By: Maayan S. Heller for Uterus1
Most American women are at risk for heart disease or stroke, according to updated guidelines published by the American Heart Association (AHA). The guidelines, published February 19, 2007, center around the organization’s suggestion that women be more aggressive about lowering heart risk. Women are encouraged to ask their doctors about daily aspirin use as a preventive measure, which is a controversial prescription.
Exercise – Get a minimum of 30 minutes of moderate-intensity exercise at least three to four days per week if you’re at a generally good fitness level, and 60-90 minutes if you are overweight.
Diet – Eat more fruits and vegetables, whole grains and high-fiber foods, and fish; eat less salt; limit saturated fat intake and try to eliminate trans fat consumption; limit alcohol to one drink or less per day.
Smoking – Don’t do it.
Weight – Consult with your doctor and keep your body-mass index within a reasonable range for your age and height.
Blood pressure and Cholesterol – Keep it under control, with medication if necessary.
Aspirin – Ask your doctor first, but consider daily aspirin for preventing stroke unless you have a health condition or risk of bleeding.
This pronouncement marks the first time guidelines have urged all women to consider aspirin for stroke prevention. The new guidelines also include more specific lifestyle recommendations regarding exercise, nutrition, and smoking, and more on pharmacological treatments for blood pressure and cholesterol control.
Heart disease is the leading killer of both men and women worldwide. According to the AHA, the lifetime risk of dying of cardiovascular disease (CVD) is nearly one in three for women. The guidelines reference new evidence showing many more women than previously thought are at risk for heart disease and stroke. They also include a new model for risk assessment that focuses on risk factors, family history, and the Framingham score, which estimates the risk of developing coronary heart disease within 10 years.
In a press release on the AHA website, Dr. Lori Mosca, chair of the expert panel that drafted the guidelines, said research over the three years since the last version was published advanced science to where changing the recommendations was necessary. “Since the last guidelines were developed, more definitive clinical trials became available to suggest that healthcare providers should consider aspirin in women to prevent stroke,” Dr. Mosca said. “In addition, providers should not use menopausal therapies such as hormone replacement therapy (HRT) or selective estrogen receptor modulators (SERMs) such as raloxifene or tamoxifene to prevent heart disease because they have been shown to be ineffective in protecting the heart and may increase the risk of stroke.”
The recommendation of a daily aspirin supplement follows last summer’s AHA report that aspirin can be useful in preventing first strokes in high-risk women.
According to the AHA, men have a greater risk for heart attacks, but about 40,000 more women than men have strokes annually, and more than 60 percent of all stroke deaths occur in women. Studies have indicated that women taking one daily aspirin had a lower incidence of stroke than those who did not.
Recommending daily aspirin use has been controversial, as the drug is associated with risks, including ulcers and bleeding. The guidelines recommend daily use for women already at high risk and recommend all other women consider “baby aspirin” (81-milligrams) daily or 100 milligrams every other day.
Recent research also shows that daily aspirin can be effective in preventing heart disease in men 45 and older and in women 65 and older. The same research showed that putting young women on aspirin for stroke prevention is not necessarily effective.
However, the AHA states in a recent press release that the newest update “provides the most current clinical recommendations for preventing CVD in women 20 and older and are based on a systematic search of the highest quality science interpreted by experts in the fields of cardiology, epidemiology, family medicine, gynecology, internal medicine, neurology, nursing, public health, statistics and surgery.”
As always, the most important recommendation is for women to consult with their physicians and have their personal risks and health status assessed. As Dr. Mosca said, “medicine is still an art but these guidelines are meant to guide healthcare professionals on the best science available.”