New Recommendations for Women

The American Heart Association’s 2007 update of its Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women is shown in the picture.

Lifestyle recommendations apply to virtually all women as this is a disease many times of lifestyle management or mismanagement along with uncontrollable genetic factors.

The updated guidelines propose three levels of risk:

“High-risk” women have established coronary heart disease (CHD), cerebrovascular disease, abdominal aortic aneurysm, end-stage or chronic renal disease, or diabetes mellitus.

“At-risk” women have family history, subclinical markers of disease such as coronary calcification, and two new things: low exercise tolerance and failure of heart rate to return rapidly to normal after exercise testing.

“Optimal-risk” women have a Framingham score <10%,>

Women are counseled not to smoke and to avoid environmental tobacco-smoke exposure.

Women are given recommendations for physical activity a minimum of 30 minutes of exercise at a level of moderate intensity, e.g., brisk walking, most—and preferably all—days of the wee and an addition, in the current update, is the prescription of a higher dose of physical activity (60-90 minutes, daily if possible) for women who are trying to lose weight or sustain weight loss.

The dietary guidelines proposed for all women continues to be a variety of fruits and vegetables but several recommendations have been added including fish (oily fish in particular) twice weekly, and limiting alcohol to one drink and sodium to <2.3>

Folic acid, which had been recommended for high-risk women with elevated levels of homocysteine, should not be used for primary or secondary CVD prevention at all according to the new recommendations.

And the tentative recommendation is against antioxidant supplementation (e.g., vitamin C or E) for CVD prevention. Withholding hormone therapy for CVD prevention continues to be upheld in the current recommendations.