Feb 23, 2007

New Guidelines for Lowering Women’s Heart and Stroke Risks

Tara Dairman

The American Heart Association released updated guidelines this week for preventing cardiovascular disease (heart disease and stroke) in women. The guidelines, which were published in a special issue of the journal Circulation: Journal of the American Heart Association, provide new information on how aspirin, hormone therapy, and supplements should (or should not) be used in women for cardiovascular disease prevention.

Cardiovascular disease is the number one killer of women in the United States; it is responsible for 38% of deaths among women. People with diabetes are at increased risk of developing cardiovascular disease, and about 65% of people with diabetes die from heart disease or stroke. According to the American Heart Association, diabetes "appears to be an even stronger contributing risk factor for heart disease in women than in men."

The new guidelines urge health-care professionals to focus on women's lifetime risk of developing heart disease and stroke, not just their short-term risk, which was the focus of previous guidelines released in 2004. They also contain some changes from the recommendations published in 2004, based on more recently published research. For instance, taking folic acid supplements has not been shown to be effective at protecting the heart by recent studies, even though it is currently used by many people and recommended by many physicians.

The 2007 "Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women" include the following:

• Women with diabetes should use lifestyle changes and drug therapy to maintain an HbA1c level (a measure of blood glucose levels over time) of 7% or less.
• Lifestyle changes that can help manage blood pressure include controlling weight, increasing physical activity, drinking alcohol in moderation, eating less sodium, and eating more fresh fruits, vegetables, and low-fat dairy products.
• Women who smoke should quit, and smoking cessation therapy (such as counseling or nicotine replacement) is recommended.
• Women should engage in at least 30 minutes of moderate-intensity activity (such as brisk walking) most or all days of the week. Women who need to lose weight or maintain weight loss should engage in at least 60–90 minutes of activity each day. This activity can be accumulated throughout the day.
• All women should get less than 7% of their calories from saturated fat, if possible. Trans fat intake should be as low as possible.
• Oily fish rich in omega-3 fatty acids should be eaten at least twice a week, and women with heart disease or high triglycerides may want to consider taking fish oil supplements.
• Hormone replacement therapy is not recommended to prevent heart disease in women (in fact, it may increase the risk of stroke).
• Antioxidant supplements (such as vitamin C, vitamin E, or beta carotene) should not be used to prevent cardiovascular disease in women.
• Folic acid should not be used to prevent cardiovascular disease in women. (In the 2004 guidelines, it was recommended for certain high-risk women.)
• Low-dose aspirin therapy may be used in women age 65 or older if they determine that the benefits (protection against ischemic stroke and heart attack) outweigh the risks (potential for gastrointestinal bleeding and hemorrhagic stroke). Also, the maximum dose of aspirin for high-risk women has increased from 162 milligrams (mg) to 325 mg per day.
• Very high-risk women who have heart disease may want to reduce their LDL (or "bad") cholesterol levels to less than 70 mg/dl.

For more information on preventing cardiovascular disease, visit the "Heart Health" section of our Web site. You can also determine your personal risk for heart disease online at www.goredforwomen.org.

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