Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women

Mosca, Lori; Appel, Lawrence J.; Benjamin, Emelia J.; Berra, Kathy; Chandra-Strobos, Nisha; Fabunmi, Rosalind P.; Grady, Deborah; Haan, Constance K.; Hayes, Sharonne N.; Judelson, Debra R.; Keenan, Nora L.; McBride, Patrick E.; Oparil, Suzanne; Ouyang, Pamela; Öz, Mehmet C.; Mendelsohn, Michael E.; Pasternak, Richard C.; Pinn, Vivian W.; Robertson, Rose Marie; Schenck‐Gustafsson, Karin; Sila, Cathy A.; Smith, Sidney C.; Sopko, George; Taylor, Anne L.; Walsh, Brian W.; Wenger, Nanette K.; Williams, Christine L.

doi:10.1161/01.cir.0000114834.85476.81

Cited by 709 publications

(400 citation statements)

References 20 publications

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“…In this manner, it may prevent or delay the onset of high BP and therefore have large effect on public health. 48 In summary, this study showed early haemodynamic, metabolic and hormonal abnormalities in nonhypertensive young women offspring of hypertensive parents when compared with nonhypertensive women offspring of nonhypertensive parents. This study also showed that several of these abnormalities were increased in women with a strong family history of hypertension (two hypertensive parents), suggesting that there is an early vascular, metabolic and hormonal involvement in a familial hypertensive disorder.…”

Section: Limitationsmentioning

confidence: 60%

“…22 Moreover, plasma NOx following GXT are related to endothelial function. 47 Clinical implication Cardiovascular disease remains the leading cause of death in most developed area of the world, 48 whereas ischaemic heart disease and stroke are the leading killers among women. 49 Extensive data indicate that the risk of death from ischaemic heart disease and stroke increases progressively and linearly with increasing BP in women and men.…”

Section: Limitationsmentioning

confidence: 99%

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Haemodynamic, metabolic and neuro-humoral abnormalities in young normotensive women at high familial risk for hypertension

Ciolac

Bocchi²,

Bortolotto³

et al. 2010

J Hum Hypertens

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We analysed the haemodynamic, metabolic and hormonal status at rest and in response to exercise, in young normotensive women with two hypertensive parents (FH þ þ ; n ¼ 17; 25.1±4.8 years), one hypertensive parent (FH þ ; n ¼ 18; 24.9 ± 4.1 years) and normotensive parents (FHÀ; n ¼ 15; 25.3 ± 3.8 years). Casual and ambulatorial blood pressure (BP), carotid-femoral pulse wave velocity (PWV) and biochemistry were analysed. BP, nor-epinephrine (NE), epinephrine (EPI), endothelin-1 (ET-1) and nitrite/nitrate (NOx) levels were also analysed during a graded exercise test (GXT). Casual and ambulatorial BP were not different between groups, but PWV was 7.5 and 12.6% higher in FH þ þ than FH þ and FHÀ, respectively, and 4.8% higher in FH þ than FHÀ (Pp0.01). Insulin and insulin-to-glucose ratio were increased in FH þ þ and FH þ (Po0.05), and lowdensity lipoprotein (LDL)-cholesterol tended to be higher only in FH þ þ (P ¼ 0.07). FH þ þ showed higher exercise and recovery diastolic BP and EPI levels, and increased resting, exercise and recovery NE, and ET-1 levels than FHÀ (Po0.05). FH þ showed only greater resting, exercise and recovery NE, and rest ET-1 (Po0.05). Resting, exercise and recovery NOx were lower in FH þ þ and FH þ than FHÀ (Po0.01). Haemodynamic, metabolic and hormonal abnormalities were presented in nonhypertensive young women offspring of hypertensive parents before any increase in BP. Greater abnormalities were observed in women with a strong family history of hypertension (FH þ þ ). These results suggest that there is an early vascular, metabolic and hormonal involvement in a familial hypertensive disorder.

