American Heart Association Journal Report: Heart Experts Call for Action Against Missed Opportunities to Prevent Heart Disease in Women.

DALLAS--(BW HealthWire)--April 30, 1999--

The American Heart Association and American College of Cardiology called today for action against missed opportunities to reduce women's risk of coronary heart disease, the No. 1 killer of both men and women.

The scientific statement, produced in collaboration with four other professional health organizations, provides updated recommendations for closing what the AHA and ACC say is the wide gap between what is known to prevent heart disease in women and what actually is being done.

The scientific statement, "Guide to Preventive Cardiology for Women," which is published today in the Journal of the American College of Cardiology and will appear in the May 11 issue of Circulation: Journal of the American Heart Association, was produced in collaboration with the American Medical Women's Association, American College of Nurse Practitioners, American College of Obstetricians and Gynecologists, and Canadian Cardiovascular Society. Among the recommendations: -0-

--   A statin or cholesterol-lowering drug should be considered
     instead of hormone replacement therapy as the first line of drug
     therapy for lowering high blood levels of cholesterol in
     postmenopausal women.

--   The target blood level of high-density lipoprotein, HDL, the
     "good" cholesterol, should be higher than national
     recommendations.

--   Diabetes increases a woman's risk of heart disease three to seven
     times, compared with a two- to three-fold risk increase in men.
     Thus, it is imperative to step up efforts to identify women at
     risk and provide them with effective treatment. "Although more
     women die from coronary heart disease than from cancer or any
     other disease, we are missing many opportunities to reduce the
     risk of heart disease in women," says Lori Mosca, M.D., Ph.D.,
     chair of the consensus panel that developed the statement and
     chair of the AHA's "Take Wellness to Heart" campaign to inform
     women about reducing their risk for heart disease and stroke. She
     is also director of preventive cardiology research and education
     at the University of Michigan, Ann Arbor.

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Clear evidence exists that women are not being treated aggressively to prevent heart disease, the panel reported. For example, the U.S. Centers for Disease Control and Prevention's recent National Ambulatory Medical Care Survey showed healthcare professionals counsel women less often than men about exercise, nutrition, and weight reduction. There are alarming trends in the prevalence and management of risk factors in women. The prevalence of obesity in American women is increasing. About 25 percent of woman report no regular sustained physical activity. Also, smoking rates are declining less for woman than for men.

"The problem may result in part from the perception that these recommendations for reducing risk factors apply to men and may not apply to women," says Mosca. "Thus, the consensus panel's goal was to highlight the most important strategies for lowering heart disease risk in women."

Some of the panel's recommendations reflect new scientific knowledge, such as the findings from the Heart and Estrogen/Progestin Replacement Study (HERS), which found that hormone replacement therapy (HRT) did not significantly benefit women with diagnosed heart disease, and from studies that suggest women with high blood levels of cholesterol may benefit as much or even more than men by taking one of the statin drugs. Previous recommendations of the National Cholesterol Education Program suggest that HRT be considered as the initial drug therapy for lowering high cholesterol in postmenopausal women if lifestyle changes, such as switching to a low-fat diet, do not prove effective. The panel now recommends that a statin drug be considered instead of HRT as the first line of drug therapy.

"Statin drugs have been scientifically proven to lower high blood levels of cholesterol, particularly the LDL or bad cholesterol, and reduce risk of cardiac events such as a heart attack," explains Mosca, adding that research has not yet shown conclusively that HRT lowers the risk of heart disease. "The typical woman who takes HRT has a healthy lifestyle, which may confound the clinical trial results and make them uncertain."

The panel also noted that current national recommendations might not be aggressive enough in treating elevated blood cholesterol in women. It suggests that clinicians consider a lower target level of blood triglycerides (150 milligram per deciliter or less) and a higher optimum level of HDL cholesterol (at least 45 mg/dL). Triglycerides are blood fats associated with heart disease risk.

"There is a substantial gap between what we know and what we do to prevent heart disease in women," Mosca says. "Because these consensus recommendations are both scientifically based and practical, they are an important step towards closing that gap."

Coauthors of the consensus panel statement are Scott M. Grundy, M.D., Ph.D.; Debra Judelson, M.D.; Kathleen King, Ph.D., R.N.; Marian Limacher, M.D.; Suzanne Oparil, M.D.; Richard Pasternak, M.D.; Thomas A. Pearson, M.D., Ph.D.; Rita F. Redberg, M.D.; Sidney C. Smith Jr, M.D.; Mary Winston, Ed.D., R.D.; Stanley Zinberg, M.D. NR 99-1037 (Circ/Mosca) Media advisory: Dr. Mosca can be reached at 734/998-6301. (Please do not publish number.)