By Zachary Stieber
Contributing Writer
Four health organizations have issued a new approach to preventing cardiovascular disease, the leading cause of death in women.
Cardiovascular health assessments for girls should be conducted starting around age 8 and take into account changes females experience in each stage of life as they carry out the assessments, the American Heart Association and three other groups said in the guidance, released on Oct. 26.
Cardiovascular disease includes heart disease and stroke and kills more than 400,000 women each year in the United States, according to the association. That’s more than the deaths from breast cancer, lung cancer, and chronic lung disease combined.
Assessments should look at cardiovascular disease risk factors, including high blood pressure; specific heart conditions such as valvular heart disease; health behaviors such as sleep and physical activity; and other health factors, including glucose levels and menstrual issues, the organizations said.
For girls aged approximately 8 to 15, the assessment can include testing of lipids, or fatty compounds; checking body mass index and blood pressure on an annual basis; and reviewing glucose levels. The girls should be empowered to understand their cardiovascular risk profile as they age, the organizations said.
For ages approximately 15 to 44, or women who have regular ovulatory and hormone cycles, screening should incorporate components developed by the association that are associated with heart health, including healthy sleep, healthy levels of lipids, and the avoidance of nicotine.
A 10-year risk equation is recommended for women aged 30 to 79, while women aged 30 through 59 should receive 10-year and 30-year risk estimates, the organizations said.
“The estimation of 30-year risk and risk percentiles is particularly useful for women who may have low short-term risk but high long-term risk. In these women, not including 30-year risk assessment leads to the misperception that women are not at risk,” one of the guidance documents states.
Women aged approximately 45 and older should be assessed for the same components, and assessments should factor in how the transition to menopause can be accompanied by an acceleration in cardiovascular disease risk “due to metabolic and vascular changes that are driven by ovarian aging and the concomitant change in the hormonal milieu, including the progressive decline of estradiol, in addition to chronologic aging,” that document says.
The other documents can be found here and here.
“Women make up more than half the population, and their heart health must be a part of everyday care across medicine.” Dr. Mariell Jessup, chief science and medical officer of the American Heart Association, said in a statement. “These publications give clinicians and health systems a shared foundation for recognizing risk throughout a woman’s life.”
The new approach, based on the life stage framework, is needed because progress has stalled in preventing female cardiovascular deaths in the past 20 years, according to the four groups—the heart association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine.
“Women experience their healthcare across clinical specialties, but it often is fragmented or disconnected,” Dr. Sadiya S. Khan, who helped craft the guidance and is the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine in Chicago, said in a statement.
“Specifically, these reports connect the dots for clinicians, for patients and across health domains so that care is holistic and begins in adolescence, recognizing that women’s heart health is uniquely shaped by biological transitions not experienced by men—periods, pregnancy, perimenopause and menopause.”
The guidance applies to girls and women, and does not deal with handling transgender patients, the groups said.
