Heart disease and stroke continue to be the number one killer of women both in the United States and worldwide. Heart disease is the cause of one in three women’s deaths each year, and 43 million women in the United States are affected by heart disease. There were over 400,000 heart disease deaths in 2007, which claimed more women’s live than all forms of cancer, respiratory disease, Alzheimer’s disease and accidents, combined. The economic cost of heart disease in the Unites State is estimated at over 100 billion dollars each year.
Heart disease death rates in U.S. women ages 35 to 54 appear to be increasing over the past decade, at least partially related to the increase in obesity. Forty seven percent of African-American women over the age of 20 have cardiovascular disease, most likely secondary to the prevalence of hypertension. Hispanic women are likely to develop heart disease 10 years earlier than Caucasian women. And finally, 55,000 more women than men suffer a stroke every year.
All women need to understand the major risk factors associated with cardiovascular disease and stroke, since it is estimated that 80% of these risk factors are modifiable with early screening methods, lifestyle modification and medications.
These risk factors include well-established Framingham criteria which include: 1. Age, 2. Total Cholesterol, 3. HDL cholesterol, 4. Systolic Blood Pressure, and 5. Smoking History. Additional factors beyond the Framingham risk criteria include: 6. Medical, Lifestyle and Family History, 7. Markers of Preclinical Disease (coronary calcium score, carotid artery plaque) 8. Physical exam including blood pressure, Body Mass Index (BMI) and waist size, 9. Obesity, Poor Diet, Physical Inactivity and Metablic Syndrome, 10. Systemic Autoimmune Disorder, 11. Laboratory markers includingGlucose & Kidney Function, 12. High Risk Factors which include documented cardiovascular disease or stroke, peripheral arterial disease, diabetes or end-stage or chronic kidney disease.
The role of new biomarkers of cardiovascular disease, such as advanced lipid testing, high sensitivity CRP, and coronary calcium score are not included in the initial assessment of CV risk, but may play an important role in refining the risk estimates of women who are at intermediate risk on the initial screening factors outlined above.
There are many Lifestyle recommendations, which have been shown to reduce cardiovascular disease and stroke risk in women. These include the following:
1. Complete Smoking Cessation—combination of office and formal cessation program, group counselling, nicotine replacement and pharmacotherapy.
2. Physical Activity—150 minutes per week of moderate exercise (brisk walking) or 75 minutes per week vigorous exercise or combinations of the two, plus muscle strengthening exercise at least two days per week.
3. Nutrition—diet rich in fruits and vegetables, whole grain, higher fiber foods, fish (oily fish such as salmon and mackerel), poultry, lean meats, dry beans, eggs, and nuts. Avoid saturated and trans fats (partially hydrogenated fats) such as deep fried foods, bakery products, crackers, margarine, packaged snack foods, red meats, dairy products, coconut and palm oils.
4. Weight Maintenance/Reduction—maintenance or lose weight through a combination of physical activity, appropriate caloric intake and behavior modification goal for a BMI less than 25 kg/m2 or waist size less than 35 inches or other related weight metrics. Weight reductions of 10% may decrease blood pressure, cholesterol levels and reduce risk of diabetes
5. Health screenings for:
A. Blood pressure—optimal BP reading less than 120/80—weight control, physical activity, sodium reduction (less than 2,000mg/day), alcohol reduction.
B. Cholesterol levels—should be checked at least once every five years starting at age 20, or should be checked at a younger age in children with family history of heart disease, or more frequently in women with elevated cholesterol levels. (Optimal levels: Total Cholesterol less then 150, Triglycerides less than 150, HDL cholesterol greater then 50, LDL cholesterol less then 100).
C. Diabetes screening—check fasting blood sugar (optimal glucose less then 100) usually between ages 30-40 and retest every 3-5 years.
1. Aspirin (75-325 mg/daily) for women with heart disease or stroke or diabetes unless contraindicated. May be useful in women over 65 at increased risk for heart disease/stroke.
2. Lipid lowering medications—recommended for women with coronary disease/stroke/diabetes to reach goal LDL cholesterol less than 100 and may be less than 70 in high risk patients.
3. Blood pressure medications---In addition to regular exercise, good nutrition, and low sodium (less then 2000 mg sodium/daily), pharmacotherapy is indicated for women with blood pressure readings over 140/90, or women with diabetes and blood pressure readings over 130/80.
Effective-based guidelines for prevention of cardiovascular disease in women. Circulation. 2011;123:1242-1262.
Managing heart disease risk at any age. www.goredforwomen.org.