18 Sep 2020, 20:43
Harry Ridwan Dibaca : 338Prevention of Cardiovascular Disease in Women
Arief Wibowo
The myth that heart disease is a "man's disease" has been debunked; the rate of public awareness of CVD as the leading cause of death among U.S. women has increased from 30% in 1997 to 54% in 2009.(1) Although many people think of heart disease as a man's problem, women can and do get heart disease. In fact, heart disease is the number one killer of women in the United States. It is also a leading cause of disability among women.
The most common cause of heart disease is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease and happens slowly over time. It's the major reason people have heart attacks. Prevention is important: two-thirds of women who have a heart attack fail to make a full recovery. The older a woman gets, the more likely she is to get heart disease. But women of all ages should be concerned about heart disease. All women can take steps to prevent it by practicing healthy lifestyle habits.(2)
In reviewing evidence for this update to the 2007 guidelines, the authors widened their focus to include data on effectiveness (observed clinical benefits and risks) as well as on efficacy (results of controlled trials). Consequently, the revision incorporates several new strategies for the prevention of cardiovascular events in women.
Current systematic and critical review of the literature continues to update the guidelines, which have become the foundation to inform national educational programs for healthcare professionals and women consumers of healthcare. A major evolution from previous guidelines to the 2011 update is that effectiveness (benefits and risks observed in clinical practice) of preventive therapies was strongly considered and recommendations were not limited to evidence that documents efficacy (benefits observed in clinical research); hence, in the transformation from “evidence-based” to “effectiveness-based” guidelines for the prevention of cardiovascular disease 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.
Class III recommendations from prior guidelines that are not recommended for use for the prevention of CVD (Table 1) were retained as no new evidence has become available to alter the recommendations. The list of Class III recommendations is not exhaustive, and therapies that were previously searched were based on those preventive interventions commonly believed to have a potential benefit for the prevention of CVD in women despite a lack of definitive clinical trial evidence of benefit. Uses of medications for indications beyond the prevention of ischemic CVD are not addressed in this document. Some interventions (eg, screening for depression) were recognized to lack data on direct CVD outcomes benefit but were included in an algorithm for approaches to the evaluation of women because they may indirectly impact CVD risk through adherence to prevention therapies or other mechanisms (Figure).
Key Points(3)
The classification scheme for assessing cardiovascular risk now stratifies women into "high risk," "at risk," and "ideal cardiovascular health" categories.
Women with a 10-year predicted risk for cardiovascular disease of
In the at-risk category, hypertension and hypercholesterolemia are specifically defined, and evidence of subclinical atherosclerosis now includes carotid plaque and thickened carotid intima–media thickness as well as coronary calcification. In addition, systemic autoimmune collagen-vascular disease and history of preeclampsia, gestational diabetes, or pregnancy-induced hypertension are included as risk factors in this category.
Ideal cardiovascular health is defined as meeting all of the following criteria:
Non-HDL level
Blood pressure
Fasting blood glucose level
Body-mass index 2
Abstinence from smoking
Physical activity at goal for adults aged >20
A diet similar to Dietary Approaches to Stop Hypertension (DASH)
A variety of 10-year risk equations other than the Framingham risk score are now accepted for the prediction of 10-year global cardiovascular risk. Alternatives include the Reynolds risk score for women, which incorporates high-sensitivity C-reactive protein (CRP) level, although the authors do not endorse routine CRP testing.
Lifestyle interventions include stronger recommendations for increased exercise. Providers are advised to consistently encourage women to accumulate at least 150 minutes of moderate or 75 minutes of vigorous exercise per week (for additional benefit, 300 minutes of moderate or 150 minutes of vigorous exercise per week are recommended), and to sustain aerobic activities for at least 10 minutes per episode. In addition, women should be encouraged to perform strengthening exercises involving all major muscle groups at least 2 days per week.
Diet recommendations are more stringent and prescriptive than in previous guidelines:
Fruits and vegetables,
Fiber, 30 g per day (1.1 g fiber/10.0 g carbohydrate)
Whole grains,/ 3 servings per day
Sugar,
Nuts,
Saturated fat,
Cholesterol,
Sodium,
Consumption of omega-3 fatty acids in fish or in capsule form (e.g., 1800 mg/day of eicosapentaenoic acid) may be considered for primary or secondary prevention of cardiovascular events in women with hypercholesterolemia, hypertriglyceridemia, or both.
The algorithm for preventive care now includes specific recommendations for stroke prevention in women with atrial fibrillation.
Noncontraceptive hormone therapy outside of indications for menopausal symptoms
Antioxidant vitamin supplements
Folic acid supplements, except during childbearing years to prevent neural tube defects in offspring
Routine use of aspirin in healthy women aged
Finally, the guidelines continue to emphasize avoidance of therapies without demonstrated benefit or with risks that outweigh their benefits (Class III interventions):
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