Drugs for cardiovascular disease prevention in women: implications of the AHA Guidelines--2007 Update.
Lifestyle interventions constitute the initial strategy for the primary and secondary prevention of cardiovascular disease in women. However, pharmacotherapy is often indicated for control of major cardiovascular risk factors, and abundant clinical trial data support the morbidity and mortality benefit of a number of categories of drug therapy following a coronary event. Although women have increasingly been enrolled in clinical trials of pharmacotherapy, under representation of women in most research studies limits the gender-specific assessment of outcomes. Equally importantly, recent randomized clinical trial data have highlighted inappropriate preventive therapies for women (i.e. those lacking effectiveness and potentially imparting harm). Decision-making data for drug therapy for women also derive from a number of clinical trials conducted solely in women. The drug classes reviewed in this article include omega-3 fatty acids, aspirin, ACE inhibitors and angiotensin II receptor antagonists or blockers, beta-adrenoceptor antagonists (beta-blockers), aldosterone antagonists, antioxidants, folic acid and vitamins B(6) and B(12), and menopausal hormone therapy and selective estrogen-receptor modulators. Information is sparse regarding specific cardiovascular pharmacotherapies for elderly women, and women of racial and ethnic minorities. Owing to the under representation of the subset of women in many trials, analysis by age, race and ethnicity is not appropriate. This information gap presents a major challenge for future studies, as these subgroups constitute populations of women at high cardiovascular risk.
Wenger
Nanette K
NK
Emory University School of Medicine, Atlanta, Georgia, USAGrady Memorial Hospital, Atlanta, Georgia, USAEmory Heart and Vascular Center, Atlanta, Georgia 30303, USA. nwenger@emory.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D014803:Vitamin B Complex / Q000627:therapeutic use; D016387:Women's Health
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000975:Antioxidants; D000451:Mineralocorticoid Receptor Antagonists; D010975:Platelet Aggregation Inhibitors; D020845:Selective Estrogen Receptor Modulators; D014803:Vitamin B Complex; D001241:Aspirin