Heart Disease in Women: Risk Factor Goals

In the American Heart Association's latest recommendations to prevent heart disease in women, they summarized several risk factor goals that all family physicians should know by heart (pun intended) but which may not be clear to the women in our lives.  And if you don't know where you're supposed to go, how will you get there, right?

So be sure you know your blood pressure.  It's not enough to be told "it's good" or "it's normal".  You need to know how good or how normal.  AHA acknowledges the goal of an optimal blood pressure of <120/80mm Hg be obtained & maintained via lifestyle interventions.

Medication should be started when blood pressure is >140/90mm Hg (or >130/80mm Hg in those with chronic kidney disease and/or diabetes).  If the women in your life doesn't like the side effects of any particular blood pressure medication, make sure she addresses her concerns with her family physician.  In this day & age, given all the various options available to us, there is no reason (aside from cost) that someone should have to suffer from medication side effects.  This is a situation where the pound of cure should really be weightless (free of side effects).

The women in our lives also need to know their cholesterol numbers.  Again, good enough really isn't.  Specifically, the AHA acknowledges the following optimal goals: LDL <100mg/dL, HDL >50mg/dL, triglycerides <150mg/dL, and non-HDL (total cholesterol minus HDL) <130mg/dL in all women via lifestyle interventions.

Where I disagree with the AHA (and NCEP ATPIII) is their stratification as to when to start medication.  They approach this from a public health perspective (in order to ration care & save money).  However, when I meet with someone, we develop a plan specific to their needs & goals, rather than accepting a good enough attitude that comes from treating groups, rather than individuals, in order to save money for society.

AHA notes that niacin or fibrates can be used when HDL is low (<50mg/dL) or non-HDL is high (>130mg/dL) but only in high risk women after their LDL goal is reached.  High risk women are those with known heart disease or whose risk is calculated to be >20% over the next 10 years.  This can be derived via the Framingham Risk Calculator and the Reynolds Risk Score.

Finally, while the AHA did not discuss body composition, they did recommend using lifestyle interventions to reach a goal waist <35 inch and appropriate body weight such that body mass index is <25kg/m2.