Wednesday, February 21, 2007

Women Beware: Heart Disease & Stroke Risk

Fox News Nine, out of the Twin Cities headlined 90 Percent of Women at Risk for Heart Disease, Stroke on the heels of the American Heart Association release of updated guidelines for women at risk for heart disease and stroke.

The article opens with an ominous warning, "Michelle Bartell, 43, looks too young and too healthy to have had two heart attacks, and that is exactly the point of a new warning. It happened to her and it will happen to countless others. A new American Heart Association study shows 9 out of 10 women are at risk for heart disease or stroke."

Just nine out of ten?

Truth be told every last person is "at risk" for heart disease or stroke, just as every last person is going to die, life itself comes with a sure "risk" of death - we just don't know when.

The scare tactic headlines get your attention, but do little to help our understanding of real risk, over a lifetime, for women when it comes to heart disease and stroke.

Sadly the updated guidelines are little more than a "how to" manual to initiate drug therapy in every woman in America, as early as age 20 - the age they call for an initial risk assessement and start of intervention and treatment.

Even the recommendations, Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women - 2007 Update, published in Circulation, state that, "...nearly all women are at risk for CVD, which underscores the importance of a heart-healthy lifestyle."

Is it any wonder when you consider the criteria to be found "at risk" and therefore in need of intervention?

Have just one of the following in your initial risk assessment:
  • Cigarette smoking
  • Poor Diet
  • Physical Inactivity
  • Obesity, especially central adiposity
  • Family History of premature CVD (in a male or female relative)
  • Hypertension
  • Dyslipidemia
  • Evidence of subclincal vascular disease
  • Metabolic Syndrome
  • Poor exercise capacity on treadmill test and/or abnormal heart rate recovery after stopping exercise

Basically no woman will be found who are not at risk if we look at the list above, and then also consider what qualifies as "optimal risk" to remove one from the "at risk" category - a Framingham Global Risk score of less than 10% AND a "healthy lifestyle" AND no risk factors above.

So then we're off and running straight into the lifestyle modifications and intensive medical intervention.

Ah, yes, the lifestyle intervention - it pales in comparison to the intensive pharmacological intervention to be intiated as early as age 20; the treatment algorithm includes diet and exercise, underscored with a true lifestyle change - taking an assortment of drugs for the rest of your life!

This is "prevention"?

This is "risk reduction"?

This is the AHA "solution" to cardiovascular disease in women?

They have the gall to call this "evidence based"?

Just like the recent ADA update for diabetes, we find the AHA is now on the bandwagon to drug America - women in America - for the rest of our lives.

Not only that, they're also intent on getting public policy in line with their insanity, "Population-wide strategies are necessary to combat the pandemic of CVD in women, because individually tailored interventions are likely insufficient to maximally prevent and control CVD. Pulic policy as an intervention to reduce gender-based disparities in CVD preventive care and improve cardiovascular outcomes among women must become an integral strategy to reduce the global burden of CVD."

The media is taking this just as expected, as if it were the best thing next to sliced bread - in the WebMD section, heartwire, this was called a "bold prescription for the prevention of CVD;" and "with the goal to widen the window of opportunity for women to fight their number-one killer..."

A bold prescription? Interesting use of words there since it truly is a bold way to make every woman - healthy or otherwise - a target candidate for lifelong dependancy on prescription drugs!

"All women 20 years and older need initial CVD risk evaluation (medical history, physical exam, fasting glucose, lipids) and Framingham risk assessment; women with CVD need depression screening."

The dietary recommendations are a guaranteed recipe to induce every symptom needed to score as "at risk" of cardiovascular disease - a low-fat diet, limiting meats and animal foods, that is rich with carbohydrates and completely fails to meet essential nutrients.

The recommendation reads, "[w]omen should consume a diet rich in fruits and vegetables; choose whole grain, high-fiber foods; consume fish, especially oily fish at least twice a week; limit intake of saturated fat to less than 10% of energy, and if possible, less than 7%; cholesterol to less than 300 mg/day; alcohol intake to no more than 1 drink per day and sodium intake to less than 2.3g/day (approximately 1 tsp salt). Consumption of trans-fatty acids shoudl be as low as possible (eg, less than 1% of energy)."

ahem....this is "evidence based"?

Within the statement we find "the summary of evidence used by the expert panel can be obtained online as a Data Supplement at

Oddly, on this page referenced as the one to look to for additional information on the data presented in the statement - Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update - there isn't any file to read to evaluate the so-called evidence used for the development of the dietary recommendations.

