Women and Compliance: The Forgotten Issues in Heart Disease Prevention
Bibliographic record
Abstract
Coronary heart disease (CHD) is the leading cause of death and disability in American women, and despite advances in the diagnosis, treatment, and prevention of CHD, the rate of its decline is lower in women than in men.1 Cardiovascular risk factors are high in women, with 40% over the age of 50 estimated to have elevated cholesterol, 52% over the age of 45 to be hypertensive, and approximately 25% to be physically inactive.2 More than half of CHD risk factor intervention involves lifestyle and behavioral3 changes, yet women are less frequently counseled than men about exercise, nutrition, and weight reduction.4 An important issue for CHD risk factor reduction is compliance, or adherence to interventions, that will bring about improved outcome. Traditionally, physicians have lacked the necessary skills and expertise for counseling on diet, exercise, and smoking cessation. A recent recommendation by the American Heart Association is that programs be implemented for providers and organizations to enhance knowledge and skills in improving compliance.5 The focus of this series of papers is on improvement of CHD risk factor reduction, in women through improved compliance. In the lead paper, Dr. Barrie Guise discusses the role of behavior change in cardiac risk factor modification. Guise gives an overview on health behavior change strategies in the medical encounter and on barriers to motivation. She uses smoking cessation with recommendations on succeeding with heavy smokers as a method to teach these health behavior change strategies. Lipid interventions in women are underutilized, with nearly half of women over the age of 45 considered to have elevated cholesterol. In the next paper Goldberg examines some of the reasons for undertreatment of lipid abnormalities in women. The relative benefits of diet, exercise, statins, and alternatives to hormone replacement therapy are discussed. Despite the benefit of hormone replacement therapy with respect to CHD risk reduction for postmenopausal women, compliance to this therapy is low. Part of the low compliance rate is explained by women's concerns about the potential risks of breast and uterine cancer. Another concern is the inexperience of practitioners outside of obstetrics and gynecology in the prescription of this therapy. Dr. Ruth Freeman discusses these issues in her paper “Hormone Replacement Therapy (Estrogen and Progesterone)—Is It Necessary for Heart Disease Prevention?” She points out that the benefits of hormone therapy go beyond cholesterol reduction and cites its benefits in vascular physiology. Also reviewed in this paper are the differences in the various hormonal agents available, including the selective estrogen receptor modulators. Most important, Freeman puts into perspective the results of the Heart Estrogen Replacement Study (HERS).6 Nearly 3000 women with heart disease were randomized in this study to either combined estrogen and progesterone or placebo. In the first year there was a higher event rate in the hormone group. Although this result is not completely understood, this paper gives guidelines for the use of hormone therapy for women with and without CHD. Many women turn to alternative or complementary medicine for treatment and prevention of a variety of illnesses. There are few randomized studies of these therapies and oftentimes the patients we treat do not volunteer this information. Particularly problematic is the potential interaction of some herbal therapies with prescribed medication. Dr. Adriane Fugh-Berman discusses the risk and benefits in the use of herbal therapies, antioxidant vitamins, and other supplements. Compliance to both lifestyle and medical interventions are important to CHD risk reduction. The issue of compliance is complex and involves both the patient and the physician. The collective focus of this series of papers is that women have special concerns and in order to bring about more effective CHD risk reduction in this large segment of our population we must improve our incorporation of lifestyle and quality of life issues in clinical practice.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".