Heart disease is the number one killer in the U.S. If you don't know if you are at risk of heart disease, work with your doctor to find out.  There are dietary, pharmacological and lifestyle actions you can take to help prevent having a heart attack.

The most familiar and most effective lifestyle actions are simply to live in a "heart-healthy way." This means living in a way that promotes general health, by emphasizing exercise, non-smoking, moderation in alcohol use, and a healthy diet.  Specifically, for a heart healthy lifestyle:

• Start and maintain a program of regular physical exercise.  The choices are virtually endless, from taking a simple (but not too slow) walk to swimming to team sports to exercises classes with a professional trainer.
  
• Stop smoking
  
• Stop drinking alcohol heavily
  
• Keep your blood pressure under control.  If you need blood pressure lowering medicine, get it and use it.
  
• Keep your cholesterol under control. If you need cholesterol lowering medicine, get it and use it and eat a heart-healthy diet.

In February 2007 the American Heart Association published its "2007 Guidelines for Preventing Cardiovascular Disease in Women" in Circulation: Journal of the American Heart Association. They updated the 2004 guidelines by saying healthcare professionals should focus on women's lifetime heart disease risk, not just on short-term risk. They included a new paradigm for risk assessment based on risk factors and family history, as well as the Framingham risk score.  (For information on the Framingham risk score, go to Key Point 1.)

In the past, women were classified as being at high, intermediate, or low (optimal) risk for heart disease.  The new classifications are high risk, at-risk, or optimal.  Optimal represents an estimated ten percent of women.

The 2007 guidelines also offer new directions for using aspirin, hormone replacement therapy, and vitamin and mineral supplements for heart disease and stroke prevention in women.  The highlights of the new guidelines are:

• Manage blood pressure with weight control, increased physical activity, alcohol moderation, sodium restriction and eating fresh fruits, vegetables and low-fat dairy products.
• Reduce saturated fats intake to less than 7 percent of calories if possible.
• Eat oily fish (a source of omega-3 fatty acid) at least twice a week.
• Supplement omega-3 fatty acid intake.  Women with heart disease should consider taking a capsule supplement of  850–1000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).  Women with high triglycerides should consider taking 2 to 4 grams.
• Control cholesterol.  Women at very high risk for heart disease should aim for LDL ("bad") cholesterol of less than 70 mg/dL. Women at high-risk should aim for LDL of less than 100 mg/dL.
• Exercise at least 30 minutes per day.  Women who need to lose weight or maintain weight loss should exercise moderately (e.g., brisk walking) at least 60 to 90 minutes on most if not all days.
• Quit smoking.  Get counseling, nicotine replacement, or other forms of smoking cessation therapy.  Also, avoid secondhand smoke.
• Consider "aspirin therapy:"
• The upper dose of aspirin for women at high-risk has been raised to 325 mg per day (from 162 mg).
• Women 65 and over should consider taking low-dose aspirin routinely regardless of their risk level.
• Women under 65 need not take aspirin routinely, but it has been shown to have a benefit for stroke prevention only.
• Be aware of the following:
• Hormone replacement therapy and selective estrogen receptor modulators (SERMs) are not recommended to prevent heart disease in women.
• Antioxidant supplements (such as vitamin E, C and beta-carotene) should not be used for primary or secondary prevention of cardiovascular disease (CVD).
• Folic acid should not be used to prevent CVD.

In the same issue of Circulation, the AHA also reported on results from several other research studies:

• Age, rather than health care disparities, seems to explain why more women than men die in the hospital after a heart attack; women are generally older than men when they have a first heart attack.
• Differences in an estrogen gene do not appear to affect the risk of heart attack and stroke in response to hormone replacement therapy, as was previously thought. The gene may, however, be associated with an elevated risk of breast cancer.
• Some 40 percent of postmenopausal women have "pre-hypertension," associated with a 58 percent higher risk of cardiovascular death.
• Taking calcium/vitamin D supplements had no effect on heart disease and stroke risk in generally healthy postmenopausal women.
• Estrogen, when delivered by patch or gel, does not seem to increase the risk of blood clots in the vein (venous thromboembolism or VTE). Only estrogen taken orally seems to increase this risk.