The American Heart Association recently announced new guidelines for preventing heart disease and stroke in women based on a woman’s individual cardiovascular health.

The guidelines are published in Circulation: Journal of the American Heart Association.

Cardiovascular disease is the leading cause of death for men and women in the US. Nearly 500,000 women die from cardiovascular disease each year. “For the first time we are giving clarity about how much we know and how much we don’t know,” said Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center.

“The concept of cardiovascular disease (CVD) as a ‘have-or-have-not’ condition has been replaced with the idea that CVD develops over time and every woman is somewhere on the continuum,” Dr. Mosca says.

The guidelines are based on the highest-quality evidence from all the available research related to CVD prevention, according to the American Heart Association.

The new recommendations say that the aggressiveness of treatment should be linked to whether a woman has low, intermediate, or high risk of having a heart attack in the next 10 years, based on a standardized scoring method developed by the Framingham Heart Study.

“This provides a very individual approach to preventing CVD throughout the population,” Dr. Mosca said.

Low risk means a woman has a less than 10 percent chance of having a heart attack in the next 10 years, intermediate risk is a 10 to 20 percent chance, and high risk is a greater than 20 percent chance.

Aspirin recommendations illustrate how therapy varies across three risk levels. For all high-risk women and for those who have documented cardiovascular disease, daily aspirin intake is recommended, but is not recommended for low-risk women.

Among intermediate-risk women, aspirin can be considered as long as blood pressure is controlled and the benefit is likely to outweigh the risk of side effects such as gastrointestinal bleeding or hemorrhagic stroke.

Lifestyle interventions such as smoking cessation, regular physical activity, heart-healthy diet, and maintaining a normal weight were given a strong priority for all women, not only because of their potential to reduce existing CVD, but also because heart-healthy lifestyles may prevent major risk factors such as hypertension and diabetes from developing.

Medications including ACE inhibitors and beta-blockers are recommended for all high-risk women.

The guidelines also include a strong recommendation that high-risk women, even those with low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, receive cholesterol-lowering drugs, preferably medications called statins.

Routine statin therapy has not previously been recommended for these women, but recent studies show a benefit in this subgroup. Other cholesterol-lowering drugs of particular benefit in specific cases, such as niacin and fibrates, also are discussed.

For stroke prevention in women with atrial fibrillation and intermediate or high risk for embolic stroke the anticoagulant warfarin (Coumadin) is recommended. If they cannot take warfarin, or if they are at low risk for stroke, they should be given aspirin.

Prevention measurements, both lifestyle and medical, are divided into classes based on the strength of the recommendation for each level of risk.

Class I is the most strongly recommended intervention, followed by Class IIa and IIb. The guidelines also provide guidance on what not to do, with certain interventions labeled Class III - indicating that an intervention is either not useful or could be harmful, or both.

“The Class III category is important, especially in areas where there has been a lot of confusion, such as hormone therapy and antioxidant supplements," Dr. Mosca says. "Research has shown that these interventions have no benefit for preventing CVD in women."

Another example is aspirin use, which is Class III for low-risk women because the side effects may outweigh benefits. Until more research is available, Dr. Mosca said it is more prudent for physicians to wait before recommending aspirin therapy in this group of women.

“Overwhelming evidence suggests that the risk of developing CVD can be decreased in both women and men,” she said. “These recommendations should help healthcare providers and the public avoid initial or recurrent heart attacks and strokes.”

The guidelines represent a major collaborative effort by representatives of the American Heart Association and 11 other professional and governmental co-sponsoring organizations. Another 22 organizations, including some lay organizations, endorsed the guidelines.

Always consult your physician for more information.