Features May 2011 Issue

Real World Heart Health Guidelines Target Women

The latest research is based more on the average patient rather than the participants in clinical studies.

The American Heart Association has released its first heart disease prevention guidelines aimed specifically at women. The guidelines were published in February in the journal Circulation. The focus of these guidelines is to use more real-world experience, rather than just findings from clinical research, which has been used to develop previous guidelines.

"It is important to talk to your primary care doctor about your risk factors for heart disease," says Leslie Cho, MD, FACC, director of the Women’s Cardiovascular Center at Cleveland Clinic and Editor-in-Chief of Heart Advisor. Having multiple risk factors will help your doctor better determine your best course of treatment.

The drawback to conclusions reached in clinical trials is that inclusion criteria is very specific, and may not account for co-morbidities which are very often seen in older patients. For example, researchers testing a new hypertension drug may recruit women who have high blood pressure, but no other problems. In reality, many women with high blood pressure may also suffer from obesity, diabetes, or heart disease.

Suffering from multiple medical problems may mean that you need your own, specific game plan for combating cardiovascular disease. Not all patients are created equal. "For example, rheumatologic diseases such as lupus and rheumatoid arthritis can increase heart disease risk by three to five times," says Dr. Cho. "So these patients will need to work extra hard to protect their hearts."

The New Guidelines

The new guidelines are broken down into three separate categories: lifestyle interventions, major risk factor interventions, and preventive drug interventions. As far as lifestyle goes, women should be advised not to smoke and to avoid secondhand smoke. Smokers should be provided with counseling during each doctor’s visit and educated about nicotine replacement therapy and behavioral programs to help them quit.

You should also accumulate at least 150 minutes per week of moderate exercise, 75 minutes per week of vigorous exercise, or an equivalent combination of both. Aerobic activity should be performed in episodes of at least 10 minutes, preferably spread through the week. Additional cardiovascular benefits are provided by increasing moderate-intensity aerobic physical activity to five hours per week, two and a half hours per week of vigorous-intensity physical activity, or an equivalent combination of the both. Engage in muscle-strengthening activities that involve all major muscle groups at least twice a week.

Consume a diet rich in fruits and vegetables, whole-grain, high-fiber foods. Eat fish (especially oily fish) at least twice a week and limit your intake of saturated fat, cholesterol, alcohol, sodium, and sugar; and avoid trans-fatty acids. Consumption of omega-3 fatty acids in the form of fish or in capsule form (EPC 1,800 mg/day) may be considered in women with high cholesterol and/or high triglycerides.

Maintain a body mass index (BMI) of less than 25, a waist size of less than 35 inches, and an optimal blood pressure of less than 120/80 mmHg. Medication should be prescribed to women with a blood pressure greater than or equal to 140/90 mm/Hg.