Guidelines for the Prevention of Cardiovascular Disease in Women

According to an update to the American Heart Association’s cardiovascular disease prevention guidelines for women, “real world” tactics may be more effective in preventing cardiovascular disease in women than tactics based entirely on clinical research.

Clinical recommendations for the prevention of cardiovascular disease in women were first published by the American Heart Association (AHA) in 1999. In 2004, the AHA, in collaboration with other organizations, expanded its focus on female-specific clinical recommendations and sponsored the “Guidelines for Cardiovascular Disease Prevention in Women.” These guidelines are viewed as the foundation for national educational programs for healthcare professionals and for women healthcare consumers in the prevention of cardiovascular disease.

Until now, the guidelines, once referred to as “evidence-based” and now referred to as “effectiveness-based,” were based primarily on findings observed in clinical research. The most recent guidelines, however, identify factors unique to women than increase risk and barriers that discourage women and physicians from following the guidelines. The document also outlines strategies for addressing those obstacles.

Awareness of symptoms and risks specific to women are the key to prevention. These guidelines not only shift the focus from clinical research to everyday situations, they also help both women and their doctors understand the risks of cardiovascular disease and provide practical steps for preventing heart disease and stroke.

Many recommendations from past guidelines have not changed. These include interventions that are not useful in the prevention of cardiovascular disease in women, such as menopausal therapy and antioxidant supplements. The guidelines also incorporate illnesses that increase heart disease in women, including lupus and rheumatoid arthritis, and pregnancy complications such as preeclampsia, gestational diabetes or pregnancy-induced hypertension.

The guidelines emphasize the importance of recognizing racial and ethnic diversity and its impact on cardiovascular disease. For example, hypertension is a particular problem among African-American women while diabetes greatly affects Hispanic women.

Cardiovascular Disease Risk Factors

Modifiable Risk Factors (risk factors you can do something about)

• Smoking 
• Abnormal cholesterol or triglyceride levels 
• High blood pressure 
• Diabetes 
• Metabolic syndrome 
• Obesity 
• Physical inactivity 
• Alcohol abuse 
• Cocaine abuse

Risk Factors Specific to Women

• History of preeclampsia 
• History of gestational diabetes or pregnancy-induced hypertension 
• Maternal history of stroke

Emerging Risk Factors for Heart Disease

• Low levels of “good” HDL cholesterol 
• High levels of coronary artery calcium 
• Psychosocial factors such as depression, isolation, anger and caregiver stress 
• Abnormally high blood levels of C-reactive protein, lipoportein(a), homocysteine, myeloperoxidase

Diseases, Conditions and Medications that Increase the Risk of Heart Attack 

• Systemic autoimmune disease such as rheumatoid arthritis or lupus 
• Diagnosis of coronary artery disease, cerebrovascular disease or peripheral arterial disease 
• Abdominal aortic aneurysm 
• End-stage or chronic kidney disease
• Non-alcoholic fatty liver disease [NAFLD] 
• Breast cancer radiation therapy occurring before 1984 
• Yellow bumps on or around the eyelids, known as xanthelasmata 
• Emphysema 
• Poor flexibility 
• Exposure to air pollutants containing ozone, nitrates, sulfates, metals and aldehydes 
• Polyvascular disease, defined as symptomatic atherosclerosis in more than one site 
• Age-related macular degeneration 
• Glaucoma and ocular hypertension in blacks; treatment with the beta-blocker timolol maleate 
• Carrying the gene HLA-DRB1, which increases the risk of inflammatory arthritis 
• Severe menopausal symptoms 
• Restless legs syndrome 
• Colorectal cancer 
• Gout, particularly in older women 
• Chemotherapy with anthracyclines or trastuzumab/Herceptin

Diseases and Conditions that Increase the Risk of Stroke 

• Aortic arch atheroma 
• Heart valve disease 
• Atrial fibrillation 
• Patent foramen ovale 
• Sleep apnea 
• Cerebral aneurysms 
• Ocular shingles caused by herpes zoster 
• Exposure to common viruses and bacteria, including herpes simplex 1 and 2, cytomegalovirus, Chlamydia pneumoniae and Helicobacter pylori