What do I like best about the 2007 update of the American Heart Association’s guidelines for women? For years, the National Cholesterol Education Program has promoted use of the Framingham risk score as the best way to assess a woman’s risk of having a heart attack.

The problem is that the Framingham score gives only an indication of short-term risk, that is, her chances of having a heart attack within the next 10 years. The new AHA guidelines, however, rightly recognize that the high incidence of heart disease in women and the fact that most of us are living longer these days, means that a greater emphasis should be placed on a woman’s lifetime risk rather than on her short-term risk.
 
Most confusing about the revised guidelines is their recommendation about the use of aspirin, which I wrote about in a previous entry. But the new guidelines have other, less confusing recommendations that are worthy of mention, even though most are unchanged from previous editions:

• Beta-blockers and ACE inhibitors, two classes of drugs that lower blood pressure, should be used indefinitely by all women after a heart attack. ACE inhibitors should also be used in all women with diabetes or clinical evidence of heart failure.
• Fish, especially oily fish, should be eaten at least twice a week. The one exception is pregnant and lactating women, who should avoid eating fish known to contain high levels of methylmercury, including shark, swordfish, king mackerel, and tilefish.
• Capsules containing at least one gram of omega-3 fatty acids from fish are recommended for women with coronary heart disease.
• Supplements of antioxidant vitamins (beta-carotene and vitamins C and E) or of folic acid with or without vitamins B-6 or B-12 should not be taken in an effort to prevent cardiovascular disease; multiple studies have shown they provide no benefit against cardiovascular disease.
• All women should strive to include at least 30 minutes of moderately intense exercise (such as brisk walking) on most, preferably all, days of the week.
• Women who need to lose weight or sustain weight loss should participate in moderately intense physical activity for at least 60 to 90 minutes on most, preferably all, days of the week.

Though I agree completely with the importance of exercise, I do question the feasibility of this last recommendation. I myself find it hard enough to manage 30 minutes of daily exercise, so it seems somewhat unrealistic to expect that couch potatoes who for most of their lives haven’t walked briskly for 10 minutes a day are going to begin walking for 60 to 90 minutes on any day of the week, let alone every day.