Women and Cardiovascular Disease
Heart Disease Prevention—Guidelines for a Healthy Heart1
With the recognition that women face a greater risk of death due to cardiovascular disease, guidelines for heart-disease prevention for women have been drafted. An updated set of guidelines from the American Heart Association that focuses on long-term preventive strategies was published in 2011. Recommendations include:
- Lifestyle changes, including smoking cessation and moderation in alcohol consumption
- Increased physical activity, with at least 150 min/wk of moderate exercise, 75 min/wk of vigorous exercise, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity
- Consumption of a diet rich in fruits and vegetables; whole-grain, high-fiber foods; and oily fish, with limited consumption of saturated fat, cholesterol, trans-fatty acids, sodium, and sugar
- Weight control through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated to maintain or achieve an appropriate body weight
- Maintenance of an optimal blood pressure of <120/80 mm Hg. Pharmacotherapy is indicated when blood pressure is ≥140/90 mm Hg (≥130/80 mm Hg in the setting of chronic kidney disease and diabetes mellitus)
- Encouraging healthy lipid levels through lifestyle approaches: LDL-C <100 mg/dL, HDL-C >50 mg/dL, triglycerides <150 mg/dL, and non–HDL-C (total cholesterol minus HDL) <130 mg/dL. LDL-C–lowering drug therapy is recommended simultaneously with lifestyle therapy in women with CHD to achieve an LDL-C <100 mg/dL. In women >60 years of age and with an estimated CHD risk >10%, statins could be considered if hsCRP is >2 mg/dL after lifestyle modification and no acute inflammatory process is present.
- Lifestyle and pharmacotherapy can be useful in women with diabetes mellitus to achieve an HbA1C <7% if this can be accomplished without significant hypoglycemia.
- Regardless of the cardiovascular-disease status, the routine use of low-dose aspirin in women 65 years or older needs to be considered only if benefits are likely to outweigh risks.
1. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women – 2011 update: A guideline from the American Heart Association. J Am Coll Cardiol. 2011 Mar 22; 57(12):1404-1423.