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Section: Limitationsmentioning

confidence: 60%

Section: Limitationsmentioning

confidence: 99%

Haemodynamic, metabolic and neuro-humoral abnormalities in young normotensive women at high familial risk for hypertension

Ciolac

Bocchi²,

Bortolotto³

et al. 2010

J Hum Hypertens

View full text Add to dashboard Cite

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“…The data from the current study indicate that even modestly elevated BMI (≥25 kg/m 2 ) is associated with abnormal endothelial function, supporting the current recommendations for an ideal BMI of 18.5-24.9 kg/m 2 in women. 10 These findings suggest that women who are overweight but do not meet criteria for obesity (i.e., BMI ≥30 kg/m 2 ) may still be at increased risk for cardiovascular events.…”

Section: Risk Factor Modification and Endothelial Functionmentioning

confidence: 91%

“…Elevated body mass index (BMI) was defined as a body mass index ≥25 kg/m 2 . 10,11 Subjects with a history of diabetes, hypertension, or hyperlipidemia were allowed to continue on their usual medications. The following clinical variables were considered to be cardiac risk factors: age>65 years, hypertension, hypercholesterolemia, diabetes mellitus, current smoking, family history of premature coronary artery disease, and BMI ≥25 kg/m 2 .…”

Section: Methodsmentioning

confidence: 99%

Modestly Overweight Women Have Vascular Endothelial Dysfunction

Patel

Han

Kuvin

et al. 2009

Clinical Cardiology

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Background: Vascular endothelial dysfunction occurs early in the atherosclerotic process and is predictive of cardiovascular prognosis. However, the association between specific cardiovascular risk factors and endothelial dysfunction in women has not been well characterized. This study examined the relationship between endothelial dysfunction and cardiovascular risk factors (body mass index [BMI] ≥25 kg/m 2 , current smoking, age, diabetes, hypertension, hypercholesterolemia, and family history of early coronary heart disease) in a population of women that included those already being treated for risk factors. Methods: Endothelial function was assessed by brachial artery ultrasound flow-mediated vasodilation (FMD) in 185 consecutive women without a history of coronary heart disease. Women with hypertension, diabetes, or hyperlipidemia were allowed to continue on their usual therapy. Results: There was an inverse linear association between age and FMD. Subjects who were active smokers had lower FMD compared with nonsmokers, and subjects with BMI ≥25 kg/m 2 had lower FMD than subjects with BMI <25 kg/m 2 . FMD in overweight women (BMI ≥25 and <30 kg/m 2 ) was similar to that of obese women (BMI ≥30 kg/m 2 ). Multivariate analysis demonstrated that body mass index, current smoking, and age were independent predictors of endothelial dysfunction in this population. Conclusion: Modestly elevated BMI, smoking, and age predict endothelial dysfunction in women, even in the presence of treatment for other atherosclerotic risk factors. These findings demonstrate the importance of modest elevation in BMI as a risk factor for impaired vascular health in women, and underscore the need for focusing further attention on lifestyle modification as a component of cardiovascular disease prevention. IntroductionVascular endothelial dysfunction develops early in the atherosclerotic process and cardiac risk factors are associated with vascular endothelial dysfunction. Several studies have demonstrated that the presence of vascular endothelial dysfunction predicts an increase in risk of future cardiac events 1 -5 in both men and women. Cardiovascular risk factors such as hypertension, diabetes, hyperlipidemia, smoking, and obesity have been observed to be associated with vascular endothelial dysfunction, even prior to the development of clinically evident coronary atherosclerosis. Furthermore, treatment of cardiovascular risk factors can reverse endothelial dysfunction 6,7 in some patients.Although the association between cardiac risk factors and endothelial dysfunction has been observed in prior studies, 8 the relationship between specific risk factors and endothelial dysfunction in women in the current treatment era has not been well established. There is evidence that there are gender-based differences in vascular endothelial function, supporting the concept of investigating the relationship between atherosclerotic risk factors and endothelial dysfunction specifically in women. 9 The purpose of this study was to examine the relation...

