Guidelines on Preventing Heart Disease in Women

Heart Disease (Coronary Artery Disease) Slideshow

Medical Author: Dr. Daniel Kulick, MD, FACC, FSCAI
Medical Editor: Dr. Melissa Conrad Stöppler

As more information is learned on the prevention of coronary artery disease, it becomes increasingly clear that women should be considered at similar risk as men, and should undergo equally as aggressive preventative measures. Coronary artery disease is the leading cause of death in women, accounting for 38% of deaths among women, according to the American Heart Association.

The accepted risk factors for coronary artery disease (lipid status, smoking, high blood pressure, diabetes, and genetic profile) should be as aggressively pursued and modified in women as well as men. Every effort should be made to lower LDL cholesterol (ideally below 70-80), increase HDL cholesterol, use whatever means to stop smoking, and control blood pressure, especially in women with multiple risk factors. This includes aggressive dietary measures, 45 to 90 minutes of aerobic exercise daily, and pharmaceutical therapies as directed by by one's personal physician. The majority of over the counter supplements have not been proven to be of benefit in preventing coronary artery disease - including folic acid, antioxidants such as Vitamin E, and beta carotene.

Agents that have been shown to be effective in preventing coronary artery disease include fish oils, which can be obtained from eating oily fish several times a week or taking daily fish oil capsules as a supplement, which is particularly beneficial in women with low levels of HDL cholesterol, high triglyceride levels, and a strong family history of premature coronary artery disease. Aspirin has also been shown to be of preventive benefit in women to reduce the incidence of coronary artery disease and strokes. In women with multiple risk factors for coronary artery disease, a dose of 325 mg per day is recommended, while in lower-risk women, 81 mg is probably sufficient. In women with a history of gastrointestinal disorders, enteric-coated aspirin is preferred.

The topic of hormone replacement therapy in postmenopausal women is controversial. At this point in time, there is no conclusive data to suggest the initiation of hormone therapy can prevent heart attack or stroke, and hormone therapy may in fact be detrimental to a woman's health. The need for female hormone replacement therapy should be carefully considered and determined by the patient's gynecologist or primary physician.