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Senior Citizen Health & Medicine
Older Women May Take Low Dose Aspirin is One of New
Heart Risk Guidelines for Women
Focus on lifetime heart disease risk by American
Heart Association
 Feb. 20, 2007 – Women received new advice today on
how to avoid heart disease and stroke from the American Heart
Association, and it includes significant changes from guidelines
published in 2004. For senior citizens, for example, the new guidelines
now say women age 65 and older should consider regular use of low dose
aspirin. It has not been recommended before for healthy women.
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Health & Medicine |
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A major focus of the new guidelines is to urge
healthcare professionals to focus on women’s lifetime heart disease
risk, not just short-term risk.
The 2007 Guidelines for Preventing Cardiovascular
Disease in Women – published today in a special women’s health issue of
Circulation: Journal of the American Heart Association – also include
new directions for using aspirin, hormone therapy and vitamin and
mineral supplements in heart disease and stroke prevention in women.
“The updated guidelines emphasize the lifetime risk
of women, not just the more short-term focus of the 2004 guidelines,”
said Lori Mosca, M.D., Ph.D., director of preventive cardiology at New
York–Presbyterian Hospital and chair of the American Heart Association
expert panel that wrote the guidelines.
“We took a long-term view of heart disease
prevention because the lifetime risk of dying of cardiovascular disease
(CVD) is nearly one in three for women. This underscores the importance
of healthy lifestyles in women of all ages to reduce the long-term risk
of heart and blood vessel diseases.”
The guidelines include a new paradigm for risk
assessment based on risk factors and family history, as well as the
Framingham risk score. (The Framingham risk score, first published in
1998, estimates the risk of developing coronary heart disease within 10
years.)
The new guidelines include expanded recommendations
on lifestyle factors such as physical activity, nutrition and smoking
cessation, as well as more in-depth recommendations on drug treatments
for blood pressure and cholesterol control.
Furthermore, guidelines on hormone and aspirin
therapy and antioxidant and folic acid supplements are revised based on
recently published data.
“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,” 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.”
A recent American Heart Association survey showed
that women are confused about methods to prevent heart disease including
the role of aspirin, hormones and dietary supplements.
“The new guidelines reinforce that unregulated
dietary supplements are not a method proven to prevent heart disease.
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,” Mosca said.
“These recent findings emphasize the importance of
using well-conducted clinical trial data to develop national
recommendations to help patients and their doctors use best practices to
prevent heart disease – practices based on data rather than myth or
wishful thinking.”
CVD is the largest single cause of mortality among
women, accounting for 38 percent of all deaths among females. The
public health impact of CVD in women is not solely related to mortality,
as advances in science and medicine allow many women to survive heart
disease. For example, in the United States 42.1 million (36.6 percent)
women live with CVD and the population at risk is even larger.
In fact, “nearly all women are at risk for CVD,
underscoring the importance of a heart-healthy lifestyle in everyone,”
the authors wrote. “Some women are at significant risk of future heart
attack or stroke because they already have CVD and/or multiple risk
factors. These women are candidates for more aggressive preventive
therapy and we define them as high risk.”
Physicians can easily identify high-risk women, but
tools to determine other levels of risk are limited, Mosca said. The
authors have aligned their recommendations with treatments proven to
work and give strong advice for what not to do, as well.
“Therefore, we have more aggressive recommendations
for high-risk women, and strongly emphasize lifestyle strategies to
reduce risk in all women,” she said. “Medicine is still an art but
these guidelines are meant to guide healthcare professionals on the best
science available.”
Highlights of the changes include:
● Recommended lifestyle changes to help
manage blood pressure include weight control, increased physical
activity, alcohol moderation, sodium restriction, and an emphasis on
eating fresh fruits, vegetables and low-fat dairy products.
● Besides advising women to quit smoking,
the 2007 guidelines recommend counseling, nicotine replacement or other
forms of smoking cessation therapy.
● Physical activity recommendations for
women who need to lose weight or sustain weight loss have been added –
minimum of 60–-90 minutes of moderate-intensity activity (e.g., brisk
walking) on most, and preferably all, days of the week.
● The guidelines now encourage all women to
reduce saturated fats intake to less than 7 percent of calories if
possible.
● Specific guidance on omega-3 fatty acid
intake and supplementation recommends eating oily fish at least twice a
week, and consider taking a capsule supplement of 850–1000 mg of EPA (eicosapentaenoic
acid) and DHA (docosahexaenoic acid) in women with heart disease, two to
four grams for women with high triglycerides.
● Hormone replacement therapy and
selective estrogen receptor modulators (SERMs) are not recommended to
prevent heart disease in women.
● Antioxidant supplements (such as
vitamin E, C and beta-carotene) should not be used for primary or
secondary prevention of CVD.
● Folic acid should not be used to
prevent CVD – a change from the 2004 guidelines that did recommend it be
considered for use in certain high-risk women.
● Routine low dose aspirin therapy may be
considered in women age 65 or older regardless of CVD risk status, if
benefits are likely to outweigh other risks. (Previous guidelines did
not recommend aspirin in lower risk or healthy women.)
● The upper dosage of aspirin for
high-risk women increases to 325 mg per day rather than 162 mg. This
brings the women’s guidelines up to date with other recently published
guidelines.
