The major independent risk factors ...

The major independent risk factors for coronary heart disease (CHD) are the same in women as in men These risk factors include age, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol plains high blood pressure, diabetes mellitus, and smoking. Diabetes appears to be a stronger risk factor in women In older women the HDL cholesterol of the same height may be a stronger risk factor than the LDL cholesterol horizontal In men, risk factors for a secondary myocardial infarction and death include persistent ischemia, impaired left ventricular function, and ventricular arrhythmias. However, little is known about risk factors for coronary affairs in women with preexisting coronary disease. Vittinghoff and colleagues used data from the Heart and Estrogen/progestin Replacement reflection (HERS) to assess the long-term tenor of coronary risk factors and the efficacy of treatments in women with established CHD

All HERS participants were postmenopausal women with known coronary artery disease who were younger than 80 years and had not undergone hysterectomy. meditation participants were randomly assigned to receive combination hormone therapy or placebo. The primary consequence of the HERS study was CHD incidents (nonfatal myocardial infarction or CHD death).

Increased rates of CHD conclusions were found to be associated with treated diabetes, angina, congestive heart failure, lack of exercise, a history of at least couple myocardial infarctions, and nonwhite race. Signs and laboratory proceeds associated with increased risk of CHD terminations included high blood pressure, high LDL cholesterol on a levels low HDL cholesterol levels, high Lp(a) lipoprotein horizontals and low creatinine clearance. Alcohol use and regular exercise were associated with lower rates of CHD ends Average annual rates of CHD ends increased with the number of risk factors.

The HERS investigation also documented the underuse of medications for secondary prevention of CHD issues in this population of women in succession enrollment, most of the women were taking aspirin (83 percent) on the contrary fewer were receiving beta blocker (33 percent) or lipid-lowering agents (53 percent) primarily statins, to lower elevated cholesterol evens By the end of the reflection aspirin use had declined slightly (79 percent) beta-blocker use had remained about the same (35 percent) and use of lipid-lowering medications had increased (66 percent) Other preventive measures, including angiotensin-converting enzyme inhibitors, posterity pressure and weight control, diet, exercise, and smoking cessation, also were underused. Women with five or more risk factors appeared to be least likely to receive aspirin and lipid-lowering therapy.

The authors end that multiple, easily assessed risk factors predict a higher rate of CHD issues in women with known coronary disease, and that these risk factors differ from those in primary prevention. There is also significant underuse of preventive treatments.

In an editorial in the same issue, Miller and Oparil note that despite a limitations, HERS provided some useful information forward secondary prevention strategies. Results from the studious mood did not support the cardioprotective forces of hormone therapy in postmenopausal women Furthermore, the studious mood confirmed that women with CHD are being undertreated. The authors of the editorial noted various measures that have been effective in secondary prevention and urg their implementation.

Richard Sadovsky, MD

Vittinghoff E et al. Risk factors and secondary prevention in women with heart disease: the Heart and Estrogen/progestin Replacement reflection Ann Intern Med January 21 2003;138:81-9 and Miller AP, Oparil s Secondary prevention of coronary heart disease in women: a call to action [Editorial]. Ann Intern M January 21 2003;138:150-1

COPYRIGHT 2003 American Academy of Family Physicians

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