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“…11 Mild hyperinsulinemia, which may be a cause or consequence of preeclampsia, possibly contributes towards increased risk of cardiovascular disease (CVD) in the future, with higher likelihood of developing diseases such as diabetes mellitus (DM), high systemic arterial pressure (SAP) and ischemic coronary disease. 11,12 Although the role of preeclampsia as another non-classical risk factors for CVD among women has become increasingly recognized, 13 the traditional risk factors (positive family history of cardiovascular disease, low levels of physical activity, high BMI and central obesity) interact to compound the cardiovascular risk. The Framingham study model used age, smoking, systolic blood pressure and total and high-density lipoprotein cholesterol (HDL-c) to estimate the 10-year risk of CVD in women.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for cardiovascular disease ten years after preeclampsia

et al. 2010

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CONTEXT AND OBJECTIVE: Preeclampsia is a gestational disease that occurs mainly among nulliparous women after the 20 th week of gestation, and frequently close to delivery. The effects of preeclampsia on women's blood pressure over the long term are still controversial. Patients with recurrent preeclampsia or preeclampsia in the early stages of pregnancy appear to present higher risk of hypertension. The aim of this study was to determine the risk factors for cardiovascular disease among women with preeclampsia 10 years earlier. DESIGN AND SETTING:Cross-sectional study at Hospital de Clínicas de Porto Alegre (HCPA). METHODS:Forty women with preeclampsia and 14 normotensive pregnant women followed up 10 or more years earlier at HCPA underwent clinical and laboratory examinations. Spearman's correlation coefficient was used to correlate body mass index (BMI) and systolic and diastolic pressures. The risk of developing hypertension was measured using the chi-square test. P < 0.05 was considered significant. RESULTS:The patients with preeclampsia 10 or more years earlier had significantly higher diastolic blood pressure (P = 0.047), BMI (P = 0.019) and abdominal circumference (P = 0.026). They presented positive correlations between BMI and diastolic blood pressure (0.341; P = 0.031) and between BMI and systolic blood pressure (0.407; P = 0.009). CONCLUSION:The patients with preeclampsia 10 or more years earlier had significantly higher diastolic blood pressure, BMI and abdominal circumference than did the control group. This emphasizes the importance of long-term follow-up assessment for cardiovascular risk factors among patients with preeclampsia.RESUMO CONTEXTO E OBJETIVO: Pré-eclâmpsia é uma doença gestacional que ocorre principalmente em mulheres nulíparas, após a vigésima semana de gestação e frequentemente próximo do parto. Os efeitos da pré-eclâmpsia sobre a pressão sanguínea das mulheres a longo prazo ainda são controversos.Pacientes com pré-eclâmpsia recorrente ou pré-eclâmpsia na fase inicial da gestação parecem apresentar maior risco para hipertensão. O objetivo foi determinar os fatores de risco para doença cardiovascular em mulheres com pré-eclâmpsia há 10 anos. TIPO DE ESTUDO E LOCAL: Estudo transversal, realizado no Hospital de Clínicas de Porto Alegre (HCPA).MÉTODO: Quarenta mulheres com pré-eclâmpsia e 14 mulheres grávidas com pressão arterial normal acompanhadas há 10 anos ou mais no HCPA foram submetidas a exames clínicos e laboratoriais. Para se encontrar a correlação entre índice de massa corporal (IMC) e as pressões sistólica e diastólica, foi calculado o coeficiente de correlação de Spearman. O risco de desenvolvimento de hipertensão foi calculado através do teste de qui-quadrado. P < 0,05 foi considerado significante. RESULTADOS:Pacientes com pré-eclâmpsia há 10 anos ou mais tiveram pressão arterial diastólica (PAD) (P = 0,047), IMC (P = 0,019) e circunferência abdominal (P = 0,026) mais elevadas e apresentaram correlações positivas entre IMC e PAD (0,341, P = 0,031) e sistólica (0,4...

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Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women

Cited by 709 publications

References 20 publications

Haemodynamic, metabolic and neuro-humoral abnormalities in young normotensive women at high familial risk for hypertension

Haemodynamic, metabolic and neuro-humoral abnormalities in young normotensive women at high familial risk for hypertension

Modestly Overweight Women Have Vascular Endothelial Dysfunction

Risk factors for cardiovascular disease ten years after preeclampsia

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