Skip to main content
SpringerLink
Log in

Risk Detection and Primary Prevention in Women

  • Chapter
Coronary Disease in Women

Part of the book series: Contemporary Cardiology ((CONCARD))

  • 104 Accesses

Abstract

Prevention of coronary heart disease (CHD) in asymptomatic individuals has traditionally been termed primary prevention because it aims to avert the clinical presentation of symptomatic disease along with major adverse cardiac events (1). Our current management paradigm has been effective in reducing the burden of cardiovascular disease (CVD), with 35–50% declines in related mortality (2). However, the CVD burden for most Westernized countries remains high. Prevention strategies are less often not instituted until after the clinical presentation of the atherosclerotic diseases. Primary CHD prevention offers the greatest opportunity to reduce the burden of disease in the United States (3). This latter point becomes critical for the 40–60% of asymptomatic women whose initial presentation includes sudden cardiac death or acute myocardial infarction (AMI; 4). There are a number of published guidelines from the American Heart Association (AHA), American College of Cardiology (ACC), and National Institutes of Health-National Heart, Lung, and Blood Institute (NIH-NHLBI, e.g., NCEP III-ATP) that detail management strategies for primary prevention risk-reducing methods for men and women (3,5). Risk-reducing strategies, including control of major cardiac risk factors (e.g., weight, blood pressure, smoking, and regular exercise), can decrease a woman’s risk for CHD by as much as 80% (6,7). This chapter provides an introduction to primary prevention strategies and our current understanding of the traditional risk factors and emerging markers for CHD.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Pasternak RC, Abrams J, Greenland P, et al. Identification of CHD and CHD Risk: Is there a detection gap? J Am Coll Cardiol 2003; 41: 1863–1874.

    Article  PubMed  Google Scholar 

  2. American Heart Association. 2003 Heart and Stroke Update. American Heart Association, Dallas, TX, 2002.

    Google Scholar 

  3. http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf. Framingham risk score: access date: July 2002.

  4. Women and Cardiovascular Disease: AHA Biostatistical Fact Sheet.

    Google Scholar 

  5. Mosca L, Grundy SM, Judelson D, et al. Guide to preventive cardiology for women. AHA/ACC Scientific Statement Consensus panel statement. Circulation 1999; 99: 2480–2484.

    Article  PubMed  CAS  Google Scholar 

  6. Mosca L, Manson JE, Sutherland SE, et al. Cardiovascular disease in women: a statement for healthcare professionals from the American Heart Association. Writing Group. Circulation 1997; 96: 2468–2482.

    Article  PubMed  CAS  Google Scholar 

  7. Mosca L, Jones WK, King KB, et al. Awareness, perception, and knowledge of heart disease risk and prevention among women in the United-.States. American Heart Association Women’s Heart Disease and Stroke Campaign Task Force. Arch Pam Med 2000; 9: 506–515.

    CAS  Google Scholar 

  8. Mosca L. Epidemiology and prevention of coronary artery disease. In: Humes D, ed. Kelley’s Textbook of Internal Medicine, 4th Edition. Lippincot, Williams and Wilkins Philadelphia, PA, 2000, pp. 182–191.

    Google Scholar 

  9. Ridker PM, Rifai N, Rose L, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002; 347: 1557–1565.

    Article  PubMed  CAS  Google Scholar 

  10. Vaccarino V, Parsons L, Every NR, et al. Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants. N Engl J Med 1999; 341: 217–225.

    Article  PubMed  CAS  Google Scholar 

  11. Lerner DJ, Kannel WB. Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J 1986; 111: 383–390.

    Article  PubMed  CAS  Google Scholar 

  12. Grundy SM, Balady GJ, Criqui MH, et al. Primary prevention of coronary heart disease: guidance from Framingham: a statement for healthcare professionals from the AHA Task Force on Risk Reduction. American Heart Association. Circulation 1998; 97: 1876–1887.

    Article  PubMed  CAS  Google Scholar 

  13. Ayanian JZ. Increased mortality among middle-aged women after myocardial infarction: searching for mechanisms and solutions. Ann Int Med 2001; 134: 239–241.

    PubMed  CAS  Google Scholar 

  14. Women and smoking: a report of the surgeon general. Executive summary. MMRW 2002;51:1–30.

    Google Scholar 

  15. Tobacco use-United States, 1900–1999. MMWR 1999; 48: 986–993.

    Google Scholar 

  16. Sauer WH, Berlin JA, Strom BL, et al. Cigarette yield and the risk of myocardial infarction in smokers. Arch Intern Med 2002; 162: 300–306.

    Article  PubMed  CAS  Google Scholar 

  17. Willett WC, Green A, Stampfer MJ, et al. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med 1987; 317: 1303–1309.

