Cardiovascular Health Prevention in Women
Being aware of personal risk and treatment options can empower a woman to live a long and healthy life. Guidelines have been developed to help women prevent the development of heart and vascular disease. Physicians who follow these guidelines will be able to help women make lifestyle changes and better select the right medications to help them avoid or treat heart and vascular disease.
The guidelines for cardiovascular disease prevention in women were designed to help women achieve a heart-healthy lifestyle and reduce their chances of having a heart attack or stroke.
Say "ALOHA" (Goodbye) to Heart & Vascular Disease
It is easy to remember what you need to know about the guidelines and setting priorities. Just think ALOHA:
A - Assess your risk and rank yourself as high, intermediate, or lower risk.
L - Lifestyle changes are the top priority in heart and vascular disease prevention.
O - Other interventions are prioritized according to the expert panel rating scale.
H - Highest priority for therapy is for women at highest risk.
A - Avoid medical therapies called Class III.
A - Assess Your Risk
Your risk for developing heart disease over time depends on the presence or absence of specific risk factors or lifestyle behaviors that may increase your risk of developing heart disease. When we talk about risk, we are describing the "odds" of you developing heart disease at some point in your life. The first step in lowering your risk requires assessing—or measuring—your risk. You and your doctor can use a tool called the Framingham Risk Score to calculate your risk of developing heart disease.
10 Year Heart Disease Risk Score
Your risk score tells you your chances of having a heart attack or dying of heart disease over a 10-year period. You are given points, based on your age, total cholesterol level, HDL ("good") cholesterol level, blood pressure, and whether you smoke. The points are added up and converted into a 10-year risk score—the higher your score, the higher your risk of developing heart disease. Your risk can be interpreted as the number of chances out of 100 that you will develop or die from heart disease in the next 10 years, according to your current risk profile.
If you already have heart disease, stroke, peripheral arterial disease, abdominal aortic aneurysm, diabetes mellitus, or chronic kidney disease, you are automatically considered to be at high risk. Also, some women with genetic cholesterol problems may also be at high risk.
Calculate your risk of developing heart disease. Share the results with your physician and discuss the next steps to reduce your risk of heart disease.
L - Lifestyle Change: First Line of Defense Against Cardiovascular Disease
No matter what your risk score is, the most important thing you can do to lower your risk of heart and vascular disease is to make living a healthy lifestyle your top priority. The following five lifestyle changes are recommended to all women.
- Stop smoking and avoid secondhand tobacco smoke.
- Get at least 30 minutes of exercise each day.
- Start a cardiac rehabilitation program if you have heart disease.
- Eat a heart-healthy dietof fruits, vegetables, grains, low-fat or nonfat dairy products, fish, legumes, and sources of protein low in saturated fat. Limit the amount of trans fatty acids in your diet, such as those found in hydrogenated oils.
- Maintain a healthy weight.
O - Other Interventions Prioritized by the Evidence Rating Scale
The clinical recommendations below are part of the guidelines. They are recommended based on evidence that these interventions will reduce the risk of cardiovascular disease in women. These interventions include lowering high blood pressure in all women with hypertension (high blood pressure), ensuring healthy cholesterol levels, and keeping diabetes under control.
- Blood pressure is optimal at less than 120/80 mm Hg. If there is a slight rise in pressure, the first line of self-defense is to improve your lifestyle habits. If your blood pressure stays at 140/90 or higher (or greater than 130/80 if you have diabetes), drug therapy should be started. If you note that your blood pressure has been elevated three or more times, bring this to your doctor's attention.
- Cholesterol levels are important for women to know. Total cholesterol optimally should be less than 200 mg/dL; LDL (bad cholesterol), less than 100 mg/dL or less than 70 mg/dL in the highest risk women; HDL (good cholesterol), more than 50 mg/dL; and triglycerides (a type of fat in the blood), less than 150 mg/dL.
- Diabetes (high blood sugar) is very common in women and has a greater impact on a woman's risk of developing cardiovascular disease. Unhealthy eating habits, inactivity, and gaining too much weight are leading causes of Type II (acquired) diabetes. Prevention of diabetes should be the first goal, but if you have diabetes, tight blood sugar control is the top priority. Poorly controlled diabetes can lead to a heart attack or stroke. Diet, exercise, and medication are the keys to normal blood glucose levels. Long-term control of glucose is measured with an HbA1C level and it should be maintained at less than 7%.
H - Highest Priority for Therapy Is for Women at Highest Risk
Women who are considered to be at highest risk are most likely to benefit from preventive therapy. Women at highest risk are those who already have cardiovascular disease, diabetes, or chronic kidney disease. Besides lifestyle changes and controlling major risk factors, several drugs have been shown to prevent heart and vascular disease or increase survival in this group. The drugs listed below are considered desirable therapies for women at high risk.
- ACE (angiotensin-converting enzyme) inhibitor therapy: If a woman on ACE therapy has side effects such as coughing, it is recommended that an ARB (angiotensin receptor blocker) be used instead, if she has a history of heart failure.
- Aspirin therapy (baby aspirin or a maximum dose of 162 mg): Women who have liver or kidney disease, stomach ulcers and other gastrointestinal problems, bleeding problems, or aspirin allergies should not take aspirin regularly.
- Beta-blocker therapy: Beta-blockers are recommended for women who have had a heart attack or have ongoing angina or chest pain.
- Statin therapy: Statins effectively reduce total cholesterol and LDL (bad cholesterol). Recent studies have shown statins are helpful even when the LDL is below 100, so the panel recommended that high-risk women take statins if possible.
- Niacin or fibrate therapy: The panel recommended that high-risk women with a low HDL (good cholesterol) or high non-HDL (all the bad cholesterol and fats together) use niacin or fibrate therapy. Niacin therapy lowers total cholesterol and raises HDL (good cholesterol). Prescription niacin can be used alone or together with statin therapy. Dietary supplement niacin must not be used as a substitute for prescription niacin. Over-the-counter niacin should only be used if approved and monitored by a physician.
- Fibrates: Fibrates are effective in lowering triglycerides and, to some extent, can help improve HDL (good cholesterol levels). Fibrates are generally well tolerated by most women.
- Warfarin/Coumadin®: Women with atrial fibrillation—a type of irregular heartbeat that can lead to stroke—should take the blood thinner Warfarin/Coumadin® unless they cannot or are considered to be at low risk for a stroke. In that case, they should take 325 mg of aspirin daily.
A - Avoid Medical Interventions Called "Class III"
The guidelines also outline drugs that should not be used in women to prevent cardiovascular disease because research has shown no benefit—and in some cases, found harm. You should avoid the use of the following:
- Postmenopausal hormone therapy (estrogen and progestin, or estrogen alone) have been shown to have no benefit in preventing heart disease. In some women, it may cause heart attacks, stroke, or blood clots.
- Antioxidant supplements, such as vitamin E and beta-carotene, should not be used to prevent heart disease. Several clinical trials have shown no benefit and some have shown an unexpected increase in hemorrhagic (bleeding) strokes. These supplements may also interfere with the beneficial effects of statin therapy.
- Aspirin for low-risk women is not recommended. The potential benefits may be outweighed by risks such as stomach bleeding or ulcers.
Overwhelming evidence suggests that cardiovascular disease can be prevented in both women and men. Every woman should know what her risk level is and talk to her doctor about prevention goals and the best way to reach them.
Center for Women's Cardiovascular Health
1-866-662-8467 (toll free)