, ethnic and socioeconomic traits in determining a patient’s risk for CVD, the guidelines also include several illnesses that put a woman at risk, including gestational diabetes, preeclampsia and pregnancy-induced hypertension, as well as those that put her at high risk, including clinically manifest CHD and diabetes.
Because most of the data used to develop these guidelines was based on trials of CHD prevention, the authors said future guidelines “should consider recommendations for specific outcomes of particular importance to women, such as stroke.” This, they said, is particularly critical because 55,000 more women die of stroke than men every year before they reach the age of 75 years.
The guidelines are not substantially different from the 2007 version. The authors choose to focus on strategies for guideline implementation and cost-utility description in these updated guidelines.
– C. Noel Bairey Merz, MD
Cardiology Today Editorial Board
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