Perspective:

The following are 10 points to remember from the American Heart Association guidelines on the prevention of cardiovascular disease in women:

1. Women’s awareness of cardiovascular disease (CVD) as a major cause of mortality has risen from 30% in 1997 to 54% in 2009. Mortality rates due to coronary heart disease (CHD) in women have declined significantly, in large part due to reduction in major risk factors. However, CVD still causes approximately one death per minute among women in the United States. Furthermore, CHD death rates among US women ages 35-54 appear to be increasing.

2. After the age of 65 years, more women than men have hypertension. The prevalence of hypertension among blacks in the United States is among the highest in the world.

3. Increases in the number of women with elevated body mass index have been observed over the past decade. Currently, almost two of every three women over the age of 20 years is overweight or obese.

4. More women than men die of stroke. Women have unique risk factors for stroke, including pregnancy and hormonal therapy. Women have a greater prevalence of hypertension, which places them at increased risk for stroke.

5. The lifetime risk of CVD in women is high, approaching one in two women over their lifetime. Therefore, health care professionals should consider factors beyond the Framingham risk score including lifestyle, family history of CVD, and markers of preclinical disease when making decisions regarding prevention therapy.

6. Women with conditions such as autoimmune disease may have increased risk for CVD. Preeclampsia may also be an early indicator of increased CVD risk. Therefore, such women should be considered for screening of additional CVD risk factors.

7. Improved adherence to prevention therapies is critical to improving CVD health. Women are just as likely to be nonadherent to medical therapies as men. Primary care providers including obstetricians/gynecologists and many internists are unaware of women’s risk factors, such as tobacco being a major risk factor for heart disease in young women. Currently, only 7% of patients with CHD adhere to prescribed treatments for CVD lifestyle risk factors.

8. Hormonal therapy should not be used for the primary prevention of CVD.

9. Antioxidant vitamin supplements and folic acid should not be used for the primary or secondary prevention of CVD.

10. Routine use of aspirin in healthy women <65 years of age is not recommended for primary prevention of myocardial infarction.