MIAMI-DADE COUNTY HEALTH DEPARTMENT SPRING 2004 ...

e - New Guidelines for Prevention
f heart disease or stroke.
In the majority of people, simple lifestyle
changes can have dramatic results in terms
of reducing the risk for CVD, and are recommended
to all individuals. When it
comes to more drastic interventions however,
and specifically addressing women, no
clear guidance had been available until
very recently. In fact, on February 4th the
American Heart Association announced
new guidelines for preventing heart disease
and stroke in women according to a
woman's individual cardiovascular health.
The guidelines are based on the highestquality
evidence from all the available
research related to CVD prevention, and
represent a major collaborative effort by the
American Heart Association and 11 other
professional and governmental co-sponsoring
organizations.
According to the new recommendations,
the aggressiveness of treatment should be
linked to the level of risk a woman has of
having a heart attack in the next 10 years.
Levels of risk are established using a standardized
scoring method developed by the
Framingham Heart Study. Low risk means
a woman has a less than 10 percent
chance of having a heart attack in the next 10
years, intermediate risk is a 10 to 20 percent
chance, and high risk is a greater than 20 percent
chance.
In addition to categorizing the levels of risk,
the new guidelines classified the prevention
measures, both lifestyle and medical, based on
the strength of the recommendation for each
level of risk. Details of the various classes will
not be discussed here, except to mention that
these new guidelines provide advice on what not
to do in addition to telling us what to do. To that
end, certain interventions were labeled Class III,
indicating that such interventions are either not
useful or could be harmful, or both. The following
is a simplified summary of the types of intervention
according to levels of risk:
High-Risk Women (>20% risk of having a
heart attack in the next 10 years)
Recommended intervention:
Smoking cessation
Physical activity/cardiac rehabilitation
Diet therapy
Weight maintenance/reduction
Blood pressure control
Lipid control (statin therapy)
Aspirin therapy
Blood sugar control in diabetics
Evaluate/treat depression
Omega 3 fatty-acid supplementation
Folic acid supplementation
Intermediate-risk women (10% to 20% risk)
Recommended intervention:
Smoking cessation
Physical activity
Heart-healthy diet
Weight maintenance/reduction
Blood pressure control
Lipid control
Aspirin therapy
Lower-risk women (