Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women-2011 Update A Guideline From the American Heart Association
Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women-2011 Update A Guideline From the American Heart Association
复制标题
DOI：
10.1161/cir.0b013e31820faaf8
复制
发表时间：
2011-03-22
影响因子：
24
通讯作者：
Zhao, Dong
中科院分区：
文献类型：
--
作者：
Mosca, Lori;Benjamin, Emelia J.;Zhao, Dong
自从美国心脏协会(AHA)于1999年发表了第一个针对女性的预防心血管疾病的临床建议以来，美国心脏协会(AHA)一直致力于预防女性心血管疾病(1)。心脏病是“男性疾病”的神话已经被揭穿；公众意识到心血管疾病是美国女性死亡的主要原因的比率从1997年的30%上升到2009年的54%(2)。2007年，女性因冠心病(CHD)导致的年龄调整死亡率为每10万名女性中有95.7人死亡，是1980年的三分之一(3、4)，约占女性心血管疾病死亡总数的一半。在冠心病死亡率的下降中，大约50%归因于主要危险因素的减少，另一半归因于CHD的治疗，包括二级预防治疗(4)。主要的随机对照临床试验，如妇女健康倡议，在过去十年中改变了妇女预防心血管疾病的做法(5)。与妇女的这一重大公共卫生问题作斗争的投资是巨大的，科学和医学成就也是如此。尽管已经取得了进展，但仍然存在相当大的挑战。2007年，美国每分钟仍有1人死于心血管疾病(6例)。这意味着421,918人死亡，比癌症、慢性下呼吸道疾病、阿尔茨海默病和事故造成的妇女死亡总和还要多(6)。与过去40年的趋势相反，35岁至54岁的美国女性的冠心病死亡率现在似乎正在上升，这可能是因为肥胖流行的影响(4)。在美国，黑人女性的心血管疾病发病率明显高于白人女性(286.1/100,000比205.7/100,000)。这种差异与黑人女性和白人女性对心脏病和中风的知晓率显著较低(2，6-8)相平行。令人担忧的是，在AHA最近的一项全国调查中，只有53%的女性表示，如果她们认为自己心脏病发作，第一件事就是拨打9-1-1。令人痛心的是，许多妇女缺乏对急性心血管事件紧急护理必要性的认识，这是妇女获得最佳生存的障碍，并突出表明需要开展针对妇女的教育运动(2)。在美国，黑人女性的心血管疾病发病率明显高于白人女性(286.1/100,000比205.7/100,000)，这与黑人女性对心脏病和中风的知晓率大大低于白人女性(2，6-8)的情况相同。每年，患中风的女性比男性多5.5万人。心房颤动独立地与缺血性中风的风险增加4-5倍相关，并且在所有缺血性中风中有15%-20%是由房颤引起的。已经证明，抗凝剂治疗不足会使中风复发的风险增加一倍；因此，专家小组投票决定将预防患有房颤的女性中风的建议纳入其中(6、9、10)。妇女心血管疾病风险因素的不利趋势是一个持续令人关切的问题。65岁以后，女性患高血压的比例高于男性，随着女性人口的持续老龄化，这一差距可能会扩大(6)。美国黑人的高血压患病率是世界上最高的之一，而且还在增加。从1988年到1994年，从1999年到2002年，黑人成年人的高血压患病率从35.8%上升到41.4%，黑人女性的高血压患病率尤其高，达到44.0%(11)。一个非常不祥的趋势是平均体重持续增加，…
(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 (1). The myth that heart disease is a “man’s 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 (2). 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 2007, a third of what it was in 1980 (3, 4). 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 (4). Major randomized controlled clinical trials such as the Women’s Health Initiative have changed the practice of CVD prevention in women over the past decade (5). The investment in combating this major public health issue for women has been significant, as have the scientific and medical achievements. Despite the gains that have been made, considerable challenges remain. In 2007, CVD still caused 1 death per minute among women in the United States (6). These represent 421,918 deaths, more women’s lives than were claimed by cancer, chronic lower respiratory disease, Alzheimer disease, and accidents combined (6). Reversing a trend of the past 4 decades, CHD death rates in US women 35 to 54 years of age now actually appear to be increasing, likely because of the effects of the obesity epidemic (4). CVD rates in the United States are significantly higher for black females compared with their white counterparts (286.1/100,000 versus 205.7/100,000). This disparity parallels the substantially lower rate of awareness of heart disease and stroke that has been documented among black versus white women (2, 6–8). Of concern is that in a recent AHA national survey, only 53% of women said the first thing they would do if they thought they were having a heart attack was to call 9-1-1. This distressing lack of appreciation by many women for the need for emergency care for acute cardiovascular events is a barrier to optimal survival among women and underscores the need for educational campaigns targeted to women (2). CVD rates in the United States are significantly higher for black females compared with their white counterparts (286.1/100,000 versus 205.7/100,000), which parallels the substantially lower rate of awareness of heart disease and stroke that has been documented among black versus white women (2, 6–8). Each year, 55,000 more women than men have a stroke. Atrial fibrillation is independently associated with a 4-to 5-fold increased risk of ischemic stroke and is responsible for 15% to 20% of all ischemic strokes. It has been shown that undertreatment with anticoagulants doubles the risk of recurrent stroke; therefore, the expert panel voted to include recommendations for the prevention of stroke among women with atrial fibrillation (6, 9, 10). Adverse trends in CVD risk factors among women 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 (6). The prevalence of hypertension in blacks in the United States is among the highest in the world, and it is increasing. From 1988 to 1994 through 1999 to 2002, the prevalence of hypertension in adults increased from 35.8% to 41.4% among blacks, and it was particularly high among black women at 44.0%(11).A very ominous trend is the ongoing increase in average body weight, with …