A recent update on cardiovascular disease prevention, diagnosis, and therapy in women is provided in an article published in the journal Medical Clinics of North America.
In the United States, cardiovascular disease (CVD) is the leading cause of death. Women are at a higher risk because they encounter inequities in CVD management, such as delayed diagnosis and a lack of guideline-directed treatment. However, good primary care facilities can help prevent and reduce the incidence of atherosclerotic CVD.
Preventing cardiovascular illness
The American Heart Association recently expanded from “Life’s Simple 7” (a prescription for perfect cardiovascular health) to “Life’s Essential 8” in order to build a framework for atherosclerotic CVD therapy.
“Life’s Essential 8” emphasizes a balanced diet, regular physical activity, limiting nicotine exposure, getting enough sleep, and maintaining blood cholesterol, blood sugar, and blood pressure levels.
Dietary Guidelines for the Mediterranean Diet
The Mediterranean diet is a well-known dietary regimen for reducing the risk of cardiovascular and metabolic problems. The diet has been shown to reduce the risk of cardiovascular disease and myocardial infarction by 30%.
The Mediterranean diet emphasizes fresh and seasonal vegetables and fruits, as well as minimally processed whole grains or bread. Wine can be served with the meals. The primary fat source is olive oil, with white meat, eggs, beans, and fish allowed a few times each week. However, red meat and processed meat are largely excluded.
Obesity increases the risk of CVD by 64% and 46% in men and women, respectively. Even a 5-10% weight loss in obese or overweight people can bring health benefits. A healthy diet and regular exercise are essential strategies for weight loss and maintenance. A 25-35% weight loss through surgical treatments can lessen the incidence of CVD.
The US Food and Drug Administration (FDA) has approved two glucagon-like peptide-1 receptor agonists, liraglutide and semaglutide, for the pharmaceutical therapy of obesity (GLP1-RAs). In clinical trials, liraglutide was reported to lower body weight by nearly 15%.
Tirzepatide, an anti-diabetic medication licensed by the FDA, has been shown to reduce body weight by more than 20%. This medication combines GIP (glucose-dependent insulinotropic polypeptide) and GLP1-RA. However, when anti-obesity medications are stopped, there is a general trend of weight rebound.
Blood cholesterol control
In people with atherosclerotic CVD, statin treatment is widely utilized as a supplemental preventive strategy. According to the atherosclerotic CVD Pooled Cohort Equation (PCE), a 10-year atherosclerotic CVD risk of less than 5% and greater than 20% is clinically considered to classify patients aged 40 to 75 years into low-risk and high-risk groups. For assessing cholesterol risk, the coronary artery calcium (CAC) score outperforms PCE.
Clinical cholesterol management recommendations advise low-risk individuals to engage in lifestyle modifications and high-intensity statin medication for high-risk persons aged 40 to 75. Individuals who fall between these two categories should receive moderate-intensity statin treatment. Other LDL-lowering drugs, such as ezetimibe and proprotein convertase subtilisin/kexin type-9 inhibitors, are advised for people who cannot take statin therapy.
Controlling blood sugar levels
Accurate type 2 diabetes care is critical for lowering CVD risk. While statin medication is suggested for diabetic patients aged 40 to 75 years, metformin and lifestyle changes are recommended to manage diabetes in the beginning.
GLP1-RA or sodium-glucose cotransport-2 (SGLT2) inhibitor drugs are recommended by the American Diabetes Association for diabetes care in persons at high risk for or with clinically confirmed cardiovascular or kidney problems. These medications are also useful in the treatment of CVD in persons who do not have diabetes.
Women with a history of gestational diabetes, preeclampsia, polycystic ovarian syndrome, or obesity, according to specialists, should be evaluated for diabetes and treated with GLP1-RAs and SGLT2 inhibitors for cardiovascular advantages.
Controlling blood pressure
For cardiometabolic risk management, annual monitoring of normal blood pressure (120/80 mm Hg) is indicated. Elevated blood pressure (120 to 129/80 mm Hg) requires lifestyle changes. Antihypertensive medicine is required for stage 1 hypertension (130 to 139/80 to 89 mm Hg) and stage 2 hypertension (BP 140/90 mm Hg).
Despite the fact that menopause is an increased risk factor, women experience inequities in hypertension diagnosis and management. Calcium channel blockers (particularly nifedipine), beta-blockers, and diuretics are recommended for blood pressure management in women of reproductive age.
Aspirin for CVD prevention
Low-dose aspirin is a well-established secondary prevention of CVD intervention. However, because of the danger of bleeding, the method is not suggested for primary prevention. Primary prevention with low-dose aspirin is especially not advised for adults over the age of 60.
CVD diagnosis and treatment
A major criterion for evaluating CVD is including acute coronary syndrome (ACS) in the differential diagnosis. If ACS is suspected, an ECG should be interpreted right away. Women are more likely than men to develop ACS.
The major biomarkers for detecting myocardial damage are cardiac troponin I or T and high-sensitivity troponin. Exercise stress testing is recommended for low-risk patients to detect coronary disease. Various cardiac imaging modalities are efficient for illness diagnosis in patients with intermediate risk.
Cardiac testing with minimal radiation risk is advised for pregnant and breastfeeding women. However, iodinated contrast and gadolinium tests are not suggested in these patients.
Long-term CVD management is worse in women due to missed clinic appointments or delayed diagnosis due to extremely varied symptom presentations. Women are likewise less likely to obtain guideline-directed therapy than men.
Cases of spontaneous coronary artery dissection and microvascular illness have been on the rise among various CVDs in recent years. To treat spontaneous coronary artery dissection, lipid-lowering medications, beta-blockers, or antiplatelet treatment are indicated.
Microvascular disease should be managed with targeted medicines such as beta-blockers, calcium channel blockers, and long-acting nitrates.