Guidelines Offer Women a Change of Heart :

Focusing on prevention is the best way to halt heart disease in women.

We’ve said this before and will, no doubt, say it again: Heart disease isn’t a man’s disease. It never really was, even though it has carried that reputation for years. Today, about one in every three American women is living with heart disease, the same proportion as men, and more women than men die each year of heart disease and stroke. Many women — and many of their doctors — don’t know this.

The burden heart disease places on women’s lives, their families, health care costs, and the economy is staggering. It is even more tragic when you consider that it is largely a preventable disease.

For the last 10 years, the American Heart Association (AHA) has tried to keep doctors and their female patients abreast of the latest knowledge on preventing heart disease. The association’s latest effort, published in the March 20. 2007 issue of Circulation, stresses lifestyle changes over medications, emphasizes a woman’s lifetime risk of developing heart disease, revises risk categories, advises against using hormone therapy or vitamins to prevent heart disease, and clarifies who should and who shouldn’t take aspirin.Who’s at risk?
Prior guidelines used four categories of risk: high, intermediate, lower, and optimal. The new ones have just three: high risk, at risk, and optimal. A woman is in the high-risk group if she has some form of cardiovascular disease, kidney disease, diabetes, or a 20% or higher chance of having a heart attack over the next 10 years based on the Framingham risk score.

The at-risk category is quite broad. It includes women who have one or more risk factors for heart disease, such as smoking, inactivity, obesity, high blood pressure, high cholesterol, or a parent who developed heart disease at a relatively early age. Also included are women who do poorly on a stress test or who have evidence of atherosclerosis.

The optimal category is for the select few: women with a 10% or lower chance of having a heart attack over the next 10 years who also have healthy lifestyles and no heart disease risk factors.

Aspirin for some
It wasn’t until the completion of the Women’s Health Study in 2005 that we understood how aspirin might benefit women. This trial showed that taking aspirin didn’t prevent a first heart attack any better than taking a placebo, although it did slightly reduce the risk of stroke. When the researchers looked at aspirin’s effects by age, though, they found that it generally benefited women over age 65. These results are reflected in the AHA’s guidelines. They recommend daily low-dose aspirin for all women in the high-risk group and for some women in other groups who are over age 65, particularly those with well-controlled blood pressure in whom the benefits of aspirin for prevention outweigh the risks of gastrointestinal bleeding or hemorrhagic stroke. Healthy women under age 65 shouldn’t take aspirin to prevent heart attacks.

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