New guidelines for women's heart health

Heart disease is the number one cause of death in this country. That’s true for men and women. Yet ask a woman about her biggest health concerns, and heart disease is often well down the list.

Until recently, researchers also seemed to consider heart disease a problem primarily for men. One reason for this is that heart disease tends to affect men earlier in life compared with women.

But women catch up over time. One in every three women will develop cardiovascular disease (including heart attack and stroke). What’s more, nearly all women are at risk for heart disease and stroke by age 50, according to the American Heart Association.

Increasingly, researchers have been giving heart disease in women the attention it deserves. Recent research has included large numbers of women. Based on these studies, in early 2007 the American Heart Association issued guidelines for the prevention of cardiovascular disease in women.

The new guidelines urge all women to be aware of the risk factors for cardiovascular disease and to make changes that will lower the risk. Risk factors include:

• High blood pressure (also called hypertension)
• High LDL (“bad”) cholesterol or low HDL (“good”) cholesterol
• Diabetes
• Smoking
• Family history of cardiovascular disease

A lack of exercise and being overweight are important, too. For example, an obese woman has a much higher risk of diabetes than a non-obese woman. Being overweight also increases the risks of hypertension and an imbalance of good and bad cholesterol.

The new guidelines make a number of recommendations. One recommendation encourages aspirin use, in a departure from past practice. Recent studies suggest that daily aspirin use can lower the risk of stroke and heart attack for women who are at least 65 years old. (As with all drugs, the use of aspirin must be weighed against possible side effects, which can include allergic reactions, bleeding, or stomach ulcers.)

Many of the other recommendations are not new. And they are quite similar to recommendations for men. As a result, these guidelines will probably not cause major changes in the lifestyles and medical care of women. However, they should increase awareness about heart disease among women.

Reducing your risk

About 90% of women in this country have at least one risk factor that is related to lifestyle.

Here are some of the most important recommendations from the AHA’s guidelines:

• Get more exercise. If you are trying to lose weight (or keep weight off), get at least 30 to 60 minutes of moderately intense exercise most days of the week.
• Improve your diet. The guidelines suggest eating more fruits, vegetables, fish, fiber and whole grains. Salt, saturated fat, and trans fats should be limited.
• Limit alcohol intake. Women should drink no more than one alcoholic beverage per day.
• Don’t smoke. If you have trouble quitting on your own, discuss smoking cessation programs with your doctor.
• Avoid excess weight. For most women, an ideal weight will correspond to a body mass index (BMI) between 18.5 and 25.
• Keep blood pressure and cholesterol levels low. An important first step is getting your blood pressure and cholesterol checked regularly. Some people may need medication to keep their cholesterol or blood pressure low enough to reduce risk.
• Consider daily aspirin use. Past guidelines limited this recommendation to women with multiple risk factors. The new guidelines suggest that all women ages 65 or older should consider taking up to 325 mg of aspirin each day. As mentioned above, aspirin does have risks, so talk with your doctor first.

What about supplements? There is little evidence to support the use of omega-3 fatty acids (fish oil), folic acid, vitamin C, vitamin E, or beta carotene for the prevention of cardiovascular disease. Fish oil may be beneficial, however, if heart disease is already present.

Steps to better health

These new guidelines should be embraced by women and their doctors. They are based on the best available studies in women, rather than being “lifted” from studies of men. As we learn more about heart disease in women, these guidelines will surely be revised. For example, estrogen therapy is no longer on the list of treatments thought to prevent heart disease. That is one example of high-quality research leading to more effective guidelines.

We don’t know if these new guidelines will lead to major changes in medical care or improve women’s heart health. But the guidelines are a powerful reminder to women and their doctors that cardiovascular disease is important—and that risk reduction is possible.

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