Avoiding a heart attack can start early

New guidelines for women raise level of exercise

February 20, 2007|By Jonathan Bor and Chris Emery | Jonathan Bor and Chris Emery,Sun reporters

Women should try to reduce their lifetime risk of heart attack and stroke by exercising more and watching their diet from an early age, the American Heart Association said in guidelines released yesterday.

The group suggests, among other things, that women exercise a half-hour daily - not just three or four times weekly as previously recommended. The recommendation goes up to 60 to 90 minutes for those who are overweight.

But the organization backed off slightly from its previous recommendations on aspirin as preventive medicine, saying women under 65 should consider taking it only if they have risk factors for stroke. Aspirin does little to prevent heart attacks in that age group, a large study recently found.

"If you're under 65, the big surprise is that we didn't see benefits in reducing heart attacks but a slight decrease in strokes," said Dr. Sidney C. Smith Jr., a cardiologist with the University of North Carolina and a co-author of the guidelines.

Even for younger women concerned about strokes, the Heart Association fell short of a strong recommendation. Such women should talk to their doctors about aspirin - weighing the mild benefits against the risks of stomach irritation and bleeding.

Risk factors for stroke include high cholesterol, smoking, diabetes and high blood pressure. But people with hypertension should not take aspirin unless their pressure is medically controlled, the group said.

"The bottom line is that we're not giving a strong recommendation for younger women to take aspirin," said Dr. Erin Mikos, a Johns Hopkins cardiologist and another co-author.

The evidence, however, is much stronger that aspirin prevents heart attacks and strokes in women over 65 and in men from middle age onward. Accordingly, the guidelines suggest that women 65 and older consider taking aspirin to prevent heart attack and stroke even in the absence of risk factors.

For high-risk women, the top dose increases to 325 mg per day rather than 162 mg, the association said.

The focus on women and heart disease comes at time when the death rate among females has begun to dip, according to the National Heart Lung and Blood Institute. Still, it remains the leading cause of death among women, killing 461,000 females in 2004 compared with 410,000 men.

In recent years, the Heart Association and other medical organizations have worked to combat the notion that heart disease is solely a men's disease. That notion stems from the tendency of heart attacks to strike men beginning in their 50s - 10 years before it afflicts women in large numbers.

Aspirin is widely recommended for men and women of all ages who have already had a heart attack. The drug works by thinning the blood, thereby reducing the chances of clot formation.

An update of guidelines issued in 2004, the new recommendations call on women and doctors to focus on reducing the lifetime risk of heart disease. Previously, the focus was on women who face a more imminent threat.

Prevention, said Smith, starts in the teens with regular exercise and a diet low in saturated fats and heavy in fruits, vegetables and grains, Activity can consist of brisk walking, swimming or more active sports. But it can also come from simple strategies such as taking stairs rather than elevators and parking a distance away from one's destination.

"We need to introduce the concept that if a woman has any risk factor by age 50, her lifetime risk is much higher," said Dr. Roger Blumenthal, director of preventive cardiology at the Johns Hopkins School of Medicine. "We need to do our best to prevent hypertension and high cholesterol from the early teens and young adulthood."

Dr. Stephen H. Pollock, chief of cardiology at St. Joseph Medical Center, said the focus has shifted to prevention in women as awareness of heart disease has grown. "People are living longer, so the effects are more obvious," he said.

Also, new drugs and procedures have proved effective for prevention and treatment. "In many cases, it can be as simple as taking an aspirin or a statin drug," he said.

Jean Smith, 63, a Glen Burnie resident with a family history of high blood pressure, said she takes a baby aspirin a day in keeping with her doctor's orders.

Last spring, Smith formed a weight-loss group with a few other women who belong to Pleasant Grove Baptist Church in Baltimore. "We try to do things to watch our diet, eating less salt and sugar," she said.

In warm weather, they go for walks. And this winter, she and another woman joined a line-dancing class. "Our thing is to move," Smith said, noting that some have lost 10 or 15 pounds. "We are interested in not being a statistic."

jonathan.bor@baltsun.com chris.emery@baltsun.com

GUIDELINES

The American Heart Association issued guidelines yesterday saying women should consider using aspirin, exercise more and eat less fat. The advice:

Aspirin: Consider for preventing stroke unless a health condition or bleeding risk makes this unwise. Consult a doctor first.

Exercise: At least 30 minutes most and preferably all days; 60 to 90 minutes if you need to lose weight.

Diet: Mostly fruits and vegetables, whole grain and high-fiber foods, fish at least twice a week and little salt.

Fat: Limit saturated fat to less than 10 percent of calories, 7 percent if possible, and trans fats to less than 1 percent.

Alcohol: No more than one drink a day.

Smoking: Don't. Use nicotine-replacement products if needed to stop.

Weight: Keep body-mass index under 25.

Supplements: Consider omega-3 fatty acids (fish oil) if you already have heart disease. Do not take extra folic acid or antioxidants such as vitamins E, C and beta carotene for heart disease prevention.

Blood pressure, cholesterol: Keep under control, with medicine if necessary.

[Source: American Heart Association]

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