Nutrition, Metabolism & Cardiovascular Diseases (2014) 24, e33
Available online at www.sciencedirect.com
Nutrition, Metabolism & Cardiovascular Diseases journal homepage: www.elsevier.com/locate/nmcd
LETTER TO THE EDITOR
The new cholesterol treatment guidelines and women We read with interest the new article by Gotto et al. [1], which provide a helpful overview of merits and potential downsides of the 2013 guidelines from the American College of Cardiology and the American Heart Association (ACC/AHA) on cholesterol management. These guidelines include the use of a new risk prediction algorithm to estimate ten-year risk for atherosclerotic cardiovascular disease (CVD), which includes stroke and peripheral arterial disease as well as coronary heart disease [2]. Gotto et al. argue that the new risk assessment algorithm might estimate the risk for CVD more accurately than the Framingham calculator in certain subgroups, such as women [1]. However, we are concerned that the new calculator could actually underestimate CVD risk among certain subgroups of females, such as those with pregnancy-related complications. Pregnancy is thought to provide a unique opportunity to estimate a woman’s lifetime risk because of its unique cardiovascular and metabolic stress [3]. For example, preeclampsia is associated with approximately 2-fold increase in lifetime risk of CVD [4]. Similarly, gestational diabetes increases lifetime risk of type 2 diabetes mellitus, the metabolic syndrome, and CVD [5]. Surprisingly these pregnancy-related complications have not been included in the new calculator. True insight about accuracy and applicability of the new risk calculator will come from prospective testing among females with these pregnancy-related complications. Alternatively, the calculator can be tested in large observational study cohorts. Determining the applicability of the calculator in all women, including those with pregnancy-related complications, is an important next step in screening and prevention of CVD, the leading cause of mortality among women [6].
References [1] Gotto AM, Moon JE. Merits and potential downsides of the 2013 ACC/AHA cholesterol management guidelines. Nutr
http://dx.doi.org/10.1016/j.numecd.2014.07.010 0939-4753/ª 2014 Elsevier B.V. All rights reserved.
[2]
[3]
[4]
[5]
[6]
Metab Cardiovasc Dis 2014;24(6):573e6. http://dx.doi.org/ 10.1016/j.numecd.2014.04.002. Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Lloyd-Jones DM, Blum CB, et al. ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;24; 129(25 Suppl. 2):S1e45. http://dx.doi.org/10.1161/01.cir. 0000437738.63853.7a. Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, LloydJones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women e 2011 update: a guideline from the American Heart Association. Circulation 2011;123(11):1243e62. http://dx.doi.org/10.1161/CIR. 0b013e31820faaf8. Charlton F, Tooher J, Rye KA, Hennessy A. Cardiovascular risk, lipids and pregnancy: preeclampsia and the risk of later life cardiovascular disease. Heart Lung Circ 2014;23(3):203e12. http://dx.doi.org/10.1016/j.hlc.2013.10.087. Gunderson EP, Chiang V, Pletcher MJ, Jacobs DR, Quesenberry CP, Sidney S, et al. History of gestational diabetes mellitus and future risk of atherosclerosis in mid-life: the Coronary Artery Risk Development in Young Adults study. J Am Heart Assoc 2014;3(2):e000490. http://dx.doi. org/10.1161/JAHA.113.000490. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statisticsd2011 update: a report from the American Heart Association. Circulation 2011;123:e18e209. http://dx.doi.org/10.1161/CIR. 0b013e3182009701.
M. Sattari*, R. Egerman University of Florida, Gainesville, FL, USA *Corresponding author. University of Florida, Medicine, PO BOX 100277, Gainesville, FL 32610-0277, USA. E-mail address: [email protected]fl.edu (M. Sattari)
7 July 2014
Available online at www.sciencedirect.com
Nutrition, Metabolism & Cardiovascular Diseases journal homepage: www.elsevier.com/locate/nmcd
LETTER TO THE EDITOR
The new cholesterol treatment guidelines and women We read with interest the new article by Gotto et al. [1], which provide a helpful overview of merits and potential downsides of the 2013 guidelines from the American College of Cardiology and the American Heart Association (ACC/AHA) on cholesterol management. These guidelines include the use of a new risk prediction algorithm to estimate ten-year risk for atherosclerotic cardiovascular disease (CVD), which includes stroke and peripheral arterial disease as well as coronary heart disease [2]. Gotto et al. argue that the new risk assessment algorithm might estimate the risk for CVD more accurately than the Framingham calculator in certain subgroups, such as women [1]. However, we are concerned that the new calculator could actually underestimate CVD risk among certain subgroups of females, such as those with pregnancy-related complications. Pregnancy is thought to provide a unique opportunity to estimate a woman’s lifetime risk because of its unique cardiovascular and metabolic stress [3]. For example, preeclampsia is associated with approximately 2-fold increase in lifetime risk of CVD [4]. Similarly, gestational diabetes increases lifetime risk of type 2 diabetes mellitus, the metabolic syndrome, and CVD [5]. Surprisingly these pregnancy-related complications have not been included in the new calculator. True insight about accuracy and applicability of the new risk calculator will come from prospective testing among females with these pregnancy-related complications. Alternatively, the calculator can be tested in large observational study cohorts. Determining the applicability of the calculator in all women, including those with pregnancy-related complications, is an important next step in screening and prevention of CVD, the leading cause of mortality among women [6].
References [1] Gotto AM, Moon JE. Merits and potential downsides of the 2013 ACC/AHA cholesterol management guidelines. Nutr
http://dx.doi.org/10.1016/j.numecd.2014.07.010 0939-4753/ª 2014 Elsevier B.V. All rights reserved.
[2]
[3]
[4]
[5]
[6]
Metab Cardiovasc Dis 2014;24(6):573e6. http://dx.doi.org/ 10.1016/j.numecd.2014.04.002. Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Lloyd-Jones DM, Blum CB, et al. ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;24; 129(25 Suppl. 2):S1e45. http://dx.doi.org/10.1161/01.cir. 0000437738.63853.7a. Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, LloydJones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women e 2011 update: a guideline from the American Heart Association. Circulation 2011;123(11):1243e62. http://dx.doi.org/10.1161/CIR. 0b013e31820faaf8. Charlton F, Tooher J, Rye KA, Hennessy A. Cardiovascular risk, lipids and pregnancy: preeclampsia and the risk of later life cardiovascular disease. Heart Lung Circ 2014;23(3):203e12. http://dx.doi.org/10.1016/j.hlc.2013.10.087. Gunderson EP, Chiang V, Pletcher MJ, Jacobs DR, Quesenberry CP, Sidney S, et al. History of gestational diabetes mellitus and future risk of atherosclerosis in mid-life: the Coronary Artery Risk Development in Young Adults study. J Am Heart Assoc 2014;3(2):e000490. http://dx.doi. org/10.1161/JAHA.113.000490. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statisticsd2011 update: a report from the American Heart Association. Circulation 2011;123:e18e209. http://dx.doi.org/10.1161/CIR. 0b013e3182009701.
M. Sattari*, R. Egerman University of Florida, Gainesville, FL, USA *Corresponding author. University of Florida, Medicine, PO BOX 100277, Gainesville, FL 32610-0277, USA. E-mail address: [email protected]fl.edu (M. Sattari)
7 July 2014
