• Weight control. Try to achieve a BMI less than 25 though diet and exercise.
• Omega-3 fatty acids. Consumption of omega-3 fatty acids in the form of fish or in capsule form (for example, EPA 1,800 mg/day) may be considered in women with hypercholesterolemia and/or hypertriglyceridemia for primary and secondary prevention.
• Blood pressure. The optimal level is less than 120/80 mm Hg. When BP is greater than 140/90 mm Hg, then pharmacotherapy is indicated.
• Lipids. Follow the recommendations in the ATP III guidelines. In addition, in women older than 60 years who have estimated coronary heart disease risk greater than 10%, statins may be considered if the hsCRP level is greater than 2 mg/dL.
• Aspirin. Aspirin (75-325 mg daily) is indicated in high-risk women with CHD or diabetes mellitus. Aspirin therapy can be useful in women older than 65 years (81 mg daily or 100 mg every other day) if blood pressure is controlled, and if the benefit for ischemic stroke and myocardial infarction prevention is likely to outweigh the risk of gastrointestinal bleeding and hemorrhagic stroke. Aspirin therapy may be reasonable for women younger than 65 years for ischemic stroke prevention.
• Potentially harmful drug interventions include postmenopausal hormone therapy, antioxidant supplements, folic acid, aspirin for MI prevention in healthy women younger than 65 years.
Reference
Mosca L., Benjamin E.J., Berra K., et al. Effectiveness-based guidelines for the prevention of CVD in women – 2011 update. A guideline from the American Heart Association. Circulation 2011;123:1243-62.
Dr. Ando is a third-year resident in the family medicine residency program at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.