Promoting adherence to medical and lifestyle interventions for women with cardiovascular disease

Abstract

The prevalence of cardiovascular disease (CVD) in American women is staggering. In 2008, the American Heart Association reported that one in three women had some form of CVD. An estimated 7.3 million women alive today have had a heart attack or are living with angina pectoris. This year, almost 500,000 new and recurrent myocardial infarctions are expected in women. Education and counseling focusing on the acquisition of healthy lifestyle behaviors will help to protect women against the development of atherosclerosis. It is the responsibility of health care professionals to develop skills to facilitate lifestyle change and CVD risk reduction. This change can be accomplished only through a partnership with women that is based on careful risk evaluation, trust, open communication, skill building for behavioral change, and follow-up care. This article identifi es educational and counseling approaches that have been shown to effect behavioral change in women. IntroductionThe prevalence of cardiovascular disease (CVD) in American women is staggering. In 2008, the American Heart Association reported that one in three female adults had some form of CVD and that CVD death rates for women exceeded that for men [1]. CVD is responsible for almost 500,000 deaths in women annually, nearly twice as many deaths as can be attributed to cancer of all kinds. About 7.3 million females alive today have a history of heart attack and/or are living with angina pectoris. Almost 500,000 new and recurrent myocardial infarctions will occur in women this year [1].The data for stroke in women are equally compelling. About 3.4 million women in the United States have survived a fi rst stroke, and about 60,000 more women than men are expected to have a stroke each year. Important differences also exist in heart disease risk based on ethnicity within the female population. The estimated percentages of total deaths from CVD in Hispanic, black, Asian/Pacifi c Islanders, American Indian/Alaska Natives, and white women are 33.7%, 40.8%, 36.3%, 27%, and 42.5% respectively. The sex-based differences clearly defi ne important areas of research to improve identifi cation and prompt treatment for women at risk for heart attack and stroke [1].It is well established that the risks of developing CVD and stroke for both men and women include age, family history, abnormal lipids, physical inactivity, overweight/ obesity, hypertension, diabetes, insulin resistance, nutrition, and depression [1,2]. Other important factors that infl uence risk level and prevention efforts include low socioeconomic status, social isolation, lack of access to health care (including pharmaceuticals), low literacy, cultural beliefs and language barriers, environmental factors, age, and the presence of complex comorbidities [3].In 2004 and in 2007, the American Heart Association published guidelines that defi ned scientifi cally proven strategies to identify and treat women with and at risk for CVD. The 2007 guidelines emphasized that the intensity of the intervention should match a d...