Stress. Some scientists have noted a relationship between coronary heart disease risk and stress in a person’s life. It is not yet known whether stress has any direct, long-term effects on the heart or blood vessels, but stress is known to affect lifestyle habits in ways that can raise risk. For example, people who are under stress may smoke or eat more.
Excessive consumption of alcohol. Drinking too much alcohol can raise blood pressure and may lead to heart failure or stroke. It can also raise triglyceride levels and contribute to obesity.
How diabetes affects risk
Diabetes is considered a “coronary disease risk equivalent.” This means that people with diabetes have a similar risk for having a heart attack or dying of coronary heart disease as people who have already had a heart attack or been diagnosed with coronary heart disease. Therefore, prevention goals are similar for those with diabetes and for those with diagnosed coronary heart disease.
In 2007, an expert panel for the American Heart Association in collaboration with other national health organizations updated the Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women. These prevention guidelines apply to all types of cardiovascular disease, including coronary heart disease. They are based on evidence from clinical trials and were agreed on by a consensus of experts in the field.
The table “Lowering Your Risk of Cardiovascular Disease” lists optimal goals for prevention of coronary heart disease in women at high risk as described in these guidelines. The guidelines underscore that women with diabetes are considered to be at high risk for the development of cardiovascular disease. These recommendations are consistent with the American Diabetes Association’s Standards of Medical Care in Diabetes.
The guidelines establish goals (and the means of achieving those goals) for blood pressure, blood lipids, blood glucose, smoking, diet, physical activity, body weight, and psychological adjustment to having diabetes. In addition, the expert panel recommended the following preventive drug interventions for women at high risk:
Aspirin. Aspirin therapy (75–325 milligrams) or the equivalent (if aspirin is not tolerated) is recommended for women at high risk of coronary heart disease. However, individuals should not start taking aspirin without speaking with their health-care provider first.
Beta-blockers. According to the guidelines, this class of blood-pressure-lowering drugs should be used by all women who have had a heart attack or who have chronic ischemic conditions (restricted blood flow to the heart).
ACE inhibitors. This class of blood-pressure-lowering drugs should be used by all women at high risk. If ACE inhibitors are not tolerated, another class of drugs called ARBs should be considered.
Lipid-lowering drugs. The guidelines recommend that health-care providers initiate LDL-cholesterol-lowering therapy (preferably with one of the class of drugs known as statins) simultaneously with lifestyle therapy in all women at high risk whose LDL cholesterol is greater than or equal to 100 mg/dl as well as in women at high risk whose LDL cholesterol level is lower than 100 mg/dl, as long as there is no particular reason not to prescribe the drug. Niacin or fibrate therapy (two other classes of drugs) is recommended for women whose HDL cholesterol is low or whose non-HDL-cholesterol is elevated. (Non-HDL-cholesterol is calculated by subtracting HDL cholesterol from total cholesterol.)
In all cases, the guidelines state that these drugs should be taken as long as a woman has no contraindications, or specific reasons not to take a drug. A contraindication could include taking another drug that would interact with the drug in question or having a medical condition that could be worsened by taking a particular drug.)