Katherine Sherif

Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update: A Guideline From the American Heart Association

Substantial progress has been made in the awareness, treatment, and prevention of cardiovascular disease (CVD) in women since the first women-specific clinical recommendations for the prevention of CVD were published by the American Heart Association (AHA) in 1999.1 The myth that heart disease is a “mans disease” has been debunked; the rate of public awareness of CVD as the leading cause of death among US women has increased from 30% in 1997 to 54% in 2009.2 The age-adjusted death rate resulting from coronary heart disease (CHD) in females, which accounts for about half of all CVD deaths in women, was 95.7 per 100 000 females in 2007, a third of what it was in 1980.3,4 Approximately 50% of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies.4 Major randomized controlled clinical trials such as the Womens Health Initiative have changed the practice of CVD prevention in women over the past decade.5 The investment in combating this major public health issue for women has been significant, as have the scientific and medical achievements. Despite the gains that have been made, considerable challenges remain. In 2007, CVD still caused ≈1 death per minute among women in the United States.6 These represent 421 918 deaths, more womens lives than were claimed by cancer, chronic lower respiratory disease, Alzheimer disease, and accidents combined.6 Reversing a trend of the past 4 decades, CHD death rates in US women 35 to 54 years of age now actually appear to be increasing, likely because of the effects of the obesity epidemic.4 CVD rates in the United States are significantly higher for black females compared with their white counterparts (286.1/100 000 versus …

Prevalence of hot flushes and night sweats around the world: a systematic review.

Objective Many studies have evaluated the relationships between ethnicity and culture, prevalence of menopausal symptoms, and attitudes toward them, but few have assessed menopausal symptoms across cultures world-wide. This paper aims to systematically review the prevalence of hot flushes and night sweats, two prevalent symptoms of menopause, across the menopausal stages in different cultures and considers potential explanations for differences in prevalence rates. Design Sixty-six papers formed the basis for this review. Studies were organized by geographic region, and results are presented for North America, Europe, East Asia, Southeast Asia, Australia, Latin America, South Asia, Middle East, and Africa. Studies were included if they provided quantitative information on the occurrence of hot flushes. This report focuses on hot flushes and night sweats, the most common menopausal symptoms reported in epidemiologic studies. Results Studies reviewed indicate that vasomotor symptoms are highly prevalent in most societies. The prevalence of these symptoms varies widely and may be influenced by a range of factors, including climate, diet, lifestyle, womens roles, and attitudes regarding the end of reproductive life and aging. Patterns in hot flush prevalence were apparent for menopausal stages and, to a lesser degree, for regional variation. Conclusions Caregivers should recognize that variations exist and ask patients specific questions about symptoms and their impact on usual functioning.

Benefits and risks of oral contraceptives

The major benefits of modern low-dose oral contraceptives include relative safety and a high degree of efficacy, decreasing the need for abortion or surgical sterilization; reduced risks of bacterial (but not viral) pelvic inflammatory disease and of endometrial and ovarian cancer; improved menstrual regularity, with less dysmenorrhea and blood flow; and, when low-dose combination (not progestogen-only) oral contraceptives are used, reduced acne and hirsutism. Major risks are cardiovascular. Preliminary data from nonrandomized studies suggest that oral contraceptives containing third-generation progestogens are associated with increased risk of venous thromboembolism, particularly in carriers of the coagulation factor V Leiden mutation. The risk of arterial thrombosis, such as myocardial infarction or stroke, may be directly related to estrogen dose, particularly in women who have hypertension, smoke, or are >35 years old. Considering that only users aged >/=30 years who smoke >/=25 cigarettes/d have a higher estimated mortality rate than that of pregnant women, the benefits of oral contraceptives appear to outweigh their risks.

Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians.

Venous thromboembolism is a common condition affecting 7.1 persons per 10,000 person-years among community residents. Incidence rates for venous thromboembolism are higher in men, African-Americans, and increase substantially with age. It is critical to treat deep venous thrombosis at an early stage to avoid development of further complications, such as pulmonary embolism or recurrent deep venous thrombosis. The target audience for this guideline is all clinicians caring for patients who have been given a diagnosis of deep venous thrombosis or pulmonary embolism. The target patient population is patients receiving a diagnosis of pulmonary embolism or lower-extremity deep venous thrombosis.

