Women: Say "Aloha" to Heart Disease

Summarized by Robert W. Griffith, MD
May 22, 2006

Summary

This article contains 5 important tips for women to remenber to help them prevent heart disease.

Introduction

Less than half of all US women know that heart disease is their leading killer. Well, that estimate was made 2 years ago, and it's probably improved a bit since then. But it's still too few. So specialists are looking for ways to bring the necessary information to women's attention. A new idea is the use of an easy-to-remember mnemonic, ALOHA. As any visitor to the Islands knows, "aloha" is a Hawaiian word used for greeting someone, or saying goodbye. So here's Dr Lori Mosca's recommendations for saying goodbye to heart disease.

A - Assess your Risk

You can use a tool called the Framingham Risk Assessment Calculator to find out your personal heart disease risk, whether it's high, medium, or low. Just go to the first link below, and work through the tool. You'll get a result expressed as the number of chances out of 100 that you'll develop or die from heart disease in the next 10 years.

(Note: If you already have heart disease, stroke, peripheral arterial disease, aneurism, diabetes, or chronic kidney disease, you're already at highest risk.)

L - Lifestyle Change: First Line of Defense

Whatever your risk assessment, the best thing you can do to lower it further is to make changes in your lifestyle. Here are the 5 most important changes proposed by an expert panel:

1. Stop smoking, avoid second-hand tobacco smoke.
2. Get 30 minutes of exercise daily
3. Eat a heart-healthy diet: fruits, veggies, grains, low- or non-fat dairy products, fish, legumes, and low-saturated fat protein (poultry, lean meats, plant sources). No trans-fatty acids.
4. Balance your calories-IN against your calories-OUT. If necessary, enroll in a weight-control or weight-loss program.
5. If you've recently had heart problems, enroll in a cardiac rehabilitation program.

O - Other Interventions

These depend on the Evidence Rating Scale:

Your blood pressure should be less than 120/80 mmHg. A slight rise means you must improver your lifestyle habits. If it stays at 140/90 or higher, medications will be needed.

Total cholesterol should be below 200 mg/dL; LDL cholesterol less than 100 mg/dL; HDL cholesterol above 50 mg/dL; and triglycerides below 150 mg/dL. If necessary, you may have to take cholesterol-lowering medication.

If you have diabetes, your HbA1c should be 7% or below. Otherwise, additional steps (lifestyle changes, diet, and medication) will be necessary.

H - Highest Priority for Therapy Is for Women at Highest Risk

If you're at highest risk - see under A for Assess Your Risk - you should probably be taking one of these drugs:

An ACE inhibitor (angiotensin-converting enzyme inhibitor), such as enalapril (Vasotec^®), or, if these produce a dry cough, an ARB (angiotensin receptor blocker) instead.

Aspirin therapy (a baby aspirin or up to 162 mg aspirin daily), unless you've been warned against this.

A beta-blocker such as Lopressor^® or Tenormin^®

A statin drug - these are helpful even when your LDL cholesterol is below 100 mg/dL. Examples are atorvastatin (Lipitor®) and simvastatin (Zocor^®).

Niacin for high-risk women with a low HDL cholesterol or high non-HDL cholesterols. This should be prescription niacin, not over-the-counter or dietary niacin.

Fibrates, which are effective for lowering raised triglyceride levels, and may also increase HDL cholesterol levels.

Warfarin should be taken by women with atrial fibrillation - an irregular heartbeat that can cause stroke.

A - Avoid Some Treatments of Doubtful Value

These 3 interventions have not been shown to be helpful, and they should be avoided:

Combined hormone replacement therapy (i.e. estrogen and progestin). Estrogen alone, in women who have had their uterus removed, may be useful for treating menopausal symptoms.

Antioxidant supplements, such as vitamin E and beta-carotene; these two agents have been shown to be harmful rather than beneficial, and may also interfere with the good effects of statins.

Aspirin for low-risk patients; the benefits may be outweighed by the risk of stomach bleeding or ulcers.

In addition to the above, Dr Mosca recommends treating any depression that may exist, and possibly adding omega-3 and folate supplements for women at high risk.

These guidelines, if followed, can help women lower their risk of getting heart disease. But they are guidelines, not rules. You should discuss them with your physician, who can help you interpret them to your best advantage as an individual, and then you can really say "Aloha" to heart disease.

Source

• Heart disease prevention in women. Cardiology Patient Page. L. Mosca, Circulation, 2004, vol. 10, pp. e158--e160

Related Links
Framingham Risk Assessment Calculator
National Coalition for Women with heart disease: Fact Sheet
American Heart Association: Healthy Lifestyle

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