Updated Guideline Helps Identify Heart Risks in Women

But women were underrepresented in clinical trials leading up to creation of the 2007 guideline
By Rick Ansorge
HealthDay Reporter

WEDNESDAY, Feb. 17 (HealthDay News) -- The updated 2007 American Heart Association guideline for cardiovascular disease prevention in women identifies cardiovascular risk with accuracy similar to that of current Framingham risk categories. However, women were underrepresented in randomized clinical trials that led to creation of the guideline, according to two reports published online Feb. 16 in Circulation: Cardiovascular Quality Outcomes.

Judith Hsia, M.D., of George Washington University in Washington, D.C., and colleagues assigned 161,808 Women's Health Initiative participants to risk categories as described in the American Heart Association guideline, and identified 11 percent as high risk, 72 percent as at-risk, 4 percent as optimal risk, and 13 percent as other. They found that the guideline predicted coronary events about as accurately as current Framingham risk categories but less accurately than proposed Framingham 10-year risk categories of less than 5 percent, 5 to 20 percent, and greater than 20 percent.

Chiara Melloni, M.D., of the Duke University Medical Center in Durham, N.C., and colleagues abstracted 156 randomized clinical trials of cardiovascular disease prevention cited by the updated 2007 American Heart Association guideline. Between 1970 and 2006, they found that the overall proportion of women enrolled in the trials increased from 9 to 41 percent, and from 18 to 34 percent in trials that enrolled both women and men.

"After at least a decade of renewed interest in women's cardiovascular health, we are left with more questions than answers," states the author of an accompanying editorial. "Key questions remain about why women are protected from cardiovascular disease, why this protection is restricted to the coronary system, and why this protection ends when women have diabetes or an acute myocardial infarction."

One author of the first study reported a financial relationship with AstraZeneca. One author of the second study reported a financial relationship with GlaxoSmithKline.

Abstract - Hsia
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Abstract - Melloni
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