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  • The American Heart Association’s Guidelines for Women

    Woman heart disease image Cardiovascular disease (CVD) is a leading cause of death of American women. Are you at risk? The American Heart Association (AHA) offers a way to classify the likelihood of developing CVD—one that goes beyond the Framingham global risk score. The Framingham score places women in categories (from high risk to optimal) based on factors like age, total cholesterol, and blood pressure. The total score has been to calculate a woman’s 10-year risk of developing the disease. The problem with this is that a low score does not necessarily reflect risk over the course of a lifetime.
    With that in mind, the AHA recommends doctors take a more comprehensive view of cardiovascular risk. Adding to the Framingham score, doctors should examine the patient’s medical and lifestyle history, family history of CVD, as well as other genetic conditions. The AHA aims to tackle heart disease in women by evaluating lifetime risk and determining the most appropriate preventive measures. The goals also include more aggressive tactics for those at high risk.
    AHA's classification focuses on three categories: high risk, at risk, and ideal heart health. Women in the “high risk” category have one or more of the following:
    Those “at risk” have one or more risk factors for CVD:
    • Smoking
    • Elevated or high blood pressure
    • Dyslipidemia (cholesterol problems or high triglycerides)
    • Obesity
    • Poor diet
    • Physical inactivity
    • Family history of CVD (eg, CVD less than age 55 in a male relative, CVD less than age 65 in a female relative)
    • Metabolic syndrome (combination of usually mild to moderate hypertension, dyslipidemia, overweight, as well as pre-diabetes)
    • Evidence of subclinical (asymptomatic) vascular disease (eg, coronary calcification)
    • Poor exercise capacity on treadmill test and/or abnormal heart rate after stopping exercise
    • Systemic autoimmune collagen-vascular disease (eg, lupus or rheumatoid arthritis)
    • History of pre-eclampsia, gestational diabetes, or pregnancy-induced hypertension
    Women in the ideal heart health category have ideal cholesterol, blood pressure, body mass index, and fasting blood glucose values. A healthy diet, physical activity, and not smoking are also characteristic of those in this category.

    Making Changes for Your Heart

    The AHA recommends these lifestyle changes to prevent CVD for all women:
    • Do not smoke and avoid secondhand smoke. If you do smoke, talk to your doctor about strategies to quit.
    • Get at least 150 minutes a week of moderate exercise or 75 minutes a week of vigorous exercise.
    • Eat a healthy diet that is rich in fruits, vegetables, and fiber. Twice a week try to include fish in your diet. Limit saturated fat, trans fat, sugar, and sodium.
    • Drink alcohol only in moderation. Women should have no more than one alcoholic drink per day.
    • If you are overweight, lose weight. Try to maintain a healthy weight for you.

    Current Disease

    If you have high cholesterol, talk to your doctor about taking omega-3 fatty acids. Your doctor should also screen you for depression.
    In addition, if you have recently suffered a cardiovascular event (eg, angina, heart attack, stroke, peripheral artery disease) or have had heart surgery, undergo a comprehensive rehabilitative program to manage your condition and lower your risk of recurrence or other future complications.

    At Risk for CVD

    There are many interventions available if you are at risk for CVD. The AHA recommends:
    • Aiming for an optimal blood pressure reading (<120/80 mmHg) and taking blood pressure medicine if needed
    • Aiming for healthy cholesterol levels (talk to your doctor about what ideal levels are for you) and taking cholesterol medicine if needed
    • Controlling diabetes with diet, exercise, and medicine
    • Starting aspirin therapy or other medicines if your doctor recommends them


    American Heart Association http://www.americanheart.org

    Go Red for WomenAmerican Heart Association http://www.goredforwomen.org/


    Canadian Cardiovascular Society http://www.ccs.ca/home/index%5Fe.aspx/

    Heart and Stroke Foundation of Canada http://www.heartandstroke.com/


    Estimate of 10-year risk for coronary heart disease Framingham point scores. National Cholesterol Education Program. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/risk%5Ftbl.htm#women. Accessed February 22, 2007.

    Fish oils in heart cells can block dangerous heart rhythms. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3012101. Accessed February 22, 2007.

    How is blood cholesterol diagnosed? Diseases and Conditions Index. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Hbc/HBC%5FDiagnosis.html. Accessed February 22, 2007.

    Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Circulation. 2011;123:1-20.

    What is high blood pressure? Diseases and Conditions Index. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP%5FWhatIs.html. Accessed February 22, 2007.

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