Heart Health: A New Tool to Catch Women at Risk
Women have not been doing as well as men in the battle against heart disease. While the number of men dying of heart attacks, strokes, and other cardiovascular diseases has dropped over the past quarter-century, from 500,000 to 400,000, women have seen no improvement, dying at a rate of about 460,000 per year.
Cardiologist Paul Ridker and his colleagues hope to change that. Today they unveiled a new tool called the Reynolds Risk Score, designed to give women the most accurate view of their risk of heart disease ever–and a chance to prevent it. "Heart disease is different in women," says Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston. "The biology is different, yet most of the tools for measuring risk have been developed using men" and so have not worked well for women.
The new tool, described in the Journal of the American Medical Association, is a disarmingly simple seven-step risk calculator based on a painstaking analysis of 24,000 women. By plugging in items like age, family history of heart disease, and cholesterol levels, women can, in a sense, peer into the future and learn their risk of heart disease during the next 10 to 40 years. "This really is a landmark study," says Roger Blumenthal, a preventive cardiologist at Johns Hopkins University School of Medicine. "It will change our approach to women."
Currently, the dominant tool for estimating risk was developed by the Framingham Heart Study, a research project that has studied residents of a Massachusetts town for more than 50 years. But it focused mainly on identifying the factors that led to heart attacks, says cardiologist Daniel Levy, present director of the study. And that, some critics say, doesn't represent women fairly. Unlike men, who typically first learn they have a problem when their heart seizes up in an attack, women's first sign of heart-related trouble is just as likely to be a stroke or chest pain caused by blocked arteries, Ridker says. And that's why, Blumenthal adds, "I think you get a much better picture of women's risks if you include these things."
That's what Ridker and his team did. Then they examined 35 possible factors that could lead to these events. The strongest connections were to:
– age
– smoking history
– systolic blood pressure (the first number in your blood pressure reading)
– total cholesterol level
– "good" or HDL cholesterol level
– level of C-reactive protein, a marker of inflammation
– whether a parent had a heart attack before age 60
"These last two factors–family history and C-reactive protein–are new," Ridker says. "The Framingham calculations hadn't incorporated them."
And the impact of those factors showed up when he ran women in his study through both the Framingham risk estimator and the Reynolds Risk Score. (The name comes from the Donald W. Reynolds Foundation, which funded the calculator research.) A number of women were classified by the older system as at "intermediate risk, which basically means we don't know what to do with them, whether to intervene or to let them alone," Ridker says. But the newer system put a quarter of those same women at higher risk, and another quarter at low risk. "With the high-risk women, you can consider blood pressure medication or aspirin or statins," says Ridker. "And those at low risk you can tell not to worry."
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