In its first overhaul in 4 years of guidelines on cardiovascular disease (CVD) prevention in women, the American Heart Association (AHA) has lowered the threshold for who is considered high risk from a ≥20% risk of dying from a heart attack in the next 10 years to a ≥10% risk of dying from any cardiovascular event in the next 10 years, says a Heartwire article.
The reasons behind the change, say experts, is that primary risk-assessment tools that are used tend to underestimate risk in women. Also, women are more likely than men to experience a stroke vs a heart attack. "… [W]e wanted to make sure we encompass that in the risk assessment," says the chair of the writing committee, Lori Mosca, MD, who is the lead author of the manuscript, which was published online February 16, in Circulation.
The other important change in the guidelines is a paradigm shift from evidence-based to effectiveness-based. "We recognize that the guidelines themselves are based on science, but we also acknowledge that the results that we see in clinical practice are often less impressive than what we would see in clinical trials, because women are often older and have more comorbidities…" says Mosca, who says that physicians should look at the balance of benefits and risks in the real-world setting. "There are certain conditions where they might not want to be as aggressive as the guidelines suggest—for example, older frail women who are more likely to have side effects."
In addition, the new guidelines categorize women who have had pregnancy complications as being at risk and "soften" a number of prior recommendations.