During February, the American Heart Association’s Go Red for Women and Go Red Por Tu Corazon raise awareness about the number one killer of women. National Wear Red Day is February 7 this year. For more information, visit the American Heart Association at www.goredforwomen.org. 

Are You at Risk?

1. Pregnancy: Conditions such as gestational diabetes and      pregnancy-induced hypertension should be taken seriously because they can      have implications for heart disease risk. Women who develop preeclampsia      when pregnant will have two times the risk of stroke, heart disease, or      deep vein thrombosis during the 5−15 years after giving birth.
2. Autoimmune diseases: Autoimmune diseases, such as rheumatoid      arthritis and lupus, are associated with heart disease as well, possibly      by causing inflammation that damages the coronary arteries.
3. Emotional health: Talk about your emotional health, because      depression can decrease compliance in regard to diet and medication.
4. Race and ethnicity: Race and ethnicity are correlated to your risk.      For example, African American women are more likely to have hypertension,      and Hispanic women are more likely to have diabetes. Hispanics have the      lowest percentage of cardiovascular deaths.
5. Non-adherence: Patient-related non-adherence is common and most prevalent in several circumstances. Many barriers hindering adherence to prevention recommendations for cardiovascular disease (CVD) may include: Family and care-taking responsibilities, stress. sleep deprivation, fatigue and lack of personal time

Guidelines for preventing CVD in women

• Self-monitoring: Food records, blood pressure and blood glucose logs, group sessions, etc, improve both lifestyle and medication adherence.
• Smoking: Women should not smoke and should avoid secondhand smoke. Smokers who quit can reduce their heart disease risk to that of a non-smoker in less than 15 years.
• Exercise: Women should have at least 150 minutes/week of moderate exercise or 75 minutes/week of vigorous activity. Additional cardiovascular benefits are provided by increasing moderate-intensity exercise to 300 minutes/week or 150 minutes/week of vigorous activity. Women should perform muscle-strengthening exercises that involve all major muscle groups at least 2 days/week. Women wanting to lose weight should accumulate a minimum of 60−90 minutes of at least moderate-intensity exercise on most or all days.
• CVD risk-reduction: Women who recently have suffered acute coronary syndrome or coronary revascularization, new onset or chronic angina, or current/prior symptoms of heart failure who meet certain criteria, a recent cerebrovascular attack, or peripheral vascular disease should enroll in a comprehensive CVD risk-reduction regimen, such as rehabilitation or a community-based exercise program.
• Diet: Women should eat plenty of fruits and vegetables, choose whole-grain and high-fiber foods, consume fatty fish at least twice a week, and limit intake of saturated fat, cholesterol, alcohol, sodium, sugar, and trans-fat. Specific heart healthy diet guidelines include: More than 4.5 cups of fruits and vegetables/day,  7 ounces (cooked) of fatty fish each week, 30 grams/day of fiber, three servings/day of whole grains, less than five servings/week of sugar and fewer than 450 calories/week from sugar-sweetened beverages, more than four servings of nuts, legumes, and seeds/week, less than 7% of calories from saturated fat, less than 150 milligrams (mg)/day of cholesterol, less than one serving of alcohol/day, less than 1500 mg of sodium/day, no trans fatty acids
• Body mass index (BMI): Women should maintain or lose weight to achieve a BMI of less than 25, a waist size below 35², and other targets.  Women who sustain 10% loss body weight for two years decrease their heart disease risk.
• Eicosapentaenoic acid (EPA): Women who already have hypercholesterolemia or hypertriglyceridemia are advised to take 1800 mg/day of EPA, an omega-3 fatty acid. Check with your physician before starting any supplements.
• Blood pressure: An optimal blood pressure of <120/90 millimeters of mercury (mm Hg) is encouraged. If blood pressure is more than 140/90 mm Hg (or more than 130/80 mm Hg in women with chronic kidney disease and diabetes), most patients are prescribed medication.
• Lipids: The lipid goals are low-density lipoprotein (LDL) <100 mg/deciliter (dL), high-density lipoprotein (HDL) >50 mg/dL, triglycerides <150 mg/dL, and non-HDL cholesterol <130 mg/dL.
• LDL: Women with coronary heart disease should use diet, exercise and possibly medication to decrease their LDL to <100 mg/dL. Medication also is indicated for women with other atherosclerotic CVD or diabetes or a 10-year absolute risk of >20%. Women who are very high risk should aim for an LDL of 70 mg/dL.
• HDL: When HDL levels are low or when non-HDL cholesterol is high, niacin or fibrate therapy may prove useful.  You may also need to increase your physical activity.
• A1c: Women with diabetes should achieve an A1c of <7% (if possible without hypoglycemia).
• Antioxidants: Antioxidants such as vitamins E and C taken in supplemental doses are not useful for the prevention of heart disease. Neither are the B vitamins.
• Low-dose aspirin: If you are younger than 65, you probably do not need to take low-dose aspirin. In older women, baby aspirin can help to reduce the risk of stroke. Talk to your doctor if you have questions about this.
• Hormone therapy and selective estrogen-receptor modulators: Hormone therapy and selective estrogen-receptor modulators are not used for the primary or secondary prevention of cardiovascular disease.
• Medications: There are several medications that may be prescribed.  Discuss your medication plan with your physician.

−  Warfarin is used for women with chronic or paroxysmal atrial fibrillation.

−  Dapigatran is an alternative to warfarin, used for the prevention of stroke and systemic thromboembolism.

−  Beta blockers are used in all women after MI or acute chest pain with normal ventricular function or with left ventricular failure.

−  ACE inhibitors are used for women after MI or for those who have heart failure, left ventricular ejection fraction (LVEF) <40%, or diabetes.

−  Aldosterone blockade after MI is indicated in women without hypotension, renal dysfunction, or hyperkalemia if they are already on ACE inhibitors and beta blockers and have an LVEF of <40% and symptomatic heart failure. 

References and recommended readings

American Heart Association. Updated heart disease prevention guidelines for women focus more on “real-world” recommendations than clinical research. Accessed at: http://www.newsroom.heart.org/index.php?s=43&item=1239. Accessed March 17, 2011.

American Heart Association’s Scientific Sessions 2013.

Keehn J, senior ed. New heart-disease prevention guidelines for women. Available at: http://blogs.consumerreports.org/health/2011/02/new-heart-disease-prevention-guidelines-for-women.html. Accessed March 17, 2011. 

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.  Circulation [serial online]. 2011;123:1243-1262. Available at: http://circ.ahajournals.org/cgi/reprint/CIR.0b013e31820faaf8. Accessed March 17, 2011.