The American Heart Association released new guidelines for preventing and treating heart disease in women on Wednesday and said most women still do not realize heart disease is more likely to kill them than anything else.
The new guidelines stress lifestyle as the first line of attack — stopping smoking, losing weight, exercising every day and eating a healthy diet. But they also call for aggressive use of drugs to lower cholesterol and blood pressure in high-risk women.
Although surveys show women consider cancer to be their No. 1 health risk, cardiovascular disease is the leading killer of women globally, the Heart Association said. It takes the lives of nearly 500,000 U.S. women each year — one every minute.
In 1997 the Heart Association found that 30 percent of women listed heart disease as women’s leading cause of death. But the latest survey of more than 1,000 women found that 46 percent now know the risk — an improvement, but still fewer than half of those surveyed.
“However, when asked what they consider their own greatest health risk, only 13 percent of respondents cited heart disease,” Dr. Lori Mosca of Columbia University and New York Presbyterian Hospital, who headed the guidelines committee, told a telephone briefing.
The committee took a hard lesson from the hormone replacement therapy disaster, in which doctors had to make an about-face in the strongly held belief that HRT would prevent heart disease in menopausal women.
Scientific studies showed that in fact HRT raises the risk of heart attack and stroke and now it is no longer recommended except as a short-term treatment for severe menopause symptoms such as hot flashes.
Determine your risk
The new recommendations incorporated more than 7,000 separate studies and divide women into three general groups — those at high risk of a heart attack or other “event,” those at medium risk and those at low risk.
A high-risk women, for instance, already has heart disease and has had a heart attack or stroke, or has diabetes. A woman considered at moderate risk may have high blood pressure and high cholesterol, while a woman at low risk may be at a healthy weight with healthy blood pressure and cholesterol readings.
Low risk means a woman has a less than 10 percent chance of having a heart attack in the next 10 years, intermediate risk is a 10 to 20 percent chance, and high risk is a greater than 20 percent chance.
The guidelines say low-risk women should not take daily aspirin to thin the blood because the risks of aspirin — it can cause stomach bleeding — outweigh the benefits. Also, women are more likely than men to have a hemorrhagic stroke, one marked by bleeding instead of a blockage.
Instead, if a low-risk woman has slightly elevated cholesterol she can try to lower it with diet and exercise.
But the recommendations call for using statins or other cholesterol-lowering drugs in high-risk women even if their cholesterol is at normal levels. ACE inhibitors and beta-blockers are recommended for all high-risk women -- even those whose blood pressure is normal.
And unlike in men, women with heart disease should be checked for depression, as the two often go hand-in-hand, the Heart Association said.
“If you have heart disease, if you have diabetes, if you have multiple risk factors, you want to have a very low level of cholesterol,” said Dr.Nanette Wenger of Emory University in Atlanta, who helped write the guidelines.
“The diabetic woman is at enormous risk. She is at the same risk of having a heart attack as a woman who already has had a heart attack.”