Updated guidelines advise focusing on women's lifetime heart risk

http://www.americanheart.org/presenter.jhtml?identifier=3045524

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.

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).