    Article  PubMed  CAS  Google Scholar 

  18. Nyboe J, Jensen G, Appleyard M, Schnohr P. Smoking and risk of first acute myocardial infarction. Am Heart J 1991; 122: 438–447.

    Article  PubMed  CAS  Google Scholar 

  19. Castelli WP. Cardiovascular disease: pathogenesis, epidemiology, and risk among users of oral contraceptives who smoke. Am J Ob Gyn 1999; 180: S349 - S356.

    Article  CAS  Google Scholar 

  20. LaCroix AZ, Lang J, Scherr P, et al. Smoking and mortality among older men and women in three communities. N Engl J Med 1991; 324: 1619–1625.

    Article  PubMed  CAS  Google Scholar 

  21. Kawachi I, Colditz GA, Stampfer M.1, et al. Smoking cessation in relation to total mortality rates in women. A prospective cohort study. Ann Intern Med 1993; 119: 992–1000.

    PubMed  CAS  Google Scholar 

  22. Rich-Edwards JW, Manson JE, Hennekens CH, et al. The primary prevention of coronary heart disease in women. N Engl J Med 1995; 332: 1758–1766.

    Article  PubMed  CAS  Google Scholar 

  23. Mosca L, Grundy SM, Judelson D, et al. AHA/ACC scientific statement: consensus panel statement. Guide to preventive cardiology for women. American Heart Association/American College of Cardiology. J Am Coll Cardiol 1999; 33: 1751–1755.

    Article  PubMed  CAS  Google Scholar 

  24. Mosca L. The role of hormone replacement therapy in the prevention of postmenopausal heart disease. Arch Int Med 2000; 160: 2263–2272.

    Article  CAS  Google Scholar 

  25. Mendelsohn ME, Karas RH. The protective effects of estrogen on the cardiovascular system. N Engl J Med 1999; 340: 1801–1811.

    Article  PubMed  CAS  Google Scholar 

  26. Cushman M, Legault C, Barrett-Connor E, et al. Effect of postmenopausal hormones on inflammation-sensitive proteins: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Study. Circulation 1999; 100: 717–722.

    Article  PubMed  CAS  Google Scholar 

  27. Mosca L, Collins P, Herrington DM, et al. American Heart Association. Hormone replacement therapy and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 2001; 104: 499–503.

    Article  PubMed  CAS  Google Scholar 

  28. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288: 321–333.

    Article  Google Scholar 

  29. Wilansky S. Pathophysiology, clinical recognition, therapy, and prevention of hypertension. In: Wilansky S, Willerson JT, eds. Heart Disease in Women. Churchill Livingstone, New York, NY, 2000, pp. 339–341.

    Google Scholar 

  30. Stokes J III, Kannel WB, Wolf PA, et al. The relative importance of selected risk factors for various manifestations of cardiovascular disease wmong men and women from 35 to 64 years old: 30 years of follow-up in the Framingham Study. Circulation 1987; 75: V64 - V73.

    Google Scholar 

  31. Stokes J III, Kannel WB, Wolf PA, et al. Blood pressure as a risk factor for cardiovascular disease: the Framingham Study-30 years of follow-up. Hypertension 1989; 13: 113–118.

    Article  Google Scholar 

  32. Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA 1996; 275: 1571–1576.

    Article  PubMed  CAS  Google Scholar 

  33. Stamler J. Blood pressure and high blood pressure: aspects of risk. Hypertension 1991; 18: I95 - I107.

    Article  PubMed  CAS  Google Scholar 

  34. Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995; 25: 305–313.

    Article  PubMed  CAS  Google Scholar 

  35. Hayes SN, Taler SJ. Hypertension in women: current understanding of gender differences. Mayo Clin Proceedings 1998; 73: 157–165.

    Article  CAS  Google Scholar 

  36. Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. Arch Int Med 1993; 153: 598–615.

    Article  CAS  Google Scholar 

  37. hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof. Framingham risk score: access date: July 2002.

    Google Scholar 

  38. Kannel WB. Metabolic risk factors for coronary heart disease in women: perspective from the Framingham Study. Am Heart J 1987; 114: 413–419.

    Article  PubMed  CAS  Google Scholar 

  39. Castelli WP. Cholesterol and lipids in the risk of coronary artery disease-the Framingham Heart Study. Can J Cardiol 1988; (4 Suppl) A:5A–10A.

    Google Scholar 

  40. LaRosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999; 282: 2340–2346.

    Article  PubMed  CAS  Google Scholar 

  41. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial Investigators. N Engl J Med 1996; 35: 1001–1009.

    Article  Google Scholar 

  42. Lipid Study Group. Prevention of cardiovascular events and a broad range of initial cholesterol levels. The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. N Engl J Med 1998; 339: 1349–1357.

