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Helping Women Beat Heart Disease

Heart disease kills nearly half a million women each year in this country, and the American Heart Association has some new guidelines for women when it comes to preventing and treating the illness.

Dr. Lori Mosca, the lead author of those guidelines and the director of Preventive Cardiology at New York-Presbyterian Hospital, visited The Early Show to explain the recommendations.

Cardiovascular disease is the leading cause of death for men and women in the United States. It kills nearly 500,000 women each year. Women experience heart disease differently than men. Mosca says the new guidelines for the first time give clarity about how much medical professionals know and don't know about the disease. The concept of cardiovascular disease as a "have-or-have-not" condition has been replaced with the idea that heart disease develops over time and every woman is somewhere on the continuum, she explains.

The new guidelines from the American Heart Association try to get women to acknowledge their risk, even if it's low. The guidelines stress lifestyle as the first line of attack, like stopping smoking, losing weight, exercising every day and eating a healthy diet. They also call for aggressive use of drugs to lower cholesterol and blood pressure in high-risk women.

Experts say low-risk women should not take daily aspirin to thin the blood because the risks of stomach bleeding and a bleeding stroke outweigh the benefits. Hormone replacement therapy is no longer recommended for prevention of heart disease since studies found it to raise the risk. Those findings prompted the rigorous assessment of the research concerning heart disease and women that ultimately led to these new guidelines. Antioxidant vitamins are not recommended either.

The new recommendations split women into three general groups:

  • Lower risk means a woman has a less than ten percent chance of having a heart attack in the next decade. It means one or less risk factors, and could mean a healthy weight with healthy blood pressure and cholesterol readings.
  • Intermediate risk is a 10 to 20 percent chance of having a heart attack in the next decade. Intermediate risk may be multiple risk factors or an elevated single risk factor such as smoking, high blood pressure and high cholesterol, or a family history of early heart disease.
  • High risk is a greater than 20 percent chance of having a heart attack in the next decade.
    Advanced kidney disease, aortic aneurysm, existing cardiovascular disease, a history of heart attack or stroke, or diabetes puts a woman at high risk.

    Younger women at low-risk woman can perform many lifestyle choices to avoid trouble later in life such as diet and exercise to improve risk factors that would otherwise cause problems. Also, women can do a lot in their 20s and 30s to prevent heart disease later by adopting a healthy lifestyle.

    When it comes to drug treatment, for women with existing heart disease, diabetes or other multiple risk factors, low-cholesterol is important, says Mosca. The new guidelines recommend using cholesterol-lowering drugs in high-risk women even if their cholesterol is at normal levels. Also, ACE inhibitor and beta-blocker drugs are recommended for all high-risk women even those whose blood pressure is normal.

    Recommended therapy varies across the three levels of risk:

  • For all high-risk women, aspirin is recommended.
  • Among intermediate-risk women, aspirin can be considered as long as blood pressure is controlled and the benefit is likely to outweigh the risk of side effects such as stomach bleeding or bleeding stroke.
  • It is not recommended for low-risk women.

    Lifestyle interventions such as smoking cessation, regular physical activity, heart-healthy diet and weight maintenance were given a strong priority in all women, not only because of their potential to reduce existing heart disease, but also because heart-healthy lifestyles may prevent major risk factors from developing.