The American Heart Association’s Guidelines for Women
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 person’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 3 categories: high risk, at risk, and ideal heart health. Women in the “high risk” category have one or more of the following:
- Established coronary artery disease (CAD)
- Cerebrovascular disease, which can lead to a stroke
- Peripheral artery disease (PAD)
- Abdominal aortic aneurysm
- Chronic kidney disease
- A high 10-year Framingham global risk score (over 10% chance of developing CVD)
Those “at risk” have one or more risk factors for CVD:
- Elevated or high blood pressure
- Dyslipidemia (cholesterol problems or high triglycerides)
- Poor diet
- Physical inactivity
- Family history of CVD
- Metabolic syndrome (a combination of elevated blood sugar, cholesterol, blood pressure, and being overweight)
- Evidence of subclinical (asymptomatic) vascular disease, such as coronary calcification
- Poor exercise capacity on treadmill test and/or abnormal heart rate after stopping exercise
- Systemic autoimmune collagen-vascular disease, such as 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.
There are also stroke risk factors that are sex-specific or more common in women such as:
- The use of birth control pills
- The use of hormone replacement therapy
- Atrial fibrillation
- Migraine headaches with aura
- Emotional stress
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 at least twice per week. 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, talk to your doctor about strategies to lose weight. Try to maintain a healthy weight for you.
If you have high cholesterol, talk to your doctor about taking lipid lowering medications and omega-3 fatty acids. Your doctor should also screen you for depression.
In addition, if you have recently suffered a cardiovascular event, such as angina, heart attack, stroke, or 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 additional 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 medication if needed
- Aiming for healthy cholesterol levels (talk to your doctor about what ideal levels are for you) and taking cholesterol medication if needed
- Controlling diabetes with diet, exercise, and medication
- Starting aspirin therapy or other medications if your doctor recommends them
American Heart Association
National Heart, Lung, and Blood Institute
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
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/health-pro/guidelines/current/cholesterol-guidelines/quick-desk-reference-html/10-year-risk-framingham-table#women. Accessed Aprl 21, 2015.
Explore high blood cholesterol. Diseases and Conditions Index. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/hbc. Updated September 19, 2012. Accessed April 21, 2015.
Explore high blood pressure. National Heart, Lung, and Blood Institute website. Available at:http://www.nhlbi.nih.gov/health/health-topics/topics/hbp. Updated August 2, 2012. Accessed April 21, 2015.
Mosca L, Benjamin EJ, 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(11):1243-1262.
Secondary prevention of coronary artery disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 9, 2015. Accessed April 21, 2015.
2/7/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Bushnell C, McCullough LD, et al. Guidelines for the prevention of stroke in women: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(5):1545-1588.
Last reviewed April 2015 by Michael Woods, MD Last Updated: 4/21/2015