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February 26, 2007
Guidelines released for managing heart disease risk in women

BY juliette merchant

The 2007 Guidelines for Preventing Cardiovascular Disease in Women issued Feb. 19 in Circulation: Journal of the American Heart Association include new recommendations for the use of aspirin, hormone therapy and vitamin and mineral supplements for prevention of heart disease and stroke in women.

Cardiovascular disease is the largest single cause of death among women in the United States, accounting for 38 percent of all female deaths, according to the American Heart Association. With such staggering statistics, the focus of the updated evidence-based guidelines for cardiovascular disease prevention in women is managing overall risk throughout a woman’s lifetime.

“We’re just beginning to learn that one of every three women will develop heart disease and in particular coronary disease in her lifetime, so it’s important that we consider lifetime risks and not just short term risks when we try to prevent coronary disease in women,” said Nanette Wenger, chief of cardiology at Grady Memorial Hospital and professor in Emory’s School of Medicine, and co-author of the new American Heart Association guidelines.

“Many physicians still remain unaware that heart disease is a serious problem for many women,” said Wenger.

The guidelines include heart healthy lifestyle recommendations such as exercise, good nutrition and smoking cessation. Starting as early as age 20, experts say women can make smart lifestyle changes that will go a long way to prevent cardiovascular disease and thus saving their lives.

Highlights of the changes include:

• Recommended lifestyle changes to help manage blood pressure include weight control, increased physical activity, alcohol moderation, sodium restriction and an emphasis on eating fresh fruits, vegetables and low-fat dairy products.

• Besides advising women to quit smoking, the guidelines recommend counseling, nicotine replacement or other forms of smoking cessation therapy.

• Physical activity is recommended for women who need to lose weight or sustain weight loss — a minimum of 60 to 90 minutes of moderate-intensity activity (e.g., brisk walking) on most, and preferably all, days of the week.

• Reduce saturated fats intake to less than seven percent of calories.

• Guidance on omega-3 fatty acid intake and supplementation recommends eating oily fish at least twice a week, and consider taking a capsule supplement of 850-1000 mg of eicosapentaenoic acid and docosahexaenoic acid in women with heart disease, two to four grams for women with high triglycerides.
• Hormone replacement therapy and selective estrogen receptor modulators are not recommended to prevent heart disease in women.

• Antioxidant supplements (such as vitamin E, C and beta-carotene) should not be used for primary or
secondary prevention of CVD.

• Folic acid should not be used to prevent CVD — a change from the 2004 guidelines that did recommend its use by some women.

• Routine low dose aspirin therapy may be considered in women age 65 or older regardless of CVD risk status, if benefits are likely to outweigh other risks. The upper dosage of aspirin for high-risk women increases to 325 mg per day rather than 162 mg. This brings the women’s guidelines up to date with other recently published guidelines.

• Consider reducing LDL cholesterol to less than 70 mg/dL in very high-risk women with heart disease (which may require a combination of cholesterol-lowering drugs).

Above all, the updated guidelines call for women to take charge of their personal health by being aware, according to Wenger.

“We are now saying most women have a high lifetime risk of developing coronary disease and the time to begin prevention is now,” she said. “I tell all adult women, when you see your primary care physician, whether it be a family physician, an internist or an OB/GYN, you should discuss your risks for coronary heart disease. And work in partnership with your physician.”

Wenger said the intensity of risk reduction is proportionate to the intensity of risk so it’s vital for women to know where they stand. She recommends that women knowing their waist circumference measurement, blood pressure and blood fat levels or cholesterol. Women who are at high risk need more intensive intervention but the key is to start now.

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