2011 guidelines for the prevention of cardio vascular disease in women

8/3/2019 2011 Guidelines for the Prevention of Cardio Vascular Disease in Women

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De La Salle Health Sciences InstituteCollege of Nursing and School of Midwifery

Dasmariñas City, Cavite

UPDATES ONCARDIOVASCULAR

DISEASEMANAGEMENT

Submitted by:Imari Jean L. Gatbonton

BSN46

Submitted to:Ms. Joselita M. Bongcaron

Ms. Cheryl Rose L. MagbanuaMs. Anabelle S. Umali

Ms. Cherrylyn U. VidalloProfessors, MS

October 12, 2011



2011 Guidelines for the Prevention of

Cardio vascular Disease in Women –

The Need for Efficacy Thursday, September 29, 2011

The notion that heart disease was a man’s disease has now been debunked, for heart disease

is the leading cause of death in women in developed countries & emerging economies. The

American Heart Association (AHA) reports that inspite of the fact that cardio vascular disease

(CVD) deaths in women in the US have come down by two thirds over the last three decades,

one woman still dies of CVD every minute.

The major causes of heart disease amongst women are the increasing rate of hypertension and

obesity. Nearly 2 out of 3 women over the age of 20 years in the US are overweight or obese.

This is also a major contributing factor to diabetes mellitus type 2 amongst women. Diabetes is

associated with an overall risk of developing myocardial infarction and stroke.

Given the worldwide health and economic implications of CVD in women it has become

necessary to control factors responsible for the disease and apply evidence based therapies to

control it.

The American Heart Association thus recently released its 2011 guidelines for prevention of

CVD in women.



Women At Risk - Categories

Women are now classified as: high risk, at risk and ideal cardiovascular health.

‘At risk’: greater than or equal to 1 major risk factors

• Women who smoke, have hypertension or treated hypertension, dyslipidemia or treated

for dyslipidemia, obesity – particularly central obesity, a poor diet, physical inactivity,

family history of CVD, metabolic syndrome, advanced subclinical atherosclerosis and

poor results on treadmill test.

• The ‘at risk’ category now includes women who earlier suffered from pregnancy

complications like preeclampsia, gestational diabetes or pregnancy induced

hypertension. This helps in the unmasking of a system that isn’t working well. This opens

up opportunities to evaluate the overall cardiac risk and initiate preventive strategies

early.

• The new guidelines also put women who have a systemic collagen vascular

disease like lupus or arthritis at increased risk.

‘High risk’: greater than or equal to 1 high risk states- women who :

• Clinically manifest CHD / cerebrovascular / peripheral arterial disease

• Have abdominal aortic aneurysm

• End stage or chronic kidney disease

• Diabetes mellitus

• 10 year predicted CVD risk greater than or equal to 10%



‘Ideal cardiovascular health’: all of these

• Total cholesterol <200 mg/dL (untreated)

• BP <120/<80 mm Hg (untreated)

• Fasting blood glucose<_100 mg/dL (untreated)

• Body mass index <25 kg/m2

• Abstinence from smoking

• Physical activity at goal for adults >20 y of age: >or equal to 150 min/wk moderate

intensity,>or equal to75min/wk vigorous intensity, or combination

• Healthy (DASH-like) diet

Threshold for treatment

According to the current guidelines, "high risk" women are those who have a > or = 10% risk of

dying from any cardiovascular event in the next 10 years as compared to the older guideline of

> or = 20% risk of dying from a heart attack in the next 10 years.

• Dr Lori Mosca (Columbia University, New York, NY), Chair of the writing committee and

who is also lead author of the manuscript, explained that, “There are two main reasons

for this," she says. "First, the primary risk-assessment tools that are used tend to

underestimate risk in women, and second, women are more likely than men to

experience a stroke vs. a heart attack, so we wanted to make sure we encompass that

in the risk assessment."



• Mosca says that women and even most doctors are "definitely not aware that older

women are more likely to have a stroke than a heart attack and that the ratio of stroke to

heart attacks is always higher in women than in men."

Ineffective /harmful interventions

The current guidelines highlight that:

• Hormone therapy and selective estrogen-receptor modulators(SERMs)

• Antioxidant vitamin supplements like C, E and beta carotene should not be used for the

primary or secondary prevention of CVD.

• Folic acid, with or without B6 and B12 supplementation, should not be used for the

primary or secondary prevention of CVD, except in the childbearing years to prevent

neural tube defects.

• Daily aspirin therapy may have a positive impact on men and women who already have

heart disease, but the routine use of aspirin in healthy women less than 65 years of age

is not recommended to prevent myocardial infarction.



Diet

The new guidelines recommend a diet rich in fruits and vegetables, whole-grains, high-

fibre foods, consumption of fish, especially oily fish at least twice a week, limited intake

of saturated fats, cholesterol, alcohol, sodium and sugar and no trans-fatty acids. ( see

table on dietary recommendations)

International applicability

An important feature of the guidelines is their international applicability because almost all

the recommendations can be used in most countries or regions, either directly or with only

slight modifications eg definitions of overweight, obesity and central obesity will change by

country.



• SPECIFIC DIETARY INTAKE RECOMMENDATIONS FOR WOMEN

Nutrient Serving Serving Size

Fruits and

vegetables

≥ 4.5 cups/d 1 cup raw leafy vegetable, 1/2 cup cut-up raw or cooked

vegetable, 1/2 cup vegetable juice; 1 medium fruit, 1/4 cup dried

fruit, 1/2 cup fresh, frozen, or canned fruit, 1/2 cup fruit juice

Fish 2/wk 3.5 oz, cooked (preferably oily types of fish)

Fiber 30 g/d (1.1 g/10 g

carbohydrate)

Bran cereal, berries, avocado, etc.

Whole grains 3/d 1 slice bread, 1 oz dry cereal, 1/2 cup cooked rice, pasta, or

cereal (all whole-grain products)

Sugar ≤ 5/wk (≤ 450 kcal/wk from

sugar-sweetened

beverages)

1 tablespoon sugar, 1 tablespoon jelly or jam, 1/2 cup sorbet, 1

cup lemonade

Nuts, legumes,

and seeds

≥ 4/wk 1/3 cup or 1 1/2 oz nuts (avoid macadamia nuts and salted

nuts), 2 tablespoons peanut butter, 2 tablespoon or 1/2 oz

seeds, 1/2 cup cooked legumes (dry beans and peas)

Saturated fat < 7%/total energy intake Found in fried foods, fat on meat or chicken skin, packaged

desserts, butter, cheese, sour cream, etc

Cholesterol < 150 mg/d Found in animal meats, organ meats, eggs, etc

Alcohol ≤ 1/d 4 oz wine, 12 oz beer, 1.5 oz of 80-proof spirits, or 1 oz of 100-

proof spirits

Sodium < 1500 mg/d

Trans-fatty

acids

0 0

• Note: The recommended serving amounts are based on a 2000-kcal diet, and recommendations vary according to

individual preference and needs.

Note for Vitamin D: It is expected that ongoing research regarding the role of vitamin D supplementation in the prevention

of cardiovascular disease will shed further light on this issue for future versions of this guideline.

• By Poonam Vaswani

Senior Dietitian, Nutritionvista.com

REFERENCE:

2011 Guidelines for the Prevention of Cardio vascular Disease in Women –

The Need for Efficacy . Retrieved October 11, 2011 from http://www.nutritionvista.com

http://www.nutritionvista.com/

http://www.nutritionvista.com/

2011 guidelines for the prevention of cardio vascular disease in women

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