Wonder why?

It's because there are no studies that can be used to support the dietary recommendations in the statement!

At the end of the paper we find "Appendix - Bibliography by Topic" and within that section, "Dietary Modification" with a laundry list of studies supposedly supporting the recommendations in the paper, that is followed by "Dietary Modification Meta-Analysis" with one citation as supportive.

This gives any reader the impression that there are mountains of data to support the recommendations.

How about we take a look?

  • Abbott et al investigated magnesium in the diet and the risk of cardiovascular disease.
    Nope, not evidence to support a low-fat diet.
  • Willett et al investigated the relationship between calcium intake from diet or supplements and risk of ischemic heart disease in MEN.
    Nope, not evidence to support a low-fat diet.
  • Bazzano et al reported results from a national survey of fiber intake and reduced risk of heart disease.
    Nope, not evidence to support a low-fat diet.
  • Boniface et al reported on 16-year coronary disease mortality in Britain and fat intake.
    Intriguing , but nope, not evidence to support a low-fat diet.
  • Dauchet et al looked at fruit and vegetable consumption.
    Nope, not evidence to support a low-fat diet.
  • Ellingsen et al investigated smoking and dietary advise in MEN.
    Nope, not evidence to support a low-fat diet.
  • Erikka et al looked at vitamin K levels as a potential marker for heart disease, not stroke, in women.
    Nope, not evidence to support a low-fat diet.
  • Howard et al - the Women's Health Initiative null findings from last year are here?
    Nope, not evidence to support a low-fat diet.
  • Hu et all appears in three separate citations - one for overall dietary pattern in MEN, one for alpha-linolenic acid and one for dietary protein.
    Nope, not evidence to support a low-fat diet.
  • Jensen et al was on whole grain intakes
    Nope, not evidence to support a low-fat diet.
  • Knoops looked at the Mediterranean dietary pattern and risk
    Nope, not evidence to support a low-fat diet.
  • Kromhout et al looked at alcohol, fish, fiber and antioxidant vitamins and risk - funny, but the title includes that these "do not explain population differences in coronary heart disease mortality"
    Nope, not evidence to support a low-fat diet.
  • Lee et al looked at vitamin C supplementation and risk
    Nope, not evidence to support a low-fat diet.
  • Liu et al at fruit and vegetable intake, and in a second citation at breakfast cereal intake in MEN
    Nope, not evidence to support a low-fat diet.
  • McCullough et al investigated adhering to the dietary guidelines and risk
    Nope, not evidence to support a low-fat diet.
  • Mukamal et al looked at coffee consumption
    Nope, not evidence to support a low-fat diet.
  • Nestel et al was a drug trial
    Nope, not evidence to support a low-fat diet.
  • Osler et al was a study to look at dietary scoring used in studies
    Nope, not evidence to support a low-fat diet.
  • Sesso et al looked at flavonoid intakes and risk
    Nope, not evidence to support a low-fat diet.
  • Steffen et al looked at whole and refined grains, fuits and vegetables to assess risk
    Nope, not evidence to support a low-fat diet.
  • Trichopoulou et al is cited twice - both studies looking at survival among patients with CHD and the mediterranean diet in Greece
    Nope, not evidence to support a low-fat diet.
  • van der Schouw et al looked at phytoestrogens from diet and risk
    Nope, not evidence to support a low-fat diet.
  • Yano et all looked at coffee and alcohol related to risk
    Nope, not evidence to support a low-fat diet.

Notice a pattern here?

How about the Meta-Analysis citation, perhaps that one is convincing enough?

Huxley et al, looked at studies to see the effects of dietary flavonol intake and CHD mortality - and once again, nope, not evidence to support a low-fat diet.

Twenty-nine references cited as supportive evidence for the low-fat diet recommendation within the document - not one actually shows such a diet will prevent cardiovascular disease or stroke in women.

Yet to any casual reader, this list in impressive and is assumed to be support for the recommendations within the document; that's because it's assumed citations are used properly, in context to what's written and because they support of statements.

It's also assumed those writing have the integrity to utilize the evidence accurately and truthfully.But after looking at the citations it's clear this is not the case.

We have before us "evidence-based recommendations" without foundation in the science; without support in the data; being foisted upon us to follow without question because the AHA says it's evidence-based.

