1、Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women2011 UpdateA Guideline From the American Heart AssociationContents Background123 Pharmacotherapy Lifestyle InterventionsSubstantial progress has been made in the awareness,treatment,and prevention of cardiovascular d
2、isease(CVD)in women since the first women-specific clinical recommendations for the prevention of CVD were published by the American Heart Association(AHA)in 1999.BackgroundMosca L,Grundy SM,Judelson D,et al.Guide to preventive cardiology for women:AHA/ACC Scientific Statement Consensus panel statem
3、ent.Circulation.1999;99:24804.The myth that heart disease is a“mans disease”has been debunked,the rate of public awareness of CVD as the leading cause of death among US women has increased from 30%in 1997 to 54%in 2009.Mosca L,Mochari-Greenberger H,Dolor RJ,Newby LK,Robb KJ.Twelve-year follow-up of
4、American womens awareness of cardiovascular disease risk and barriers to heart health.Circ Cardiovasc Qual Outcomes.2010;3:1207.The age-adjusted death rate resulting from coronary heart disease(CHD)in females,which accounts for about half of all CVD deaths in women,was 95.7 per 100 000 females in 20
5、07,a third of what it was in 1980.Xu JQ,Kochanek KD,Murphy SL,B.T-V.Deaths:Final Data for 2007:National Vital Statistics Reports.Hyattsville,MD:National Center forHealth Statistics;2010.Ford ES,Ajani UA,Croft JB,et al.Explaining the decrease in U.S.deaths from coronary disease,19802000.N Engl J Med.
6、2007;356:238898.Approximately 50%of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies.Hypertension is recognized as one of the main factors for CVD.Adverse trends in CVD risk factors among wom
7、en are an ongoing concern.After 65 years of age,a higher percentage of women than men have hypertension,and the gap will likely increase with the continued aging of the female population.Roger VL,Go AS,Lloyd-Jones DM,et al.,on behalf of the American Heart Association Statistics Committee and Stroke
8、Statistics Subcommittee.Heart disease and stroke statistics2011 update:a report from the American Heart Association published correction appears in Circulation.2011;123:e240.Circulation.2011;123:e18209.An optimal blood pressure of 120/80 mm Hg should be encouraged through lifestyle approaches such a
9、s weight control,increased physical activity,alcohol moderation,sodium restriction,and increased consumption of fruits,vegetables,and low-fat dairy products.Lifestyle InterventionsCigarette smokingWomen should be advised not to smoke and to avoid environmental tobacco smoke.Provide counseling at eac
10、h encounter,nicotine replacement,and other pharmacotherapy as indicated in conjunction with a behavioral program or formal smoking cessation program.Physical activityWomen should be advised to accumulate at least 150 min/wk of moderate exercise,75 min/wk of vigorous exercise,or an equivalent combina
11、tion of moderate-and vigorous-intensity aerobic physical activity.Aerobic activity should be performed in episodes of at least 10 min,preferably spread throughout the week.Women should also be advised that additional cardiovascular benefits are provided by increasing moderate-intensity aerobic physi
12、cal activity to 5h(300min)/wk,21/2h/wk of vigorous-intensity physical activity,or an equivalent combination of both.Women should be advised to e n g a g e i n m u s c l e-strengthening activities that involve all major muscle groups performed on 2 d/wk.Women who need to lose weight or sustain weight
13、 loss s h o u l d b e a d v i s e d t o accumulate a minimum of 60 t o 9 0 m i n o f a t l e a s t moderate-intensity physical activity(eg,brisk walking)on most,and preferably all,days of the week.Women should be advised to consume a diet rich in fruits and vegetables;to choose whole-grain,high-fibe
14、r foods;to consume fish,especially oily fish,at least twice a week;to limit intake of saturated fat,cholesterol,alcohol,sodium,and sugar;and avoid trans-fatty acids.Dietary intakeNote:Pregnant women should be counseled to avoid eating fish with the potential for the highest level of mercury contamin
15、ation(eg,shark,swordfish,king mackerel,or tile fish).Weight maintenance/reductionWomen should maintain or lose weight through an appropriate balance of physical activity,caloric intake,and formal behavioral programs when indicated to maintain or achieve an appropriate body weight(eg,BMI 25 kg/m2 in
16、US women),waist size(eg,35 in),or other target metric of obesity.Omega-3 fatty acidsConsumption of omega-3 fatty acids in the form of fish or in capsule form(eg,EPA 1800 mg/d)may be considered in women with hypercholesterolemia and/or hypertriglyceridemia for primary and secondary prevention.Note:Fi
17、sh oil dietary supplements may have widely variable amounts of EPA and DHA(likely the only active ingredients).4.5 cups/d1 cup raw leafy vegetable1/2 cup cut-up raw or cooked vegetable 1/2 cup vegetable juice1 medium fruit 1/4 cup dried fruit1/2 cup fresh,frozen,or canned fruit1/2 cup fruit juiceFis
18、h 2/wk 3.5 oz,cooked(preferably oily types of fish)Fiber 3 0 g/d (1.1 g/10 g carbohydrate)Bran cereal,b e r r i e s,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/w(450 kcal/wk fromsugar-sweetened beverages)1 tablespoon
19、 k sugar,1 tablespoon jelly or jam,1/2 cup sorbet,1 cup lemonadeSugar 5/wk(450 kcal/wk from sugar-sweetened beverages)1 tablespoon sugar,1 tablespoon jelly or jam,1/2 cup sorbet,1 cup lemonadeNuts,legumes,and seeds 4/wk 1/3 cup or 1 1/2 oz nuts(avoid macadamia nuts and salted nuts),2 tablespoons pea
20、nut 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,etcCholesterol 150 mg/d Found in animal meats,organ meats,eggs,etc.Alcohol 1/d 4 oz wine,
21、12 oz beer,1.5 oz of 80-proof spirits,or 1 oz of 100-proof spiritsSodium 1,500 mg/dTrans-fatty acids 0 0PharmacotherapyPharmacotherapy is indicated when blood pressure is140/90 mm Hg(130/80 mm Hg in the setting of chronic kidney disease and diabetes mellitus).Thiazide diuretics should be part of the
22、 drug regimen for most patients unless contraindicated or if there are compelling indications for other agentsin specific vascular diseases.Initial treatment of high-risk women with acute coronary syndrome or MI should be with-blockers and/or ACE inhibitors/ARBs,with addition of other drugs such as thiazides as needed to achieve goal blood pressure.A C E i n h i b i t o r s a r e contraindicated in pregnancy and ought to be used with caution in women who may become pregnant.
