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New Women's Heart
Guidelines Stress Early Action
The American Heart Association
released new guidelines for preventing and treating heart disease
in women and said most women still did not realize heart disease
was more likely to kill them than anything else.
The new guidelines, available on
the Internet at http://www.americanheart.org,
stress lifestyle as the first line of attack -- stopping smoking,
losing weight, exercising every day and eating a healthy diet.
But they also call for aggressive use of drugs to lower cholesterol
and blood pressure in high-risk women.
Although surveys show women consider
cancer to be their No. 1 health risk, cardiovascular disease is
the leading killer of women globally, the Heart Association said.
It takes the lives of nearly 500,000 U.S. women each year -- one
every minute.
In 1997 the Heart Association found
that 30 percent of women listed heart disease as the leading cause
of death among women. But the latest survey of more than 1,000
women found that 46 percent now know the risk -- an improvement,
but still fewer than half of those surveyed.
"However, when asked what they
consider their own greatest health risk, only 13 percent of respondents
cited heart disease," Dr. Lori Mosca of Columbia University and
New York Presbyterian Hospital, who headed the guidelines committee,
told a telephone briefing.
The committee took a hard lesson
from the hormone replacement therapy disaster, in which doctors
had to make an about-face in the strongly held belief that HRT
would prevent heart disease in menopausal women.
Scientific studies showed that
in fact HRT raises the risk of heart attack and stroke. It is
no longer recommended except as a short-term treatment for severe
menopause symptoms such as hot flashes.
BASED ON EVIDENCE
The new recommendations incorporated
more than 7,000 separate studies and divide women into three general
groups -- those at high risk of a heart attack or other "event,"
those at medium risk and those at low risk.
A high-risk woman, for instance,
already has heart disease and has had a heart attack or stroke,
or has diabetes. A woman considered at moderate risk may have
high blood pressure and high cholesterol, while a woman at low
risk may be at a healthy weight with healthy blood pressure and
cholesterol readings.
The guidelines say low-risk women
should not take daily aspirin to thin the blood because the risks
of aspirin -- it can cause stomach bleeding -- outweigh the benefits.
Also, women are more likely than men to have a hemorrhagic stroke,
one marked by bleeding instead of a blockage.
Instead, if a low-risk woman has
slightly elevated cholesterol she can try to lower it with diet
and exercise.
But the recommendations call for
using statins or other cholesterol-lowering drugs in high-risk
women even if their cholesterol is at normal levels.
The experts said a woman should
think 50-100-150 -- and seek a high-density lipoprotein or HDL
reading of 50. This goal for so-called good cholesterol is higher
than previous guidelines. LDL or bad cholesterol should be below
100 and triglycerides should be below 150.
ACE inhibitors and beta-blockers
are recommended for all high-risk women -- even those whose blood
pressure is normal.
And unlike in men, women with heart
disease should be checked for depression, as the two often go
hand-in-hand, the Heart Association said.
Reference
Source 89
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