The American Heart Association has updated its guidelines on women and heart disease prevention, with a focus on a woman’s lifetime risk for heart disease. The guidelines include new directions for aspirin use, hormone replacement therapy and vitamin and mineral supplementation.

“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,” said Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital and lead author of the guidelines. “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.”

Mosca was interviewed Monday on NPR’s “All Things Considered,” along with Michael Pignone of the Carolina Cardiovascular Biology Center at the University of North Carolina and Roger Blumenthal, director of the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins Hospital. The audio is available here.

The new guidelines, published in  “Circulation: Journal of the American Heart Association,” include the following recommendations:

– 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.

“Cardiovascular disease is the leading cause of death among women,” Mosca said at an AHA press conference Tuesday. “The rate of awareness among women has increased from 30 to almost 60 percent, but we still need to work on the confusion around preventive strategies. We are very encouraged that the release of these new guidelines can help clear up some of this confusion and help our women engage in more conversations with physicians and health care providers as to what are the best strategies to reduce the burden of the number-one killer of women.”

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