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Top 10 Changes to American Heart Association Guidelines

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Updated June 22, 2007

The American Heart Association, or AHA, is considered the final authority when it comes to making policy decisions regarding treatment for cardiovascular diseases. The treatment of diseases like high blood pressure, heart disease, and high cholesterol is guided by a set of general recommendations that the AHA publishes. Recently, these official guidelines were updated to include new research information, and several important changes were made, especially with regard to heart health in women.

1. Increased Emphasis on Lifestyle Changes

The AHA has explicitly reinforced the idea that drug therapy is not sufficient for adequate heart health. Rather, lifestyle changes are an important component of maintaining blood presure and keeping your heart healthy. Weight control, physical activity, and a balanced diet were especially stressed.

2. Hormone Replacement Therapy Doesn't Help Heart Disease

Hormone replacement therapy is not recommended as a therapy for treating or avoiding heart disease. This includes treatment with either traditional estrogen replacements or the class of drug known as selective estrogen receptor modulators (SERM). This was a topic of some debate for several years, since the protective role of estrogen is recognized to decrease the risk of heart disease in young women.

New research has shown that the risk/benefit profile for estrogen supplimentation does not support using it to prevent heart disease.

3. All Women Need Adequate Intake of Omega-3 Fatty Acids

Omega-3 fatty acids are stressed as important for all women, and are especially emphasized for women with existing heart disease or high triglycerides. The guidelines now specifically say that all women should be eating oily fish, such as salmon, at least two times per week. Additionally, the guidelines recommend that women with heart disease consider taking a daily oral Omega-3 suppliment containing 850mg-1000mg of EPA and DHA. For women with high triglycerides, the supplement recommendation is 2000mg-4000mg of EPA and DHA.

4. All Women Should Decrease Intake of Saturated Fats

A new recommendation has clearly identified a goal for saturated fat intake: No more than 7 percent of daily calories should come from saturated fats.

5. All Women Need Frequent Exercise

Specific exercise guidelines for women who need to lose weight have been added. A minimum of 60 minutes of medium intensity activity, such as walking quickly, is recommended for most days of the week. The guidelines prefer that this level of activity be conducted on a daily basis, and actually define the activity goal as between 60 and 90 minutes daily.

6. Nicotine Replacement Therapy May be Used

For the first time, AHA guidelines specifically allow for, and encourage, the use of both nicotine replacement therapy and counseling as aids to smoking cessation. These changes are meant to underscore the vital importance of smoking cessation. While nicotine replacement aids are now supported as a way to help people quit smoking, they are not recommended for long term or permanent use. The inclusion of these replacement therapies underscores how important it is to quit smoking.

7. Antioxidants Don't Prevent Heart Disease

Vitamins E, C, and beta carotene are not to be used as a primary or secondary means of preventing cardiovascular disease. These antioxidants have no beneficial effect at preventing death from cardiovascular events. This has been shown conclusively by a number of large, well-controlled studies. Antioxidants are still good for you in general, but will not help to control or avoid heart disease or high blood pressure.

8. Folic Acid Doesn't Prevent Heart Disease

Folic acid should not be used to prevent cardiovascular disease. Like antioxidants, it shows no benefit at reducing death from cardiovascular events. This statement is an important change, and represents a reversal from earlier guidelines, which did recommend that folic acid be considered as a treatment option in certain high-risk patients.

9. All Women Older Than 65 Should Consider Daily Aspirin

Routine aspirin therapy should be considered in all women 65 and older, regardless of their risk for cardiovascular disease. However, this therapy should only be considered if the benefits to therapy (lowered risk of heart attack and stroke) outweigh the risks (possibility of bleeding). The upper limit of daily aspirin dosing has been raised from 162mg to 325mg.

10. High Risk Women Need More Aggressive Cholesterol Treatment

Very high-risk women with existing heart disease may need to be treated to attain an LDL level of less than 70mg/dL. In these cases, combination therapy (more than one drug) may be necessary.

Sources:
Mosca, et al. Evidence Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation, Suppliment: February 19,2007.

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