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cardiovascular disease in women

Etiology: - see cardiovascular risk factors - systemic lupus erythematosus [6] Epidemiology: - more women than men die of cardiovascular disease each year - the number of women dying of cardiovascular disease has not decreased over time - at the age of 55, women & men have a similar lifetime risk for developing cardiovascular disease [12] Clinical manifestations: - initial manifestations of cardiovascular disease differ in men & women [12] - men are more likely to have suffer an acute coronary event - women are more likely to suffer a stroke or heart failure Laboratory: 1) serum apoliproteins & their ratios no better than standard lipid profile in predicting cadiovascular risk in women [4] 2) serum C-reactive protein may be of use in assessing risk for women taking statins [4] Complications: - women treated with fibrinolytic therapy, antiplatelet agents, or anticoagulation have a higher risk of bleeding complications than men [6] Management: - prevention [5] - healthy diet & lifestyle* - regular physical exercise - no smoking - control hypertension - diet rich in fruits & vegetables* - diet rich in omega-3 fatty acids may be of benefit - maintain BMI < 25 [10] - alcoholic beverages in moderation or not at all - pharmaceuticals - aspirin 81 mg QD - risks outweigh benefits for primary prevention [11] - statins* of benefit in women, including primary prevention [8] - provastatin may be statin of choice in women [7] - screen for depression; may affect treatment compliance * No study has has compared statins with beneficial lifestyle changes & found that statins had a superior or additive effect on clinical outcomes [9] * Healthy diet & lifestyle reduces risk of ischemic stroke in women - RR as low as 0.38 depending on number of healthy behaviors - translates to number needed to treat as low as 1.6 [10] * Young women with healthy habits are less likely to develop coronary heart disease or cardiovascular risk factors as they age - no smoking - normal BMI, - physical activity of at least 2.5 hours weekly - television viewing of 7 hours or less weekly - moderate alcohol consumption - healthy diet [13] See selected reference & clinical guidelines.

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women's health

General

cardiovascular disease (CVD)

References

  1. Prescriber's Letter 11(3):16 2004 Detail-Document#: 200315 (subscription needed) http://www.prescribersletter.com
  2. Women Are Not Reducing Their Risk Factors for Heart Disease after Bypass Surgery http://www.nih.gov/news/WordonHealth/jun2000/story05.htm
  3. Mieres JH, Shaw LJ, Arai A, Budoff MJ, Flamm SD, Hundley WG, Marwick TH, Mosca L, Patel AR, Quinones MA, Redberg RF, Taubert KA, Taylor AJ, Thomas GS, Wenger NK; Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation. 2005 Feb 8;111(5):682-96. Epub 2005 Feb 1. PMID: 15687114 http://circ.ahajournals.org/cgi/content/full/111/5/682
  4. Journal Watch 25(17):136, 2005 Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE. Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA. 2005 Jul 20;294(3):326-33. PMID: 16030277
  5. Prescriber's Letter 14(4): 2007 Summary of 2007 AHA Evidence-based guidelines for Cardiovascular Disease Prevention in women Detail-Document#: 230403 (subscription needed) http://www.prescribersletter.com
  6. Mosca L et al Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women-2011 Update A Guideline From the American Heart Association Circulation Feb 16, 2011 PMID: 21325087 http://circ.ahajournals.org/cgi/reprint/CIR.0b013e31820faaf8v1 corresponding NGC guideline withdrawn Jan 2017
  7. Mizuno K et al. Usefulness of pravastatin in primary prevention of cardiovascular events in women: Analysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA study). Circulation 2008 Jan 29; 117:494. PMID: 18172039
  8. Kostis WJ, Cheng JQ, Dobrzynski JM, Cabrera J, Kostis JB. Meta-analysis of statin effects in women versus men. J Am Coll Cardiol. 2012;59:572-582 PMID: 22300691
  9. Mascitelli L, Pezzetta F. Questioning the "beatification" of statins. Int J Cardiol. 2008;123:197-198 PMID: 17320217 - Jenkins DJ; Kendall CW; Marchie A et al Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA. 2003; 290(4):502-10 (ISSN: 1538-3598) PMID: 12876093
  10. Larsson SC, Akesson A, Wolk A. Healthy diet and lifestyle and risk of stroke in a prospective cohort of women. Neurology. 2014 Nov 4;83(19):1699-704 PMID: 25298305
  11. van Kruijsdijk RCM et al Individualised prediction of alternate-day aspirin treatment effects on the combined risk of cancer, cardiovascular disease and gastrointestinal bleeding in healthy women . Heart. Dec 4, 2014 PMID: 25475110 http://heart.bmj.com/content/early/2014/09/30/heartjnl-2014-306342 - Ferrario MM, Veronesi G Aspirin use in women for primary prevention. Heart. Dec 4, 2014 PMID: 25475109 http://heart.bmj.com/content/early/2014/11/26/heartjnl-2014-306770
  12. Leening MJG et al. Sex differences in lifetime risk and first manifestation of cardiovascular disease: Prospective population based cohort study. BMJ 2014 Nov 17; 349:g5992 PMID: 25403476 http://www.bmj.com/content/349/bmj.g5992
  13. Chomistek AK et al Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women. J Am Coll Cardiol. 2015;65(1):43-51 PMID: 25572509 http://content.onlinejacc.org/article.aspx?articleID=2087922 - Arnett DK Healthy Habits, Healthy Women J Am Coll Cardiol. 2015;65(1):52-54 PMID: 25572510 http://content.onlinejacc.org/article.aspx?articleID=2087921