Lori Mosca, M.D., Ph.D., who is director of preventive cardiology at New York-Presbyterian Hospital and chair of the American Heart Association expert panel that wrote the Guidelines for Preventing Cardiovascular Disease in Women, said the panel took “a long-term view of heart disease prevention” because the lifetime risk of women dying of cardiovascular disease (CVD) is nearly one in three.

Since the last guidelines were developed, more definitive clinical trials became available to suggest two important new recommendations, Dr. Mosca said:

• Health care providers should consider aspirin in women to prevent stroke.
• Providers should not use menopausal therapies, such as hormone replacement therapy (HRT), or selective estrogen receptor modulators (SERMs), such as raloxifene or tamoxifene. “They have been shown to be ineffective in protecting the heart and may increase the risk of stroke,” she said.

The new guidelines also discount unregulated dietary supplements as a method to prevent heart disease, according to Dr. Mosca. “For example, recent studies have shown that folic acid is ineffective to protect the heart—despite widespread use by patients and physicians hoping for a heart benefit.”

While CVD is the largest single cause of mortality among women, advances in science and medicine allow many women to survive heart disease. In the United States, 42.1 million women live with CVD. These women are signifi cantly at risk for future heart attack or stroke.

Physicians can easily identify high-risk women, but tools to determine other levels of risk are limited, Dr. Mosca said. “Therefore, we have more aggressive recommendations for high-risk women, and strongly emphasize lifestyle strategies to reduce risk in all women,” she said.

The new recommendations are:

• Make lifestyle changes to manage blood pressure. This includes weight control, increased physical activity, alcohol moderation, sodium restriction, and an emphasis on eating fresh fruits, vegetables, and low-fat dairy products.
• Increase physical activity if you need to lose weight or sustain weight loss—a minimum of 60-90 minutes of moderate-intensity activity.
• Reduce saturated fat intake to less than 7 percent of calories, if possible.
• Increase omega-3 fatty acid intake and supplementation. This means eating oily fish at least twice a week. Women with heart disease should consider taking a capsule supplement of 850-1,000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).
• Vitamin E, C, and beta-carotene should not be used for primary or secondary prevention of CVD.
• Routine low-dose aspirin therapy may be considered in women age 65 or older regardless of CVD risk status, if benefi ts are likely to outweigh other risks.
• The upper dosage of aspirin for high-risk women increases to 325 mg per day rather than 162 mg.
• Very high-risk women with heart disease should consider reducing LDL cholesterol to less than 70 mg/dL (which may require a combination of cholesterol-lowering drugs).
• Besides advising women to quit smoking, the report recommends counseling, nicotine replacement or other forms of smoking cessation therapy.