Blood Pressure Increase With Impaired Glucose Tolerance in Young Adult American Blacks

Hypertension and non-insulin-dependent diabetes mellitus are more prevalent in blacks than whites. The convergence of these 2 disorders augments the expression and severity of cardiovascular disease. The purpose of this study was to determine whether alterations in glucose metabolism are related to an increase in blood pressure (BP). This study was conducted on 304 nondiabetic blacks (mean age=32 years). Measurements in all subjects included BP, anthropometric measures, oral glucose tolerance test, insulin clamp to measure insulin sensitivity, and plasma lipids. The sample was stratified according to plasma glucose on oral glucose tolerance test to normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM). A 2-way ANOVA was performed to determine differences between the metabolic groups. With the use of American Diabetic Association criteria, 20.4% of the samples were classified as IGT and 5.9% were diabetic. A significant increase in BP existed from NGT to IGT to DM, which was stronger in women than men (systolic blood pressure in women: NGT=122, IGT=127, and DM=140 mm Hg, P<0.001) with a significant linear trend (P<0.001). With the use of body mass index as a covariate, the group difference in BP remained significant (P=0.006). Measures of insulin sensitivity demonstrated significant metabolic group differences (P<0.001) with a linear trend (P<0.001) of decreasing insulin sensitivity from NGT to DM. These results indicate that early alterations in glucose metabolism effects an upward shift in BP. The higher BP in IGT and DM may be due to vascular endothelial cell resistance to insulin action.

The Association of Left Ventricular Mass with Cardiovascular Risk Factors in African American Women

BACKGROUND African American women have disproportionately high rates of myocardial infarction and stroke. Left ventricular hypertrophy is an independent risk factor for cardiovascular disease. Increases in left ventricular mass (LVM) may precede the expression of hypertension. The purpose of this study was to determine whether LVM is related to cardiovascular risk variables in healthy, premenopausal African American women. METHODS Normotensive or borderline hypertensive nondiabetic African American women (N = 52; mean age, 31 years) underwent anthropometric and blood pressure measurements, oral glucose tolerance test, euglycemic clamp, fasting lipid profile, and two-dimensional echocardiography. LVM was calculated by the cube root formula and adjusted for height [LVM index (LVMI)]. RESULTS LVMI correlated with body mass index (r = .36, P = 0.009), systolic blood pressure (r = .44, P = 0.001), diastolic blood pressure (r = .43, P = 0.002), and central body fat (r = .42, P = 0.002). LVMI also directly correlated with lipoprotein (a) (r = .34, P = 0.02). Significant independent relationships of other metabolic variables with LVMI were not detected. DISCUSSION These data show that increased LVMI is associated with body mass index and central obesity, but not with lipids, insulin resistance, or insulin sensitivity. LVMI is also associated with blood pressure before the expression of severe hypertension in healthy, premenopausal African American women.

The information problem in women's health: a piece of the solution.

Researchers and practitioners in the womens health field frequently express difficulty in locating information about sex and gender differences in medicine. This study hypothesized that a major reason for this is that when sex and gender differences are reported in the literature, they are not indexed in a way that facilitates locating the information. Search strategies were devised for the MEDLINE database to create three bibliographies related to women in each of six clinical areas. At one end of the spectrum, the strategy maximized precision (a high number of articles found were relevant). At the other end, recall was maximized (a high number of the known relevant articles were found). One intermediate strategy was formulated in an attempt to find the best combination. Precision and recall were measured for each strategy by performing the searches (18 total) and then randomly selecting 10 retrieved references. First, the abstracts were judged for relevance. Whenever it was not clear from the abstract that the article was relevant, women in the field of womens health evaluated the original article. The criterion for relevance was provision of clinically useful information about the health of women. The results show that it is possible to devise an efficient MEDLINE strategy to retrieve on average 64% of articles reporting sex or gender differences. This is consistent with the results of other studies of retrieval in MEDLINE. Strategies for effective searching are recommended.

