Evaluation of the American Heart Association cardiovascular disease prevention guideline for women
Open accessAbstract
Background— The 2007 update to the American Heart Association (AHA) guidelines for cardiovascular disease prevention in women recommend a simplified approach to risk stratification. We assigned Women’s Health Initiative participants to risk categories as described in the guideline and evaluated clinical event rates within and between strata. Methods and Results— The Women’s Health Initiative enrolled 161 808 women ages 50 to 79 years and followed them prospectively for 7.8 years (mean). Applying the 2007 AHA guideline categories, 11% of women were high risk, 72% at-risk, and 4% at optimal risk; 13% of women did not fall into any category, that is, lacked risk factors but did not adhere to a healthy lifestyle (moderate intensity exercise for 30 minute most days and <7% of calories from saturated fat). Among high risk, at-risk, and optimal risk women, rates of myocardial infarction/coronary death were 12.5%, 3.1%, and 1.1% per 10 years ( P for trend <0.0001); the event rate was 1.3% among women who could not be categorized. We observed a graded relationship between risk category and cardiovascular event rates for white, black, Hispanic, and Asian women, although event rates differed among ethnic groups ( P for interaction=0.002). The AHA guideline predicted coronary events with accuracy similar to current Framingham risk categories (area under receiver operating characteristic curve for Framingham risk, 0.665; for AHA risk, 0.664; P =0.94) but less well than proposed Framingham 10-year risk categories of <5%, 5% to 20%, and >20% (area under receiver operating characteristic curve for Framingham risk, 0.724; for AHA risk, 0.664; P <0.0001). Conclusions— Risk stratification as proposed in the 2007 AHA guideline is simple, accessible to patients and providers, and identifies cardiovascular risk with accuracy similar to that of the current Framingham algorithm. Clinical Trial Registration— clinicaltrials.gov. Identifier: NCT00000611.
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In the US Women's Health Initiative, only 4% of women had ideal cardiovascular health and 13% had no risk factors but failed to follow a healthy lifestyle.
“In the US Women's Health Initiative, only 4% of women fell into this ideal state and a further 13% had no risk factors but failed to follow a healthy lifestyle.83”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [83]
There was an 18% difference in major CVD events in favour of ideal lifestyle versus no-risk factor groups: 2.2% and 2.6% per 10 years.
“There was a 18% difference in major CVD events in favour of the ideal lifestyle vs. the no-risk factor groups: 2.2% and 2.6% per 10 years, respectively.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [83]
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- Authors
- Hsia, J., Rodabough, R. J., Manson, J. E., Liu, S., Freiberg, M. S., Graettinger, W., Rosal, M. C., Cochrane, B., Lloyd-Jones, D., Robinson, J. G., & Howard, B. V.
- Affiliations
- Brigham and Women's Hospital (US)
- From George Washington University (J.H.), Washington, DC; Fred Hutchinson Cancer Research Center (R.J.R.), Seattle, Wash; Brigham and Women’s Hospital (J.E.M.), Harvard Medical School, Boston, Mass; University of California at Los Angeles (S.L.); University of Pittsburgh (M.S.F.), Pittsburgh, Penn; University of Nevada (W.G.), Reno; University of Massachusetts (M.C.R.), Worcester; University of Washington (B.C.), Seattle; Northwestern University (D.L.-J.), Chicago, Ill; University of Iowa (J.G.R.),...
- ORCID
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2010-03
- Volume
- 3
- Issue
- 2
- Pages
- 128-134
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- PMC
- PMC2841216
- OpenAlex
- W2142586294
- Cited by
- 45
- References
- 34
- Citations by year
- 2024: 2 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 3 · 2018: 1 · 2017: 1 · 2016: 4 · 2015: 4 · 2014: 2 · 2013: 5 · 2012: 9
- FWCI
- 6.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Funders
- National Institutes of Health (n01wh32105-27-0-1, n01wh32108-30-0-1, n01wh32100-28-0-1, n01wh42108-21-0-1, n01wh32118-27-0-1, n01wh44221-7-0-1, n01wh42129-23-0-1, n01wh32111-28-0-1, n01wh32115-26-0-1, N01 WH 44221, n01wh22110-38-0-0, N01-WH-3-2115, N01WH24152, n01wh24152-12-0-0, n01wh32122-31-0-1, N01-WH-3-2122, n01wh42107-22-0-1, N01WH42129-32, N01-WH-32108-9, N01WH 32111-13, N01 WH 32105-6, N01 WH022110, N01-WH-32100-2, N01-WH-42107-26, N01 WH042108, N01WH 32118-32119)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- cardiovascular disease prevention, women, risk stratification, American Heart Association guidelines, Women's Health Initiative, myocardial infarction, coronary artery disease, Framingham risk score, 10-year cardiovascular risk prediction, ethnic differences, healthy lifestyle, saturated fat intake, physical activity
- MeSH terms
- Aged, Algorithms, American Heart Association, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Life Style, Middle Aged, Prognosis, Prospective Studies, Risk Factors, ROC Curve, Sex Factors, Time Factors, United States, Women's Health Services, Chi-Square Distribution, Logistic Models, Proportional Hazards Models, Women's Health, Practice Guidelines as Topic, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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