In women at intermediate or high risk of cardiovascular disease, you need to pay special attention to your heart attack risk.  In fact, prevention can't hurt, and all women can benefit from it.  Maintaining a healthy weight, blood pressure and cholesterol, exercising daily and avoiding tobabcco will protect your heart – no matter your risk level. 

Risk factors, such as not getting enough exercise, smoking, and having too much cholesterol in the blood, are controllable.  They relate to how we live, and we can always change that if we try.  In other words, the easiest and most effective way to prevent coronary artery disease (CAD) is to live in a "heart-healthy" way.  That means:

• 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 
• Eat a heart-healthy diet, which includes:
• fruits and vegetables
• more fish, less meat
• "good" oils, such as olive oil and canola oil
• antioxidants
• antioxidants are nutrients and other substances that protect cells in the body from the damage caused by "oxygen free radicals" (molecules that seek to become oxidized, a process that harms body tissues and has been linked to many diseases, including stroke, heart disease, and cancer); antioxidants are found naturally in food but are also available as dietary supplements (antioxidates found in food work far better than pill supplements)
• important antioxidants include:
• Vitamins A, C, E and beta-carotene (found in carrots)
• Lycopene  (found in tomatoes)
• Flavonoids  (found in ginkgo biloba, black cherries, blackberries, bilberries and blueberries)
• Quericetin  - a specialized flavonoid found in apples, onions, tea and red wine
• Coenzyme Q10 - a vitamin-like substance found in soy, whole grains, mackerel, and chicken
• folates – foods rich in folic acid, such as:
• green vegetables
• strawberries, oranges, raspberries
• tomatoes
• nuts and seeds

Most of the ingredients of a "heart healthy" diet have been known for a while.  They're based on long-running heart health studies, such as the Framingham study, which has followed a population in Massachusetts for 46 years.  Recently a group of European doctors used these studies to support the idea of the "Polymeal" diet, their term for a "natural alternative" to the Polypill (discussed below).  The Polymeal daily diet calls for: 

• fruit and vegetables (400 grams (g) per day; 1 apple = 150 g)
• fish (114 g four times a week; 3 oz  = 85 g)
• a garlic clove
• a small dose of dark chocolate (no more than 100 grams per day; 1 oz = 28 g)
• a small glass of wine (150 milliliters per day)

Clinical trials have shown that all these ingredients help reduce either "cardiovascular disease events" (such as heart attack) or risk factors for CVD.  That doesn't mean you should instantly start eating only what's in the Polymeal diet. Nor does it mean you should start drinking wine if you're a non-drinker. But it does remind us, once again, that a heart healthy diet, along with regular exercise, is the best preventative against CVD.

The name "Polymeal" was invented, in part, as a tongue-in-cheek response to another recent European cardiac health recommendation by a different group of scientists, the Polypill.   Just as the Polymeal consists of ingredients known to be part of a heart healthy diet, the Polypill consists of a mixture of drugs known to be effective in treating various kinds of heart and cardiovascular disease. 

The Polypill, first proposed in June 2003, would be a "cocktail" of six of these drugs, including a statin, three beta blockers, aspirin, and folic acid to reduce homocysteine levels in the blood.  (Homocysteine is an amino acid made by the body; high levels of it in the blood are associated with atherosclerosis.)  But the Polypill is not yet commercially available; it is still a concept under investigation