Principles of Practice

For decades, menopausal-range women have been treated as a homogenous subgroup, with HT seen as a one-size-fits-all prescription. Hormone therapy can no longer be expected to be the automatic prescription and “cure” for female aging that clinicians only a few years ago desired it to be. Today, HT and menopause management demand a focus on managing individual symptoms, paying close attention to what the patient reports, understanding the science, and helping patients demystify the many confusing popular reports they may have heard about menopause and about hormone therapies. The menopausal-range years offer a window of therapeutic opportunity, in which clinicians can help women move from their years of reproductive potential, to the postmenopausal period, with concern for symptomatic relief and general good health.

Perceptions of a Healthy Diet: Insights From a 3-Country Survey

Limited data exist on consumer beliefs and practices on the role of omega-3 fatty acid and vitamin D dietary supplements and health. For this reason, the Global Health and Nutrition Alliance conducted an online survey in 3 countries (n = 3030; United States = 1022, Germany = 1002, United Kingdom = 1006) of a convenience sample of adults (aged 18–66 years) who represented the age, gender, and geographic composition within each country. More than half of the sample (52%) believed they consume all the key nutrients needed for optimal nutrition through food sources alone; fewer women (48%) than men (57%), and fewer middle-aged adults (48%) than younger (18–34 years [56%]) and older (≥55 years [54%]) adults agreed an optimal diet could be achieved through diet alone. Overall, 32% reported using omega-3s (45% in United States, 29% in United Kingdom, and 24% in Germany), and 42% reported using vitamin D dietary supplements (62% in United States, 32% in United Kingdom, and 31% in Germany). Seventy eight percent of the sample agreed that omega-3 fatty acids are beneficial for heart health; however, only 40% thought that their diet was adequate in omega-3 fatty acids. Similarly, 84% agreed that vitamin D was beneficial to overall, and 55% of adults from all countries were unsure or did not think they consume enough vitamin D in their diet. For most findings in our study, US adults reported more dietary supplement use and had stronger perceptions about the health effects of omega-3s and vitamin D than their counterparts in the United Kingdom and Germany. Nevertheless, the consistent findings across all countries were that adults are aware of the importance of nutrition, and most adults believe their diet is optimal for health. Our data serve to alert dietitians and health professionals that consumers may have an elevated sense of the healthfulness of their own diets and may require guidance and education to achieve optimal diets.

Discrepancy between Knowledge and Perceptions of Dietary Omega-3 Fatty Acid Intake Compared with the Omega-3 Index

Little is known about the relationship between perceptions of nutrient adequacy and biomarkers of nutrition status. This cross-sectional study of U.S. and German adults (n = 200; 18–80 years) compared dietary practices, knowledge, and beliefs of omega-3 fatty acids (O3-FA) with the omega-3 index (O3-I), an erythrocyte-based biomarker associated with cardiovascular disease (CVD) risk. More than half of adults believed that O3-FAs are beneficial for heart and brain health and could correctly identify the food sources of O3-FA. However, the mean O3-I in the U.S. (4.3%) and Germany (5.5%) puts the majority of adults sampled (99%) in intermediate or high CVD-risk categories. More Americans were considered at high CVD-risk (40%) when compared with Germans (10%). In the U.S., but not Germany, women had a significantly higher O3-I than men (4.8% vs. 3.8%, p < 0.001). In the intermediate CVD-risk group, about one-third of adults in both countries (30% in the U.S. and 27% in Germany) believed their diet was adequate in O3-FA. Notably, mean O3-I concentrations did not significantly differ with dietary perceptions of adequacy. More adults in Germany (26%) than in the U.S. (10%) believed that dietary supplements are needed to achieve a balanced diet. In spite of adequate knowledge about food sources and a consistent belief that O3-FA are important for health, very few participants had O3-I concentrations in the range for CVD protection.