    Article  Google Scholar 

  43. Scandinavian Simvastatin Survival Study. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study. Lancet 1994; 344: 1383.

    Google Scholar 

  44. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 1995; 333: 1301–1307.

    Article  PubMed  CAS  Google Scholar 

  45. Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: Results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998; 279: 1615–1622.

    Article  PubMed  CAS  Google Scholar 

  46. Schrott HG, Bittner V, Vittinghoff E, et al. Adherence to National Cholesterol Education Program Treatment goals in postmenopausal women with heart disease. The Heart and Estrogen/Progestin Replacement Study (HERS). The HERS Research Group. JAMA 1997; 277: 1281–1286.

    Article  PubMed  CAS  Google Scholar 

  47. LaRosa JC. The role of diet and exercise in the statin era. Prog Cardiovasc Dis 1998; 41: 137–150.

    Article  PubMed  CAS  Google Scholar 

  48. Lakka H-M, Laaksonen DE, Lakka TA, et al. The Metabolic Syndrome and Total and Cardiovascular Mortality in middle aged men. JAMA 2002; 288: 2709–2716.

    Article  PubMed  Google Scholar 

  49. Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24: 683–689.

    Article  PubMed  CAS  Google Scholar 

  50. Winkleby MA, Pudaric S. Cardiovascular disease risk factors among older black, Mexican-American, and white women and men: an analysis of NHANES III, 939 women1988–1994. Third National Health and Nutrition Examination Survey. J Am Ger Soc 2001; 49: 109–116.

    Article  Google Scholar 

  51. Anonymous. Preventive Cardiology: How can we do Better? Proceedings of the 33rd Bethesda Conference. December 18, 2001, Bethesda, MD. J Am Coll Cardiol 2002; 40; 580–651.

    Article  Google Scholar 

  52. Goraya TY. Leibson CL. Palumbo PJ. Coronary atherosclerosis in diabetes mellitus: a population-based autopsy study. J Am Coll Cardiol 2002; 40: 946–953.

    Article  PubMed  Google Scholar 

  53. Ledru F, Ducimetiere P, Battaglia S, et al. New diagnostic criteria for diabetes and coronary artery disease: insights from an angiographic study. J Am Coll Cardiol 2001; 37: 1543–1550.

    Article  PubMed  CAS  Google Scholar 

  54. Poehlman ET. Menopause, energy expenditure, and body composition. Acta Obst Gynecol Scand 2002; 81: 603–611.

    Article  Google Scholar 

  55. Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003; 289: 76–79.

    Article  PubMed  Google Scholar 

  56. Orlander PR. Diabetes mellitus. In: Wilansky S, Willerson JT, eds. Heart Disease in Women. Churchill Livingstone, New York, NY, 2000, pp. 102–119.

    Google Scholar 

  57. Bakris GL. Williams M. Dworkin L, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kid Dis 2000; 36: 646–661.

    Article  PubMed  CAS  Google Scholar 

  58. Orchard TJ, Forrest KY, Ellis D, Becker DJ. Cumulative glycemic exposure and microvascular complications in insulin-dependent diabetes mellitus. The glycemic threshold revisited. Arch Int Med 1997; 157: 1851–1856.

    Article  CAS  Google Scholar 

  59. Kanaya AM, Grady D, Barrett-Connor E. Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus: a meta-analysis. Arch Int Med 2002; 162: 1737–1745.

    Article  Google Scholar 

  60. Irwin ML, Yasui Y, Ulrich CM, Bowan D, et al. Effect of exercise on total and intra-abdominal body fat in post-menopausal women. JAMA 2003; 289: 323–330.

    Article  PubMed  Google Scholar 

  61. Hecht HS, Superko HR. Electron beam tomography and National Cholesterol. Education Program guidelines in asymptomatic women. J Am Coll Cardiol 2001; 37: 1506–1511.

    Article  Google Scholar 

  62. Festa A, D’Agostino R Jr., Howard G, et al. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000; 102: 42–47.

    Article  PubMed  CAS  Google Scholar 

  63. Tracy RP, Psaty BM, Macy E, et al. Lifetime smoking exposure affects the association of C-reactive protein with cardiovascular disease risk factors and subclinical disease in healthy elderly subjects. Art Thromb Vasc Biol 1997; 17: 2167–2176.

    Article  CAS  Google Scholar 

  64. Redberg RF, Rifai N, Gee L, Ridker PM. Lack of association of C-reactive protein and coronary calcium by electron beam computed tomography in postmenopausal women: implications for coronary artery disease screening. J Am Coll Cardiol 2000; 36: 39–43.

