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【科普】女性心脏病指导
American Heart Association Warns of Heart Attack Risk for Women With Some Pregnancy Complications
By Denise MannWebMD Health News
Reviewed by Laura J. Martin, MD
Feb. 15, 2011 -- Women who have been diagnosed with preeclampsia, pregnancy-induced hypertension, or diabetes during pregnancy are now considered at risk for heart attack or stroke going forward, according to newly updated guidelines from the American Heart Association (AHA).
The 2011 update to the AHA’s cardiovascular prevention guidelines for women recategorizes a woman’s risk for heart disease. It also serves up some gender-specific prevention advice on diet and daily aspirin therapy in women at high risk of coronary heart disease in order to prevent heart attacks.
The guidelines are being published in the journal Circulation and are based on expert reviews of the medical literature.
Women are now classified in three groups: high risk for heart disease, at risk, or ideal cardiovascular health. The high-risk group changed little from previous years and includes women with established heart disease, chronic kidney disease, or diabetes, among other risk factors.
But “the at-risk group now captures women with pregnancy complications such as preeclampsia, gestational diabetes, or pregnancy-induced hypertension,” says guideline chair Lori Mosca, MD, PhD. Mosca is director of preventive cardiology at New York-Presbyterian Hospital and a professor of medicine at Columbia University Medical Center in New York City.
“These complications are the equivalent of a failed stress test,” she says. Doctors use exercise stress tests to diagnose heart disease.
“If you do develop one of these conditions during pregnancy, it is an unmasking of the risk that tells us your vascular system doesn’t function ideally,” Mosca says.
”These complications are an opportunity to detect early that there is a problem,” she says. You can then follow up with your primary care doctor to evaluate your overall cardiac risk and quickly start appropriate prevention strategies.
“If you developed gestational diabetes, follow up and say, ‘What can I do to prevent heart disease and diabetes?’” she says. Your doctor may recommend weight loss, aggressive lifestyle changes, and possibly medication, she says. “We are unmasking a problem early so that we can prevent full-blown cardiovascular disease.”
Educating Women About Heart Risk
The new information about pregnancy complications and heart risk is “a big deal,” says guideline author Ileana L. Pi?a, MD, a professor of medicine and epidemiology and biostatistics at Case Western Reserve University in Cleveland.
“Your blood pressure may return to normal after pregnancy and your blood sugar may return to normal too, but don’t ignore these symptoms,” she says.
Some of the onus about getting the word out about pregnancy complications and heart risks falls on ob-gyns, says Mary Rosser, MD, PhD, an assistant professor in the department of obstetrics and gynecology and women’s health at Montefiore Medical Center in the Bronx, N.Y.
“We are seeing younger women and providing their primary care [and] we can make an impact,” she says.
“When I see patients with gestational diabetes, I say even though you are thin, you are still at risk for developing diabetes later on in life so you need to stay on top of this,” she says.
Other inflammatory diseases such as rheumatoid arthritis (RA) and lupus also place a woman at risk for heart disease, according to the updated guidelines.
Diseases like RA and lupus are more common in women and sometimes have heart disease manifestations.
Dietary Recommendations for Women
While the new guidelines cast a wider net to catch women at risk for heart disease, they also call for aggressive steps to control known risk factors such as high blood pressure and obesity.
For example, the guidelines call for less than 1,500 milligrams of salt per day for all women. Sugar is limited to five or fewer servings per week.
“We have a lot more data that the sodium content of food in America is too high and the prevalence of hypertension in this country is also high,” Pi?a says. “We believe that lowering sodium content can markedly lower blood pressure, particularly among African-American women whose hypertension is salt-sensitive."
As for sugar, “the high content of sugar in foods is more fodder for the current obesity epidemic and obesity is highly correlated with the onset of diabetes and metabolic syndrome,” she says. Metabolic syndrome is a cluster of risk factors linked to development of heart disease. ”Cutting down on sugar will aid in weight loss, lower blood sugar, and your cholesterol will also go down,” she says.
“It is a bit radical, especially the sodium intake,” says Suzanne Steinbaum, MD, director of women and heart disease at Lenox Hill Hospital in New York City. Steinbaum reviewed the guidelines for WebMD but did not serve on the writing committee.
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作者:admin@医学,生命科学 2011-02-16 23:37
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