Re: Most U.S. Women Face Heart, Stroke Risk

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By MARILYNN MARCHIONE AP Medical Writer

February 19,2007 | -- Nearly all American women are in danger of heart
disease or stroke and should be more aggressive about lowering their
risk -- including asking their doctors about daily aspirin use, the
American Heart Association said Monday in new guidelines.

It is the first time guidelines have urged all women to consider aspirin
for preventing strokes, although specialists warn that it can cause
ulcers and dangerous bleeding. They said it is probably not a good idea
for young women with no big health problems.

"We do not want women to go to the drugstore and just start taking this
themselves. It is critical that every woman talk to her doctor," said
Dr. Lori Mosca, director of preventive cardiology at New
York-Presbyterian Hospital and chair of the expert panel that wrote the
guidelines.

The guidelines also advise daily exercise and less fat, and declare
vitamins C and E, beta carotene and folic acid supplements worthless for
preventing heart disease.

The guidelines were published in the journal Circulation with related
studies on women's health, including one suggesting that hormone skin
patches may be safer than pills for menopause symptoms.

In general, the guidelines aim to get women and doctors to focus on the
long-term risk of high blood pressure, smoking, lack of exercise or
being overweight -- even if a woman's current health seems fine. Even a
single risk factor at age 50 greatly raises the chance of heart disease
or stroke later, and only about 10 percent of American women are free of
these problems.

"We do not want women to wait until they develop symptoms to begin to
take action," Mosca said.

The guidelines were drafted by dozens of groups worldwide, including the
American Academy of Family Physicians and the U.S. government. Of the 33
people who wrote the advice, 13 have financial ties to heart drug
makers, only three of them to a large degree.

"This is a really good gathering of evidence in women," after years of
studies done mostly on men, said Dr. Sidney Smith, heart disease chief
at the University of North Carolina at Chapel Hill and past heart
association president.

The evidence shows that many more women than thought are at risk of
heart disease and stroke -- even those whose only weakness was failure
to exercise every day. Heart disease is the leading killer of men and
women worldwide.

The advice:

--Exercise. Get at least 30 minutes of moderately intense exercise on
most and preferably all days, 60 to 90 minutes if you need to lose
weight.

Typically does not help people lose the visceral adipose tissue (VAT)
while they continue to overeat.

--Diet. Eat mostly fruits and vegetables, whole grain and high-fiber
foods, fish at least twice a week, and little salt. Limit saturated fat
to less than 10 percent of calories, 7 percent if possible, and trans
fats to less than 1 percent. Limit alcohol to one drink or less a day.

It is not what you eat but how much you eat that matters here. VAT
comes from overeating.

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

--Weight. Keep body-mass index under 25.

Here's how to get the BMI under 25 by losing visceral adipose tissue
(VAT) and keeping the VAT from coming back:

http://HeartMDPhD.com/HolySpirit/overweight.asp

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

--Blood pressure, cholesterol. Keep under control, with medicine if
needed. Keep LDL or bad cholesterol under 100 if at high risk of heart
disease and under 70 if at very high risk.

Automatically happens for many people once the VAT is gone.

--Aspirin. Daily use is already urged for women at high risk, and the
guidelines now say the dose can go up to 325 milligrams. All other women
should consider 81 milligram "baby aspirin" daily or 100 milligrams
every other day for stroke prevention.

The last is controversial. Aspirin is recommended now to prevent heart
disease in men 45 and older; but in women, a large study found it
prevented heart disease only for those 65 and older.

Aspirin did prevent strokes in women, but again, the benefit was
substantial only among older ones, said Dr. JoAnn Manson, a Harvard
University women's health expert who helped lead that study.

Putting young women on aspirin for stroke prevention is not justified by
the evidence, Manson warned. In the 10-year study, aspirin prevented
only one additional cardiovascular problem among roughly 35,000 women
under 65 and led to 20 cases of bleeding requiring transfusion, she said.

Aspirin also can be dangerous for people whose blood pressure is not
under control -- another reason women should see their doctor before
starting on it, Smith said. Many people are unaware they have high blood
pressure.

Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood
Institute, said the benefits of low-dose aspirin must be weighed against
the risk of internal bleeding, "and it is important for women to check
with their doctor about this."

Mosca conceded that in her own practice, "I would probably limit this to
women 45 and above," but would consider it for a younger woman who is
overweight, doesn't exercise and has high cholesterol and is unwilling
to change her lifestyle enough to lower her risk.

The guidelines also say that estrogen and progesterone supplements,
while often justified for menopause symptoms, should not be taken to
prevent heart disease. Nor should so-called SERM drugs, such as
tamoxifen and raloxifene, which are used to prevent breast cancer in
women at high risk of that disease.

Millions of women stopped taking menopause hormones after a landmark
study several years ago found the pills raised the risk of heart
problems and breast cancer. A new study in Circulation gives hope that
skin patches may prove safer in one key respect.

A French study found that women, aged 45 to 70, taking estrogen pills
were four times more likely to suffer a blood clot than women getting it
through a patch or not taking estrogen at all.

"If confirmed, these findings could really benefit women who are in need
of these hormones to control their post-menopausal symptoms," said Dr.
Alice Jacobs, a Boston University cardiologist and past heart
association president.

Post-menopausal symptoms wane for many women in time.

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

.

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