    Article  PubMed  CAS  Google Scholar 

  65. Ridker PM, Buring JE, Shih J, et al. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98: 731–733.

    Article  PubMed  CAS  Google Scholar 

  66. Mosca L. C-reactive protein-to screen or not to screen? N Engl J Med 2002; 347: 1615–1617.

    Article  PubMed  Google Scholar 

  67. Ridker PM, Cushman M, Stampfer MJ, et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336: 973–979.

    Article  PubMed  CAS  Google Scholar 

  68. Ridker PM, Rifai N, Pfeffer MA, et al. Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events (CARE) Investigators. Circulation 1998; 98: 839–844.

    Article  PubMed  CAS  Google Scholar 

  69. Wong TY, Klein R, Sharrett AR, et al. Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study. JAMA 2002; 287: 1153–1159.

    Article  PubMed  Google Scholar 

  70. Shaw LJ, Raggi P, Berman DS, Callister TQ. Gender differences in the prognostic value of coronary calcium. World Congress of Cardiology 2002, Sydney, Australia.

    Google Scholar 

  71. Barzilay JI, Spiekerman CF, Kuller LH, et al. The Cardiovascular Health Study. Prevalence of clinical and isolated subclinical cardiovascular disease in older adults with glucose disorders: the Cardiovascular Health Study. Diabetes Care 2001; 24: 1233–1239.

    Article  PubMed  CAS  Google Scholar 

  72. Mark DB, Shaw LJ, Lauer MS, et al. Bethesda Conference #34–Task Force 5: Is Atherosclerosis Imaging Cost Effective? J Am Coll Cardiol 2003; 41: 1906–1917.

    Article  PubMed  Google Scholar 

  73. Newman AB, Naydeck BL, Sutton-Tyrrell K, et al. Coronary artery calcification in older adults to age 99: prevalence and risk factors. Circulation 2001; 104: 2679–2684.

    Article  PubMed  CAS  Google Scholar 

  74. Shaw LJ, Raggi P, Schisterman E, et al. Prognostic value of cardiac risk factors and coronary artery calcium screening for all cause mortality. Radiol, in press.

    Google Scholar 

  75. Wong ND, Budoff MJ, Pio J, Detrano RC. Coronary calcium and cardiovascular event risk: evaluation by age-and sex-specific quartiles. Am Heart J 2002; 143: 456–459.

    Article  PubMed  Google Scholar 

  76. Hoff JA, Chomka EV, Krainik AJ, et al. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol 2001; 87: 1335–1339.

    Article  PubMed  CAS  Google Scholar 

  77. Health United States, 1998 with Socioeconomic Status and Health Chartbook. www.cdc.gov/nchs. National Center for Health Statistics, Hyattsville, MD, 1998.

    Google Scholar 

  78. Missed Opportunities in preventative counseling for cardiovascular disease: United States 1995. MMWR Morb Mortal Wkly Rep 1998; 47: 91–95.

    Google Scholar 

  79. Stafford RS. Aspirin use is low among United States outpatients with coronary artery disease. Circulation 2000; 101: 1097–1101.

    Article  PubMed  CAS  Google Scholar 

  80. Shaw LJ, Miller DD, Romeis JC, et al. Gender differences in the noninvasive evaluation and management of patients with suspected coronary artery disease. Ann Int Med 1994; 120: 559–566.

    PubMed  CAS  Google Scholar 

  81. Bowling A, Bond M, McKee D, et al. Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex, and clinical indications. Heart 2001; 85: 860–866.

    Article  Google Scholar 

  82. Battleman DS. Callahan M. Gender differences in utilization of exercise treadmill testing: a claims-based analysis. J Healthcare Qual 2001; 23: 38–41.

    Article  CAS  Google Scholar 

  83. Rathore SS, Chen J, Wang Y, et al. Sex differences in cardiac catheterization: the role of physician gender. JAMA 2001; 286: 2849–2856.

    Article  PubMed  CAS  Google Scholar 

  84. Mosca L, McGillen C, Rubenfire M. Gender differences in barriers to lifestyle change for cardiovascular disease prevention. J Wom Health 1998; 7: 711–715.

    Article  CAS  Google Scholar 

Download references

Authors
  1. Lori Mosca MD, MPH, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leslee J. Shaw PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Outcomes Research, American Cardiovascular Research Institute, Atlanta, GA, USA

    Leslee J. Shaw PhD

  2. Division of Cardiology, University of California School of Medicine, San Francisco, CA, USA

    Rita F. Redberg MD, FACC

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer Science+Business Media New York

About this chapter

Cite this chapter

Mosca, L., Shaw, L.J. (2004). Risk Detection and Primary Prevention in Women. In: Shaw, L.J., Redberg, R.F. (eds) Coronary Disease in Women. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-645-4_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-645-4_4

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-275-9

  • Online ISBN: 978-1-59259-645-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation