Women's Heart Guidelines

and shouldn't -- do for their hearts.

Feb. 20, 2007 -- Heart disease kills 1 in 3 American women, but it doesn't
have to be that way.

Women can prevent heart disease and stroke, show the latest guidelines from
the American Heart Association.

Armed with new data -- and encouraged by the fact that 60% of U.S. women now
know that heart disease is their No. 1 health threat -- the AHA has launched an
ambitious prevention program.

The program is the work of an expert panel led by Lori Mosca, MD, MPH,
director of preventive cardiology at New York-Presbyterian Hospital and of the
Columbia University Center for Heart Disease Prevention.

"Women are still confused about cardiovascular disease prevention,"
Mosca said at a news conference. "We hope to clear up some of this
confusion. These new guidelines will help our patients ... develop strategies
to combat this leading killer."

Cardiovascular disease refers to any disease that affects the heart and
blood vessels, including stroke.

The AHA women's heart disease prevention strategy has three main elements:
living a healthy lifestyle, addressing major heart risk factors, and using
appropriate medications.

Here's the plan:

  1. All women age 20 and older should see a doctor to find out their heart
    disease risk.

  2. About one in 10 women will learn she is at "optimal risk," meaning
    she's currently at no real risk of heart disease. These women should continue
    their heart-healthy lifestyles.

  3. Most women will be "at risk" -- meaning they must start thinking
    about preventing heart disease and stroke. These women must stop smoking, adopt
    a heart-healthy diet, get at least 30 minutes a day of exercise, and watch
    their weight. With a doctor's advice -- and only with a doctor's advice -- some
    of these women may need blood pressure medications, cholesterol-lowering
    therapy, or regular aspirin.

  4. Many women will be "high risk," meaning they already have some
    condition that makes it particularly likely they will suffer heart disease or
    stroke. In addition to taking the measures advised for their "at risk"
    sisters, "high risk" women may need more aggressive medical treatments
    or rehab.

  5. Depression is common in women with heart disease. All women with heart
    disease should be evaluated for depression.

The new guidelines appear in the March 13 issue of the AHA journal

Heart Disease in Women

These guidelines replace the AHA's 2004 guidelines with even more aggressive
exercise and diet rules.

"All women should exercise a minimum of 30 minutes a day," Mosca
said. For women who want to lose weight, Mosca and colleagues recommend 60 to
90 minutes of exercise "most, or preferably all, days of the week."

As for diet:

  • Fruits and vegetables, whole grains, high-fiber foods, and oily fish should
    make up the biggest part of a woman's diet.

  • Saturated fats should be no more than 10% of energy intake -- and 7% would
    be better.

  • Keep cholesterol intake to less than 300 mg per day.

  • No more than one alcoholic drink per day.

  • No more than 1 teaspoon of salt a day.

  • Totally cut out trans fats if you can, but by no means consume more than 1%
    of total energy from trans fat.

Women with heart disease or high blood-fat levels may consider taking
omega-3 fatty acid capsules.

Heart-Healthy Blood

High blood pressure is a risk factor for heart disease. Women whose blood
pressure gets to 120/80 or above should get more exercise and eat a better

But when a woman's blood pressure reaches 140/90, Mosca says, it's time for
her to talk with her doctor about blood pressure-lowering drugs.

Cholesterol is perhaps the best-known measure of heart disease risk.

Women should keep their bad LDL cholestero below 100 mg/dL. If they are at
very high risk of heart disease, Mosca says, they should talk with their doctor
about using cholesterol-lowering drugs to drop their LDL cholesterol to less
than 70 mg/dL.

Daily Aspirin for Women?

"There is a perception that aspirin protects a woman's heart the same as
a man. But that is not the case," Mosca says. "Women under 65 should
not be using aspirin routinely to benefit their heart -- unless they are at
high risk of heart disease."

For women under age 65, regular low-dose aspirin does reduce the risk of one
kind of stroke. But aspirin also greatly increases a woman's risk of serious
bleeding. For many women, the benefit does not outweigh the risk.

"Women should consider aspirin for prevention of a certain type of
stroke -- ischemic stroke -- but that choice needs to be very informed and
based on an individual woman's risk factors for stroke and risk of side
effects," Mosca says. "The additional benefit in women over 65 for
heart attack prevention should be weighed into that decision."

That said, women who already have heart disease benefit greatly from regular
low-dose aspirin, says Alice Jacobs, MD, director of interventional cardiology
at Boston Medical Center.

"For women with established heart disease, aspirin is mandatory on a
daily basis," Jacobs says.

The bottom line: Women should not take regular aspirin to prevent stroke or
heart disease without discussing the issue with their doctors.

By Daniel DeNoon
Reviewed by Louise Chang
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