Heart disease kills more American women than any other disease although guidelines and recommendations as to what to do or not to do to prevent the horrible disease have been published periodically for so many years.

The new guidelines published yesterday in a special women's health issue of Circulation: Journal of the American Heart Association advises that healthcare professionals should focus on women's long term risk of heart disease, rather than the short term risk.

In contrast to the 2004 version, the new guidelines emphasizes the lifetime risk of women rather than the short term risk, meaning that it's important to adopt a healthy lifestyle in women of all ages to reduce the risk of heart and blood vessel diseases.

"We took a long-term view of heart disease prevention because the lifetime risk of dying of cardiovascular disease (CVD) is nearly one in three for women. This underscores the importance of healthy lifestyles in women of all ages to reduce the long-term risk of heart and blood vessel diseases," said Lori Mosca, M.D., Ph.D., director of preventive cardiology at New York-Presbyterian Hospital and chair of the AHA expert panel that wrote the guidelines.

Blood pressure control is viewed as a measure to prevent heart disease in women.   The AHA recommends that women follow a healthy lifestyle including weight control, increased physical activity, alcohol moderation, sodium restriction, and an emphasis on eating fresh fruits, vegetables and low-fat dairy products to get their blood pressure under control.

Women should use counseling, nicotine replacement or other forms of smoking cessation methods to help stop smoking, the guidelines recommend.   In terms of physical exercise, 60-90 minutes of moderate intensity activity such as brisk walking on most if not all days of the week is needed to prevent heart disease.  Intake of saturated fat should be controlled below 7 percent of total calories if possible.

The guidelines provides a new risk assessment paradigm based on risk factors and family history of heart disease, as well as the Framingham risk score which was first published in 1998 to estimate the risk of developing coronary heart disease within 10 years.

In addition, the new guide lines offers detailed recommendations on drug treatments for blood pressure and cholesterol control. Routine low dose aspirin is recommended for women age 65 or older regardless their CVD risk status IF benefits are likely to outweigh other risks.   The recommended dose increases to 325 mg per day of aspirin from 162 mg in the 2004 edition.

"Since the last guidelines were developed, more definitive clinical trials became available to suggest that health care providers should consider aspirin in women to prevent stroke," Mosca said.  But one side-effect which may not be always noticed is that when women count on aspirin to prevent heart disease, they may forget to avoid other risk factors, some health observers cautioned.

“Aspirin may be helpful for women at high risk, such as women who have already had a heart attack. Aspirin can have serious side effects and may be harmful when mixed with certain medicines. If you're thinking about taking aspirin, talk to your doctor first. If your doctor thinks aspirin is a good choice for you, be sure to take it exactly as your doctor tells you to,” the U.S. government states on its website at 4women.gov.

Women may consider reducing LDL cholesterol to less than 70 mg/dL in very high-risk women with heart disease, which may require a combination of cholesterol-lowering drugs, according to the new guidelines.

In addition, the new guidelines does not recommend that women use antioxidants such as vitamin E, C, and beta-carotene and folic acid supplements as primary or secondary prevention of cardiovascular disease.    Calcium and vitamin D may not reduce or increase the risk of heart disease. But critics say that the dose used in early studies might be too low to have an effect, meaning that the benefit of the vitamin and mineral can't be excluded.

"The new guidelines reinforce that unregulated dietary supplements are not a method proven to prevent heart disease. For example, recent studies have shown that folic acid is ineffective to protect the heart despite widespread use by patients and physicians hoping for a heart benefit," Mosca said. Readers need to be aware that that does not mean an antioxidant-rich diet is not useful, a scientist affiliated with foodconsumer.org suggested.

Hormone replacement therapy and selective estrogen receptor modulators (SERMs) are not something that the new guidelines recommend for women to prevent heart disease.   "(health care) providers should not use menopausal therapies such as hormone replacement therapy (HRT) or selective estrogen receptor modulators to prevent heart disease because they have been shown to be ineffective in protecting the heart and may increase the risk of stroke."

As evidence is growing to support the beneficial effect of omega-3 fatty acid dietary intake and supplementation on the risk of heart disease in men and women, the AHA recommends eating oily fish at least twice a week, and considering taking a supplement of 850-1000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) in women with heart disease, two to four grams for women with high triglycerides.

Heart disease kills more women than any other disease including cancer, accounting for 38 percent of all female deaths.   In the United States 42.1 million (36.6 percent) women live with CVD and the population at risk is even larger, according to the AHA.   In fact, "nearly all women are at risk for CVD, underscoring the importance of a heart-healthy lifestyle in everyone,” according to the authors.

"Some women are at significant risk of future heart attack or stroke because they already have CVD and/or multiple risk factors. These women are candidates for more aggressive preventive therapy and we define them as high risk," Mosca said.

Although high risk women are easy to identify, a low risk of heart disease is hard to determine, Mosca said. "Therefore, we have more aggressive recommendations for high-risk women, and strongly emphasize lifestyle strategies to reduce risk in all women," she said.

Heart disease is serious and women should not take the disease lightly.   Nor should women think that this disease cannot be prevented or cured, suggested a scientist with foodconsumer.org, who believes that the new AHA guidelines is not enough for women to follow to prevent heart disease and stroke.   

Some brilliant researchers have found that heart disease in many cases can be reversed if the patients are willing to adopt a healthy lifestyle, particularly a healthy diet.   Foodconsumer.org recommends those who are serious in reducing their risk of heart disease follow Dr. Dean Ornish’s program for reversing heart disease.

The Dr. Ornish’s nutrition guidelines for women and men also to reverse heart disease requires that fat be controlled below 10 percent of total calories, meat, fish and poultry, and caffeine be eliminated, two servings per day of non-fat dairy or one serving of soy, one serving of alcohol and two servings of sugar be allowed.  The 10% of calories from fat can be from grains, vegetables, fruit, beans, legumes and soy foods.