Heart Assn. Toughens Women‘s Rules

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

Women can prevent heart disease and strokestroke, 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. DepressionDepression 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 Circulation.

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 pressureHigh 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 diet.

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 cholesterolLDL cholesterol 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 strokestroke. 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 attackheart 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.

SOURCES: Mosca, L. Circulation, March 13, 2007; vol 115, manuscript received ahead of print. News conference with Lori Mosca, MD MPH, director of preventive cardiology, New York-Presbyterian Hospital; director, Columbia University Center for Heart Disease Prevention, New York. Alice Jacobs, MD, director of interventional cardiology, Boston Medical Center.