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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn 2011, the American Heart Association published updated guidelines for the prevention of cardiovascular disease in women [Mosca L et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011]. This article reviews the major updates in the new guidelines.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn 2011, the American Heart Association (AHA) published updated guidelines for the prevention of cardiovascular disease (CVD) in women [Mosca L et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011]. Lori Mosca, MD, Columbia University Medical Center, New York, New York, USA, reviewed the major updates in the new guidelines.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EOne key change compared with earlier guidelines is the approach to risk stratification. Historically, the term \u201chigh risk\u201d has been defined as patients whose 10-year risk of coronary heart disease (CHD) was \u0026gt;20%. However, this definition underestimates the true risk of CVD in women. The 2011 AHA guideline shifts the focus from coronary risk alone to incorporate broader risk factors for CVD. In the new CVD prevention guideline for women, \u201chigh risk\u201d now describes patients with any of the following features:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-4\u0022\u003EEstablished atherosclerotic disease, including:\u003C\/p\u003E\n            \u003Cul class=\u0022list-simple \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n                  \n                  \u003Cp id=\u0022p-5\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u2666 \u003C\/span\u003EClinically manifest CHD, peripheral arterial disease, or cerebrovascular disease\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n                  \n                  \u003Cp id=\u0022p-6\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u2666 \u003C\/span\u003EAbdominal aortic aneurysm\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \u003Cp id=\u0022p-7\u0022\u003EEstimated 10-year cardiovascular disease risk \u0026gt;10%, based on traditional CV risk factors\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \u003Cp id=\u0022p-8\u0022\u003EDiabetes mellitus\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n            \u003Cp id=\u0022p-9\u0022\u003EEnd-stage renal disease (ESRD) or chronic kidney disease (CKD)\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-10\u0022\u003EIn previous prevention guidelines, the term \u201cat risk\u201d was used to describe patients with one or more traditional risk factors for CVD, such as cigarette smoking, hypertension, dyslipidemia, obesity, physical activity, poor diet, and physical inactivity. The 2011 AHA guideline for the prevention of CVD in women adds two more risk factors to this list:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-3\u0022\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n            \u003Cp id=\u0022p-11\u0022\u003ESystemic autoimmune collagen vascular disease (eg, lupus and rheumatoid arthritis), and\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n            \u003Cp id=\u0022p-12\u0022\u003EPregnancy-related risk factors, including a history of pregnancy-induced hypertension, gestational diabetes, preeclampsia, or polycystic ovary syndrome.\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-13\u0022\u003EThese risk factors were added to reflect the unique underlying pathophysiology of CVD in women as compared with men. Notably, these are risk factors that tend to present more frequently in younger women. Although it is an intense focus of current research, it remains to be demonstrated that initiating lifestyle or pharmacological interventions in these patients changes the natural history of their progression to incident CVD.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ELifestyle Interventions\u003C\/h2\u003E\n         \u003Cp id=\u0022p-14\u0022\u003ELifestyle modifications are essential to cardiovascular risk reduction for all at-risk patients. Earlier guidelines used abstract concepts (eg, \u201cmoderate exercise\u201d) that were difficult for patients to follow. To help physicians educate patients about lifestyle interventions, the 2011 guidelines include specific and relevant examples. For instance, moderate exercise can include dancing fast for 30 minutes, raking leaves for 30 minutes, gardening for 30\u201345 minutes, or pushing a stroller 1 mile in 30 minutes.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPharmacological Interventions\u003C\/h2\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EAspirin is the only drug intervention with gender-specific recommendations. Among high-risk women (see above), aspirin (75 to 325 mg\/day) is recommended unless it is contraindicated for those with established CHD (Class I recommendation) and is reasonable for those with diabetes, ESRD\/CKD, or \u0026gt;10% estimated 10 year CVD risk (Class IIa recommendation). Clopidogrel should be substituted when aspirin is indicated but not tolerated (Class I recommendation).\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EAspirin recommendations for other at-risk and healthy low-risk women without established CVD require weighing the benefits of preventive antiplatelet therapy against the risks. For women aged \u226565 years, aspirin (81 mg\/day or 100 mg every other day) is considered useful (if blood pressure is controlled) for prevention of incident ischemic stroke and myocardial infarction when the risks of gastrointestinal bleeding and hemorrhagic stroke are considered low (Class IIa recommendation). For women aged \u0026lt;65 years, there is conflicting evidence whether aspirin can prevent ischemic stroke (Class IIb recommendation).\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EFuture trials of primary and secondary prevention strategies in CVD should enroll diverse populations of female patients. With additional evidence, guidelines can be refined further to meet the specific needs of women who are at risk for adverse cardiovascular outcomes.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section ref-list\u0022 id=\u0022ref-list-1\u0022\u003E\u003Ch2 class=\u0022\u0022\u003EFurther Reading\u003C\/h2\u003E\u003Col class=\u0022cit-list ref-use-labels\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label ref-label-empty\u0022\u003E\u003C\/span\u003E\n            \u003Cdiv class=\u0022cit ref-cit ref-journal no-rev-xref\u0022 id=\u0022cit-11.15.31.1\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EMasca\u003C\/span\u003E  \u003Cspan class=\u0022cit-name-given-names\u0022\u003EL\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al.\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E \n               \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003ECirculation\u003C\/abbr\u003E \n               \u003Cspan class=\u0022cit-pub-date\u0022\u003E2011\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/li\u003E\u003C\/ol\u003E\u003C\/div\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/15\/31.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmvre\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}