Women must aggressively manage risk factors to reduce CVD risk

Risk factors such as diabetes and hypertension help identify women at increased risk for CVD.

CHICAGO — Predicting the prognosis of women with signs of ischemia but no evidence of obstructive coronary disease is challenging, according to a speaker at the American Heart Association Scientific Sessions 2006.

Even minimal stenosis and moderate chest pain could signal a woman at increased risk for CVD, according to Rhonda Cooper-DeHoff, PharmD, research assistant professor and associate director, clinical research program, cardiovascular medicine, University of Florida College of Medicine, Gainesville.

“Aggressive risk factor management is warranted, particularly in younger women,” said Cooper-DeHoff, describing the findings from the Women’s Ischemia Syndrome Evaluation (WISE) and the St. James Women Take Heart (WTH) studies.

WISE was a prospective cohort study that took place at four centers in the United States. It included 936 women with suspected ischemia who had all been referred for angiography. Only 40% of these women had documented stenosis greater than 50%, Cooper-DeHoff, a member of the Today in Cardiology editorial board, said. Sixty percent had no or minimal stenosis. Overall in the WISE study, those with no stenosis experienced a 3% five-year adverse event rate, and those with little stenosis experienced a 9.1% five-year adverse event rate.

Cooper-DeHoff and colleagues compared the women who had no or minimal stenosis (n=564) with an age- and race-matched cohort from the WTH study. The WTH study included 1,000 women from the greater Chicago area at a single center. All of the women in the WTH study were free of documented heart disease. The aim of the current study was to compare cardiovascular outcomes of the women in the two studies.

Young women at risk

The populations of the WISE and WTH studies were different, Cooper-DeHoff said. The WISE women had higher BMIs and were more likely to be menopausal. They also had a higher prevalence of risk factors, including diabetes, hypertension, metabolic syndrome and smoking history.

The researchers evaluated the CV outcomes of MI, hospitalization for HF, stroke or CV death. These outcomes were also higher among women in the WISE study, according to Cooper-DeHoff. The women in the WISE study had a fourfold greater risk of at least one CV event compared with women in the WTH study, she said.

In both groups, adverse event rates were increased in women who had at least one risk factor, such as diabetes, hypertension or high LDL levels. Increased age was also associated with an increase in adverse CV events in both groups, Cooper-DeHoff said. However, younger women in the WISE study faced a fourfold higher rate of developing serious cardiac problems or dying within the study’s follow-up period compared with women in the WTH study.

Researchers believe the difference between the two groups could be the longer period of plaque build-up in the smaller arteries, triggering symptoms. Because the vessels are much smaller than the heart’s arteries, the build-up was not detectable using the standard angiography.

Those women should control these risk factors by managing their diabetes, losing weight, exercising and lowering BP and LDL levels, Cooper-DeHoff said.

“Young women really need to focus on risk reduction because they are at increased risk for the rest of their lives,” Cooper-DeHoff said.

She addressed the limitations of the cohort study. The WISE and WTH women were followed with different protocols. Researchers followed up with WISE participants annually via phone, whereas WTH women were followed up only after a 10-year period. Bias is always present in cohort studies as well, she said. The WISE women were referred to the study, whereas the WTH women were volunteers. The researchers enrolled the women from different geographical regions; there is a state-by-state variation in CV rates, according to Cooper-DeHoff.

Further research to find better methods to identify women at risk is needed, she said. – by Lauren Riley

For more information:

• Cooper-DeHoff R. Adverse cardiovascular outcomes in women with no obstructive coronary artery disease: a report from the NHLBI-sponsored WISE study and the St. James WTH project. Presented at: American Heart Association Scientific Sessions 2006; Nov. 12-15, 2006; Chicago.