New Guidelines for the Prevention of Heart Disease in Women

This month, the American Heart Association is releasing updated cardiovascular disease (CVD) prevention guidelines for women--outlining the progress made since a report issued in 1999. The good news is that there has been progress:

• Physicians and more women now recognize that CVD is not just a disease of men; in fact, it is the leading cause of death among women.
• The death rate from coronary heart disease (CHD) has fallen substantially due to reducing risk factors and improvements in treatment.

But women still face many challenges that put them at risk for heart disease.

• The obesity epidemic and the associated increase of type 2 diabetes. These factors may account for the apparent increase in the death rates from CHD in U.S. women 35 to 54 years of age. The rate of diabetes is more than twice as great among Hispanic women compared with non-Hispanic white women.
• The prevalence of high blood pressure. This problem is increasing and is especially high among black women.

A major change in the focus of guidelines

Rather than basing recommendations only on the findings in clinical research settings, the new 2011 guidelines emphasize personal and socioeconomic factors that may keep women from following medical advice and treatment. This includes women who are in poverty, those with poor English skills, low literacy levels, psychiatric illness, vision and hearing problems--all factors that make it difficult to reach these women.

The guidelines also link specific illnesses with an increased risk for heart disease in women. The inflammation associated with lupus and rheumatoid arthritis is thought to cause an increased risk for CVD. Pregnancy-associated hypertension and diabetes are likely to recur later in life, both of which are associated with higher risk. In addition, depression may be linked to CVD because depressed people often do not follow preventive lifestyle measures. Be sure to talk with your doctor if you have any of these conditions so that he or she can factor in these risks.

The basic recommendations haven't changed

It is well known that lifestyle factors make a big difference in cardiovascular health, while drug treatments also play a key role. Here are the recommendations that you should still follow:

• Don’t smoke; smokers should get help to stop smoking.
• Increase your physical activity, including muscle-strengthening activities.
• Consume a diet rich in fruits and vegetables, eat fish at least twice a week, avoid trans fatty acids, and
   limit intake of saturated fat, cholesterol, alcohol, sodium, and sugar.
• Lose or control your weight with caloric restriction and physical activity.
• Follow a drug treatment plan if you have high blood pressure or abnormal blood lipids that are not lowered 
   adequately by lifestyle measures.
• If you have chronic or new onset angina, a recent CVD event, or coronary revascularization procedure you 
   should enroll in a cardiac rehabilitation program.
• If you already have CVD or diabetes, or are over age 65, you should consider regular aspirin.
• Take aspirin or warfarin if you have atrial fibrillation.
• Take ACE inhibitors and beta-blockers after a heart attack.