“In 2010, an estimated 785,000 Americans had a new coronary attack and about 470,000 had a recurrent attack,” according to the Centers for Disease Control and Prevention. “About every 25 seconds, an American will have a coronary event, and about one every minute will die from one.”
Guidelines for preventing CVD in women
Smoking: Women should not smoke and should avoid secondhand smoke.
Exercise: Women should have at least 150 minutes/week of moderate exercise or 75 minutes/week of vigorous activity. Additional cardiovascular benefits are provided by increasing moderate-intensity exercise to 300 minutes/week or 150 minutes/week of vigorous activity. Women should perform muscle-strengthening exercises that involve all major muscle groups at least 2 days/week. Women wanting to lose weight should accumulate a minimum of 60−90 minutes of at least moderate-intensity exercise on most or all days.
CVD risk-reduction: Women who recently have suffered acute coronary syndrome or coronary revascularization, new onset or chronic angina, or current/prior symptoms of heart failure who meet certain criteria, a recent cerebrovascular attack, or peripheral vascular disease should enroll in a comprehensive CVD risk-reduction regimen, such as rehabilitation or a community-based exercise program.
Diet: Women should eat plenty of fruits and vegetables, choose whole-grain and high-fiber foods, consume fatty fish at least twice a week, and limit intake of saturated fat, cholesterol, alcohol, sodium, sugar, and trans fatty acids. Specific diet guidelines include:
- More than 4.5 cups of fruits and vegetables/day
- 7 ounces (cooked) of fatty fish each week
- 30 grams/day of fiber
- Three servings/day of whole grains
- Less than five servings/week of sugar and fewer than 450 calories/week from sugar-sweetened beverages
- More than four servings of nuts, legumes, and seeds/week
- Less than 7% of calories from saturated fat
- Less than 150 milligrams (mg)/day of cholesterol
- Less than one serving of alcohol/day
- Less than 1500 mg of sodium/day
- No trans fatty acids
Body mass index (BMI): Women should maintain or lose weight to achieve a BMI of less than 25, a waist size below 35″, and other targets.
Eicosapentaenoic acid (EPA): Women who already have hypercholesterolemia or hypertriglyceridemia are advised to take 1800 mg/day of EPA, an omega-3 fatty acid.
Blood pressure: An optimal blood pressure of <120/90 millimeters of mercury (mm Hg) is encouraged. If blood pressure is more than 140/90 mm Hg (or more than 130/80 mm Hg in women with chronic kidney disease and diabetes), most patients are prescribed thiazide diuretics. Beta-blockers and/or ACE inhibitors/angiotensin receptor blockers (ARBs) are the initial treatments for high-risk women with acute coronary syndrome or myocardial infarction (MI), with other medications, such as thiazide diuretics, added as necessary.
Lipids: The lipid goals are low-density lipoprotein (LDL) <100 mg/deciliter (dL), high-density lipoprotein (HDL) >50 mg/dL, triglycerides <150 mg/dL, and non-HDL cholesterol <130 mg/dL.
LDL: Women with coronary heart disease should use drug therapy, as well as lifestyle therapy, to decrease their LDL to <100 mg/dL. Medication also is indicated for women with other atherosclerotic CVD or diabetes or a 10-year absolute risk of >20%. Women who are very high risk should aim for an LDL of 70 mg/dL.
HDL: When HDL levels are low or when non-HDL cholesterol is high, niacin or fibrate therapy may prove useful.
A1c: Women with diabetes should achieve an A1c of <7% (if possible without hypoglycemia).
Antioxidants: Antioxidants such as vitamins E and C taken in supplemental doses are not useful for the prevention of heart disease. Neither are the B vitamins.
Low-dose aspirin: If you are younger than 65, you probably do not need to take low-dose aspirin. In older women, baby aspirin can help to reduce the risk of stroke. Talk to your doctor if you have questions about this.
Hormone therapy and selective estrogen-receptor modulators: Hormone therapy and selective estrogen-receptor modulators are not used for the primary or secondary prevention of cardiovascular disease.
− Warfarin is used for women with chronic or paroxysmal atrial fibrillation.
− Dapigatran is an alternative to warfarin, used for the prevention of stroke and systemic thromboembolism.
− Beta blockers are used in all women after MI or acute chest pain with normal ventricular function or with left ventricular failure.
− ACE inhibitors are used for women after MI or for those who have heart failure, left ventricular ejection fraction (LVEF) <40%, or diabetes.
− Aldosterone blockade after MI is indicated in women without hypotension, renal dysfunction, or hyperkalemia if they are already on ACE inhibitors and beta blockers and have an LVEF of <40% and symptomatic heart failure.
Heart Health: What Are You Willing to Do?
I will avoid saturated fats.
Sources of saturated fat include:
- Fatty meat
- Poultry skin
- Whole milk
- Coconut oil
- Palm kernel oil
- Palm oil
- Cottonseed oil
I will read ingredient lists to make sure that the foods I choose do not contain partially hydrogenated oils.
These are trans fats.
I will choose healthier sources of fat.
- Olive oil
- Canola oil
- Walnut oil
I will eat fatty fish at least two times each week.
The following are fatty fish:
- Lake trout
If you do not like fish, take a fish oil supplement that contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Alpha-linolenic acid (ALA) is not as good. Your supplement should provide at least 1 gram (g)/day.
I will decrease the amount of sugar that I consume.
I will eat several sources of soluble fiber each day.
Good sources include:
- Citrus fruits
- Brussels sprouts
I will increase my intake of foods that contain calcium and vitamin D.
If you do not think that you can get enough calcium and vitamin D from your diet, take a daily supplement.
Good sources of calcium include:
- Milk products
- Fortified orange juice
- Fortified breads
- Fortified cereals
- Dried figs
- Calcium-fortified tofu
- Canned salmon with bones
- Carnation® Instant Breakfast
- Dark-green leafy vegetables
I will eat plenty of potassium-rich foods.
- Sweet potatoes
- Lima beans
- Swiss chard
- Acorn squash
- Pinto beans
- Wheat germ
- Brussels sprouts
- Milk products
I will commit to consuming more plant stanols/sterols.
I will eat the recommended amount every day.
I will eat more fresh herbs.
I will eat several servings of nuts each week.
The best kinds of nuts are:
- Brazil nuts
I will use garlic, onions, and leeks often when preparing food.
I will choose cereals that contain more than 5 g of fiber/serving.
Good choices include:
- Raisin bran
- Shredded wheat
- Fiber One®
What did you commit to?
- I will avoid saturated fats.
- I will read ingredient lists to make sure that the foods I choose do not contain partially hydrogenated oils.
- I will choose healthier sources of fat.
- I will eat fatty fish at least two times each week.
- I will decrease the amount of sugar that I consume.
- I will eat several sources of soluble fiber each day.
- I will increase my intake of foods that contain calcium and vitamin D.
- I will eat plenty of potassium-rich foods.
- I will commit to consuming more plant stanols/sterols.
- I will eat more fresh herbs.
- I will eat several servings of nuts each week.
- I will use garlic, onions, and leeks often when preparing food.
- I will choose cereals that contain more than 5 g of fiber/serving.