Armed with new data — and encouraged by the fact that 60 percent 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, M.D., 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:
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:
Women with heart disease or high blood-fat levels may consider taking omega-3 fatty acid capsules.
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 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 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.
"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, M.D., 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, M.D.
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