Press Releases (2011)

Elkhart General Hospital Center for Cardiac Care Encourages Women to Study Risk Factors, Guidelines for the Prevention of Cardiovascular Disease
September 13, 2011

prevention of heart disease and stroke

ELKHART, IN – The Elkhart General Hospital Center for Cardiac Care is urging all women to take steps to better care for their hearts following a recent update to the American Heart Association’s cardiovascular disease prevention guidelines for women.

“Heart disease is the leading cause of death in women in every major country and in most emerging economies worldwide,” said Thomas F. Nolan M.D., cardiologist at Elkhart General Hospital. “In fact, each year, more women than men have a stroke and, after age 65, a higher percentage of women than men have hypertension. This gap is likely to increase with the continued aging of the female population”

Clinical recommendations for the prevention of cardiovascular disease in women were first published by the American Heart Association (AHA) in 1999. In 2004, the AHA, in collaboration with other organizations, expanded its focus on female-specific clinical recommendations and sponsored the “Guidelines for Cardiovascular Disease Prevention in Women.” These guidelines, updated in 2007 and again in 2011, are viewed as the foundation for national educational programs for healthcare professionals and for women healthcare consumers in the prevention of cardiovascular disease.

Until now, the guidelines, once referred to as “evidence-based” and now referred to as “effectiveness-based,” were based primarily on findings observed in clinical research. The most recent guidelines, however, suggest that “real world” tactics may be more effective in preventing cardiovascular disease in women than tactics based entirely on clinical research.

“Awareness of symptoms and risks specific to women are the key to prevention,” said Donald Westerhausen M.D., cardiologist at Elkhart General Hospital. “These new guidelines not only shift the focus from clinical research to everyday situations, they also help both women and their doctors understand the risks of cardiovascular disease and provide practical steps for preventing heart disease and stroke.”

Many recommendations from the 2007 guidelines have not changed. These include interventions that are not useful in the prevention of cardiovascular disease in women, such as menopausal therapy and antioxidant supplements. The updated guidelines also incorporate illnesses that increase heart disease in women, including lupus and rheumatoid arthritis, and pregnancy complications such as preeclampsia, gestational diabetes or pregnancy-induced hypertension.

The updated guidelines emphasize the importance of recognizing racial and ethnic diversity and its impact on cardiovascular disease. For example, hypertension is a particular problem among African-American women while diabetes greatly affects Hispanic women.

“These guidelines are a critical weapon in the war against heart disease, the leading killer of women,” said Lori Mosca, M.D., M.P.H., Ph.D., chair of the guidelines writing committee. “The guidelines are an important evolution in our understanding of women and heart disease. And I cannot stress personal awareness and education enough.”

Measures identified in the 2011 Guidelines as not being useful in the prevention of cardiovascular Disease in Women are as follows:

• Menopausal Therapy: Hormone therapy and selective estrogen-receptor modulators (SERMs) should not be used for the prevention of cardiovascular disease
• Antioxidant Supplements: Vitamin supplements such as vitamin E, C and beta carotene should not be used for the prevention of cardiovascular disease
• Folic Acid: With or without B6 and B12 supplementation, Folic acid should not be used for the prevention of cardiovascular disease
• Aspirin for Heart Attack in Women under 65 Years of Age: Routine use of aspirin in healthy women under the age of 65 is not recommended to prevent heart attack. However, aspirin can help to prevent strokes in women older than 65

Cardiovascular disease risk factors as identified by the Elkhart General Hospital Center for Cardiac Care include the following:

Modifiable Risk Factors (risk factors you can do something about)

• Smoking
• Abnormal cholesterol or triglyceride levels
• High blood pressure
• Diabetes
• Metabolic syndrome
• Obesity
• Physical inactivity
• Alcohol abuse
• Cocaine abuse

Risk Factors Specific to Women

• History of preeclampsia
• History of gestational diabetes or pregnancy-induced hypertension
• Maternal history of stroke

Emerging Risk Factors for Heart Disease

• Low levels of “good” HDL cholesterol
• High levels of coronary artery calcium
• Psychosocial factors such as depression, isolation, anger and caregiver stress
• Abnormally high blood levels of C-reactive protein, lipoportein(a), homocysteine, myeloperoxidase

Diseases, Conditions and Medications that Increase the Risk of Heart Attack

• Systemic autoimmune disease such as rheumatoid arthritis or lupus
• Diagnosis of coronary artery disease, cerebrovascular disease or peripheral arterial disease
• Abdominal aortic aneurysm
• End-stage or chronic kidney disease
• Non-alcoholic fatty liver disease [NAFLD]
• Breast cancer radiation therapy occurring before 1984
• Yellow bumps on or around the eyelids, known as xanthelasmata
• Emphysema
• Poor flexibility
• Exposure to air pollutants containing ozone, nitrates, sulfates, metals and aldehydes
• Polyvascular disease, defined as symptomatic atherosclerosis in more than one site
• Age-related macular degeneration
• Glaucoma and ocular hypertension in blacks; treatment with the beta-blocker timolol maleate
• Carrying the gene HLA-DRB1, which increases the risk of inflammatory arthritis
• Severe menopausal symptoms
• Restless legs syndrome
• Colorectal cancer
• Gout, particularly in older women
• Chemotherapy with anthracyclines or trastuzumab/Herceptin

Diseases and Conditions that Increase the Risk of Stroke

• Aortic arch atheroma
• Heart valve disease
• Atrial fibrillation
• Patent foramen ovale
• Sleep apnea
• Cerebral aneurysms
• Ocular shingles caused by herpes zoster
• Exposure to common viruses and bacteria, including herpes simplex 1 and 2, cytomegalovirus, Chlamydia pneumoniae and Helicobacter pylori

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About Elkhart General Hospital
Elkhart General Hospital is an independent, not-for-profit hospital located in Elkhart, Indiana. The full-service, 325-bed main hospital is comprised of 300 physicians representing more than 30 medical specialties and over 2,000 employees serving in nursing, technical, administrative, and support capacities.