As a woman, I am highly offended by these recommendations - they're nothing more than a sure-fire way to make sure every woman in America is classified "at risk" so that intensive intervention and therapy may be initated to "save her" from herself and her poor diet, inactivity and get her on her lifelong pharmaceutical program early.


  1. "All women 20 years and older need initial CVD risk evaluation (medical history, physical exam, fasting glucose, lipids) and Framingham risk assessment; women with CVD need depression screening."

    I couldn't help but notice the next to last word in that: Depression.

    Are they talking about the kind of depression that I think they're talking about? The "I'm so depressed, is life really worth living?" kind of depression?

    Well duh, what exactly do they expect when they come up with a ridiculous list of "risk factors" to be applied to every woman over the age of 20 (!!!!!), since as you pointed out, the risk factors are going to pretty much condemn every female in the population?

    What do they expect? That all those women who are put on ultra-low-fat diets and special medication for the rest of their lives are going to jump for joy because they've just been told that what they have ahead of them is a lifetime of miserable diet and pharmaceutical debt?

    That's just stupid - based on completely un-applicable studies, they're telling young women "You're going to die of stroke or heart attack if you don't eat this awful, tasteless diet and take these medicines". And of course they left out the word "eventually", since as you pointed out, life itself is fatal. Do they think 20 year olds are so naive that they haven't figured out that they're eventually going to die from *something*?

    It's just more scare tactics - what a horrible thing to put a 20 year old through! It's bad enough to put 40 and 50 year olds through this sort of nonsense, but 20 year olds?

  2. Art Phillips10:36 PM

    Ya gotta hand it to them, they know how to promote their business. the cardiologists will be very busy. One friend has beeb advised by her "primary" to see a heart doc because it's a "good idea" She has no symptoms or history of CVD. Anyone think she'll be told she is fine? I'm bettin on Lipitor or Crestor a low fat diet and many return visits, and if things are slow in the cath lab, an angioplasty or 2.
    Be well

  3. One friend has beeb advised by her "primary" to see a heart doc because it's a "good idea" She has no symptoms or history of CVD.

    I recently went with someone to a heart doctor as "moral suport". In the examining room, there was a poster on the wall encouraging everyone to have a "million beat checkup". Apparently by the age of 50 the average heart has beat a million times, and they're encouraging absolutely everyone to have a cardiologist do a "check-up" on their heart, sort of like taking a car in for a 5,000 mile checkup.

    The problem is that the doctor claimed that the only way to check for plaque buildup was to do a catheterization. I don't know if that's true or not - this person had already had a complete blood workup, EKG, stress test, and an echocardiogram. I almost sensed disappointment in the doctor's voice when he came to tell me that there was only "modest" plaque buildup in this person's arteries.

  4. All the recommendations by the AHA are setting women up to "need" a cath or more. Look at the "risk" factors....with the cholesterol levels dropped to unreasonable levels, virtually every woman will "require" intervention.

    In my case, initially with moderately elevated cholesterol, but no family history, no diabetes, low BP, etc etc doc encouraged me to get tested for peripheral artery disease (PAD) and get a cardiac workup. Her arguement? "well just because there's no family history, the history has to start somewhere"!!!!! I refused the cardiac check, but did go along with the PAD check....and when it came out normal, I was told that the testing "isn't that accurate"! So why bother??? AND! She still wanted me treated for PAD, because she "knew" I had PAD!!!

    They get you, no matter what!

    Oh yea, I no longer see that doc!!

  5. Anonymous12:53 AM

    I have diabetes and I have a long story that I will spare you from..but let's just say that my ND has helped me more than my MD. My MD wanted to put me on blood sugar meds and cholesterol meds. The fact of the matter is after a few months of working on my diet, I don't need either. The sad part is that I don't blame him. It's the institution, it's the pharmaceutical companies...he's as ignorant as we are.

  6. We should not be surprized that as women we are being blamed for our high rates of heart disease. The truth is that the medical establishment has never taken an interest in women's heart health and thus we now have an assortment of diagnostic and treatment strategies designed for men. 50 % of women with ischemic heart disease will have a normal cath, according to a recent study on women and Ischemia. The test is designed to evaluate men and overlooks disease in women.

    As women, I think we should be suspicious of any campaign telling us to lose weight. We should question any invasive procedures which are based entirely on research done on men. And we should pause before taking drugs which were not tested on women.