Women Urged to Take Heart Disease Seriously

New guidelines designed to protect against this No. 1 killer

MONDAY, March 29, 2004 (HealthDayNews) -- For years, women have worried about the health of their partner's heart, tending to husbands or boyfriends when their cholesterol goes up or their heart starts to falter.

Now, it's time they start taking care of their own hearts, health experts say.

To help them do just that, the American Heart Association (AHA) has issued new guidelines, offering for the first time "evidence-based" recommendations for preventing heart disease and stroke in women that are tied to their individual level of risk.

"Almost every minute, a woman in the United States dies of cardiovascular disease," says Dr. Nanette K. Wenger, a member of the AHA panel that wrote the guidelines.

The new guidelines, which are more aggressive than previous ones issued in 1999, will hopefully be taken seriously by women and their doctors, says Dr. Lori Mosca. Director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center, she is also chairwoman of the panel that wrote the recommendations.

"Hopefully these guidelines have gotten substantial attention, and I do think that will help with implementation. Unlike previous guidelines, these are also being rolled out with several continuing medical education courses for doctors," Mosca says.

Heart disease and stroke are the number one and number three killers, respectively, of American women, claiming nearly a half million lives annually. But women aren't likely to consider it their greatest health risk. In fact, a survey of more than 1,000 women taken by the American Heart Association in 2003 found most women don't view themselves as personally at risk for heart trouble. While 46 percent of those surveyed knew heart disease was the leading cause of death for U.S. women, only 13 percent said they considered it their own greatest health risk.

Mosca suspects the 1999 guidelines weren't uniformly or fully put into place and that many primary-care doctors or gynecologists -- whom women are likely to see most often -- didn't even discuss them. This time will be different, she hopes.

Under the new guidelines, a woman is urged to get her personal level of risk for heart disease assessed by her doctor and then follow the appropriate strategies.

Women will be classified as "low risk," defined as those who have less than a 10 percent chance of having a heart attack in the next decade; "intermediate risk," those with a 10 to 20 percent chance of having a heart attack in the next 10 years; or "high risk," defined as a greater than 20 percent chance of an attack.

All women are also now urged to follow heart-healthy habits, such as maintaining a healthy weight, exercising for at least 30 minutes most days, and not smoking.

The importance of a healthy lifestyle can't be stressed enough, Mosca says. "We want to reinforce the idea that lifestyle has been, is, and always will be a primary method to lower a woman's risk of heart disease," she says.

Additional recommendations are now based on risk level. "A good example of that is aspirin [therapy]," says Mosca. "There is a different recommendation for aspirin based on the three levels of risk."

High-risk women, who typically have already had a stroke or heart attack, are encouraged to take a daily aspirin.

Intermediate-risk women, who typically have two or more heart disease risk factors, such as high blood pressure or high cholesterol, may be prescribed aspirin if their doctor thinks its benefit outweighs risks, such as gastrointestinal bleeding, Mosca says.

Women at low risk, typically those with no heart disease risk factors, shouldn't be put on aspirin therapy to prevent heart attacks, Mosca says. "It may do more harm than good," she says. "Wait for the clinical trials."

Dr. Raluca Arimie, staff cardiologist at Santa Monica-UCLA Medical Center in California, is another heart expert who applauds the new guidelines. "Everything we have been trying to do before now comes in the form of the guidelines," she says.

Arimie says some of her patients who need to be on cholesterol-lowering drugs, for instance, balk at the side effects and drag their feet about starting the medications. "The guidelines will help convince patients" that when medication is needed, it's better to take it than try unproven strategies, or linger too long hoping lifestyle changes alone will work, she says.

The guidelines also urge doctors to treat risk factors such as high blood pressure and high cholesterol more aggressively, Arimie says.

Once a woman knows her risk level, she should map out a strategy with her physician, Mosca says. "A woman should develop a close partnership with her physician," she says. "She has to be a very strong partner in the process."

And, it can help to give yourself some deadlines, with the help of your doctor, she adds. Suppose your doctor tells you to get more exercise or lose weight in an attempt to bring down your blood pressure. "Talk to your physician about how long you should take to get there. How long should you give it for lifestyle?"

Then, if lifestyle doesn't bring about the desired result, you need to talk about other strategies, such as medication, Mosca says.

More information

To find out more about women and heart disease, visit the American Heart Association and the National Coalition for Women With Heart Disease.

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