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2006 Heart
and Stroke Statistics for Women |
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● In 2003, 483,800 American females
died from CVD, and there were 6 million females with coronary
heart disease (CHD) and 3.1 million with stroke.
● From 1999-2003, the number of women
dying from CVD decreased by 5.7 percent and the number of women
dying from CAD decreased 1.1 percent. Looked at another way,
during that time age-adjusted death rates from CVD in women
decreased about 12 percent and for CHD they dropped about 17
percent.
● One in 2.6 deaths in women are from
cardiovascular disease (CVD).
● 64 percent of women and 50 percent of
men who died suddenly of coronary heart disease (CHD) in the
United States had no previous symptoms of this disease.
● The average age of a person having a
first heart attack is 65.8 for men and 70.4 for women.CHD rates
in women after menopause are two-to-three times those of women
the same age who are premenopausal.
● In 2003, 96,200 females and 61,600
males died from stroke. Because women live longer than men,
more women die of stroke each year. Females accounted for 61
percent of U.S. stroke deaths.
● Before age 75, a higher proportion of
cardiovascular events due to coronary heart disease occur in men
than in women, and a higher proportion of events due to
congestive heart failure occur in women than in men.
● 8 percent of women and 25 percent of
men will die within one year of having an initial recognized
heart attack.
Source: American Heart Association Heart
Disease and Stroke Statistics — 2006 Update.
Click for more… |
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● Consider reducing LDL cholesterol to
less than 70 mg/dL in very high-risk women with heart disease (which may
require a combination of cholesterol-lowering drugs).
Editor's Notes:
This 2007 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, according to the American Heart
Association.
The authors note that these guidelines cover the
primary and secondary prevention of chronic atherosclerotic vascular
diseases. Recommendations for managing vascular disease before or
after cardiac procedures or post-hospital and valvular heart disease are
covered in other American Heart Association guidelines.
Co-authors of the 2007 guidelines are Carole L.
Banka, Ph.D.; Emelia J. Benjamin, M.D.; Kathy Berra, M.S.N., N.P.;
Cheryl Bushnell, M.D.; Rowena J. Dolor, M.D., M.H.S.; Theodore G.
Ganiats, M.D.; Antoinette S. Gomes, M.D.; Heather L. Gornik, M.D., M.H.S.;
Clarissa Gracia, M.D., M.S.C.E.; Martha Gulati, M.D., M.S.; Constance K.
Haan, M.D.; Debra R. Judelson, M.D.; Nora Keenan, Ph.D.; Ellie
Kelepouris, M.D.; Erin D. Michos, M.D.; L. Kristin Newby, M.D., M.H.S.;
Suzanne Oparil, M.D.; Pamela Ouyang, M.D.; Mehmet Oz, M.D.; Diana
Petitti, M.D., M.P.H.; Vivian W. Pinn, M.D.; Rita Redberg, M.D., M.Sc.;
Rosalyn Scott, M.D.; Katherine Sherif, M.D.; Sidney Smith Jr, M.D.;
George Sopko, M.D., M.P.H.; Robin H. Steinhorn, M.D.; Neil J. Stone,
M.D.; Kathryn Taubert, Ph.D.; Barbara A. Todd, M.S.N., C.R.N.P.; Elaine
Urbina, M.D. and Nanette Wenger, M.D.
This writing group includes representatives of
the following participating organizations and major co-sponsors: The
American Heart Association; American Academy of Family Physicians;
American College of Obstetricians and Gynecologists; American College of
Cardiology Foundation; Society of Thoracic Surgeons; American Medical
Women’s Association; Centers for Disease Control and Prevention, Ad Hoc
Writing Group Member, Office of Research on Women’s Health; Association
of Black Cardiologists; World Heart Federation; National Heart, Lung,
and Blood Institute; and American College of Nurse Practitioners; with
representation from the American College of Physicians. (Representation
does not imply endorsement by the American College of Physicians.)
In addition, this report has been endorsed by:
American Academy of Physician Assistants; American Association for
Clinical Chemistry; American Association of Cardiovascular and Pulmonary
Rehabilitation; American College of Emergency Physicians; American
Diabetes Association; American Geriatrics Society; American Society for
Preventive Cardiology; American Society of Echocardiography; American
Society of Nuclear Cardiology; Association of Women’s Health, Obstetric
and Neonatal Nurses; Global Alliance for Women’s Health; The Mended
Hearts, Inc; National Black Nurses Association; National Black Women’s
Health Imperative; National Women’s Health Resource Center; North
American Menopause Society; The Partnership for Gender-Specific Medicine
at Columbia University; Preventive Cardiovascular Nurses Association;
Society for Vascular Medicine and Biology; Society for Women’s Health
Research; Society of Geriatric Cardiology; Women in Thoracic Surgery;
and WomenHeart: the National Coalition for Women with Heart Disease.
Go Red for Women
In 2004, the American Heart Association launched
its multi-tiered cause marketing Go Red For Women movement to raise
women’s awareness of their risk for heart disease and to help them take
action to reduce their risk. For more information on heart disease and
stroke or the Go Red For Women movement, call 1-888-MY-HEART or visit
goredforwomen.org.
The American Heart Association urges Congress to
make the No. 1 killer of women a national priority by passing the HEART
for Women Act this year. The HEART for Women Act is bipartisan federal
legislation that would improve the prevention, diagnosis and treatment
of cardiovascular disease in women. For more information, please visit
www.heartforwomen.org.
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