| How Women Can Prevent Heart Disease |
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Lifestyle
It has long been known that smoking increases your risk of heart disease by contributing to a condition called atherosclerosis or ‘hardening of the arteries’. It comes as no surprise then that the AHA recommends that women who smoke stop smoking and avoid environmental or ‘second hand’ smoke. They also stress that aids such as counseling and smoking cessation programs be considered in conjunction with nicotine replacement products and medications to increase the likelihood of success. The AHA has always realized the value of medications and nicotine replacement in fighting heart disease, however, only in the 2007 guidelines do they now recommend the use of counseling or smoking cessation programs.
The AHA also recommends that women maintain a certain level of physical activity to ward of heart disease. It is a well-known fact that regular physical activity contributes to a healthy heart. They recommend at least 30 minutes of moderate-intensity activity daily (or at least on most days) for women who are of normal body weight. Moderate-intensity activities include those that moderately raise your heat rate such as brisk walking. They add that women
Nutrition also plays an important part in the prevention of heart disease. The new guidelines recommend a diet rich in vegetables and high-fiber foods. Cholesterol, they say, should also be limited to less than 300 mg per day. Sodium intake should be limited to 2300 mg per day (about 1 teaspoon of salt) and trans fats should be limited to less than 1% of calories. New to the 2007 guidelines is a recommendation to consume oily fish rich in omega-3 fatty acids like salmon and cod at least twice weekly. Also new is the recommendation to limit saturated fat to less than 7% of calories and to limit alcohol consumption. A limit of 1 alcoholic drink per day is ideal. One alcoholic drink would consist of one 12 oz. beer, one 5 oz. glass of wine or one 1.5oz. shot of 80 proof liquor.
With regard to the consumption of omega-3 fatty acids mentioned above, the new guidelines recommend that women with established heart disease should consume
As suggested above, weight management is an important part of preventing heart disease. A
Finally, new to the 2007 guidelines is the recommendation for women to be screened for depression. It has been recognized by the AHA that women who suffer from depression are more likely to experience heart disease.
Risk Factors Interventions
So how do you know if you are at risk? The AHA looks at what they consider to be ‘major risk factors’ for heart disease. Major risk factors include smoking, poor diet, obesity, physical inactivity, high blood pressure, poor lipid profile, family history and premature heart disease (heart disease at less than 65 years old in women). They also consider preexisting conditions like diabetes to determine if you are at risk. The following is a summary of the AHA’s risk categories. Take a look to see where you fall.
Table 1: Risk Classifications for Heart Disease
The AHA recognizes that major risk factors like blood pressure and high cholesterol should be kept under control in order to minimize the risk of heart disease.
High blood pressure is a major risk factor for developing heart disease. According to the AHA, you should maintain a blood pressure of 140/90 or below. For women with diabetes or chronic kidney disease, a blood pressure of 130/80 or below should be maintained. For women with high blood pressure, thiazide diuretics should be utilized unless deemed inappropriate by their physician.
Maintaining a healthy lipid profile is also important to preventing heart disease. Your lipid profile typically consists of your total cholesterol,
Women with high lipid levels or at high risk for heart disease should aim for and
The presence of diabetes is also risk factor for cardiac disease. The guidelines recommend that patients with diabetes aim for a Hemoglobin A1C (HgA1C) of less than 7%. The hemoglobin A1C is a measurement of average blood sugar measurements over the last 3 months. The higher the percentage, the higher the blood sugar readings have averaged over the last 3 months. Optimal HgA1C levels are achieved through lifestyle modification and drug therapy as needed.
Medication Therapy
The AHA has recommendations regarding some popular medications, like aspirin, when it comes to preventing heart disease in women. Aspirin helps keep the blood from clotting and can help prevent strokes and heart attacks. However, aspirin is not without side effects and should be used cautiously. For example, it is recommended that women under 65 years of age NOT take aspirin routinely to prevent heart attack, unless the benefits outweigh the risks as determined by their doctor. It is also recommended that women over 65 years old consider 81mg of aspirin daily or 100mg aspirin every other day (if blood pressure is controlled). High risk women should start 75 to 325mg of aspirin per day unless contraindicated by their doctor. Women who have recently undergone cardiac bypass surgery should be started on 325 mg aspirin daily within 48 hours after surgery. Doses in these women of up to 162mg per day can be continued for up to 1 year.
The new guidelines recommend women who have experienced acute coronary syndrome (
The value of certain other drugs have been recognized by the AHA in the treatment of high blood pressure, a major risk factor for heart disease. For example, drugs called beta blockers, ACE inhibitors and angiotensin receptor blockers (ARBs) are recommended in all women with high blood pressure as needed unless contraindicated. Examples of each of these types of drugs are summarized in the table below.
Table 1: Examples of Medications Recommended to Treat High Blood Pressure
Other Considerations
It was once thought that hormone replacement therapy may help prevent heart disease. However, recent data suggests that hormone replacement therapy may increase the risk of certain types of cancers and stroke. Therefore, the AHA recommends that hormone therapy not be used solely for the prevention of heart disease. Premarin® is a common example of this type of hormone replacement therapy.
There is also a lot of preliminary information out there suggesting that antioxidant and/or folic acid supplements may help decrease the risk of heart disease. The AHA feels that more evidence is still needed to prove these theories. Therefore, they recommend that antioxidant and/or folic acid supplements NOT be taken for the sole purpose of preventing heart disease. The Bottom Line Heart disease is not often thought of as the biggest threat to the health of American women today, but it should be. There are many other conditions that affect women that get more press than heart disease. As a result, awareness regarding the prevalence of heart disease in women is less than it probably should be. Guidelines such as these presented by the AHA are meant to help doctors make sound decisions with regard to your therapy. Guidelines such as these are put together by a panel of experts who examine the latest scientific evidence and then formulate recommendations based on that data. Make sure your doctor is familiar with the AHA guidelines and that she references them when making decisions about your care.
Author: Christi Larson, Pharm. D. Dr. Larson is a Clinical Infusion Pharmacist, author of Empowered Medicine; A Guide for Consumers and creator of www.empoweredmedicine.com. You can read more about her by visiting www.EmpoweredMedicine.com and clicking on the 'About Us' tab. EmpoweredMedicine.com is committed to providing evidence-based medical information.
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According to the American Heart Association (AHA), heart disease is the leading cause of death among women. As a result, the AHA recently released the 2007 guidelines for the prevention of heart disease in women. This is an update to the last guidelines, published in 2004. Let’s take a look at how the AHA’s recommendations have changed and how they can help you keep heart disease at bay. 