||Nanette K. Wenger, M.D., M.A.C.P., F.A.C.C.,
is a Professor of Medicine in the Division of Cardiology at the Emory University
School of Medicine. She is also Chief of Cardiology at Grady Memorial Hospital.
Dr. Wenger is a nationally renowned expert in coronary heart disease in
women. She recently chaired the US National Heart, Lung, and Blood Institute
Conference on Cardiovascular Health and Disease in Women. Her work is widely
published and she is the Editor of the American Journal of Geriatric Cardiology.
Dr. Wenger has received numerous awards including the
Physician of the Year Award of the American Heart Association in 1998
and the Elizabeth Blackwell Award, the highest award given by the American
Medical Women's Association.
Coronary Heart Disease Prevention for Women
Coronary heart disease, the problem that results in heart attack (myocardial
infarction) is not solely a man's disease -- women are vulnerable. In fact,
coronary disease is the leading cause of death for U.S. women, responsible for
over 250,000 fatalities each year. Prevention is pivotal, recognizing features
that increase coronary risk and intervening to reduce that risk. The American
Heart Association/American College of Cardiology have prepared a guide for preventive
cardiology for women.
The first component addresses lifestyle factors.
Cigarette Smoking. Do not initiate cigarette smoking, stop smoking (and
ask your physician for help if needed) if you are a current smoker, and avoid
passive cigarette smoke.
Physical Activity. Do at least 30 minutes of moderate-intensity physical
activity on most, or preferably all, days of the week. Brisk walking is an ideal
activity. Pysical activity should be incorporated in daily activities, e.g.,
Nutrition. The recommended AHA diet has less than 30% fat, 8-10% saturated
fat, and less than 300 mg/day of cholesterol. Salt intake should be limited
to 6 grams a day. Total dietary fiber intake from food should be 25-30 grams/day.
At least 5 servings of fruits and vegetables should be consumed each day. Diets
rich in antioxidant nutrients and folate are preferred over nutritional supplements.
Weight Management. Achieve and maintain desirable weight. If weight
exceeds the ideal weight for height, there should be gradual and sustained weight
loss. Consult your physician for help.
Psychosocial Factors. Adopt a positive response to stressful situations,
e.g., substituting physical activity for overeating or excessive smoking in
response to stress. Maintain or establish social connections. The second component
addresses risk factors.
The second component addresses risk factors.
Blood Pressure. The ideal blood pressure is < 140/90 mm/Hg (optimal
< 120/80 mmHg). Lifestyle behaviors including weight control, physical activity
, moderation in alcohol intake, and moderate sodium restriction should be initially
undertaken if the blood pressure is elevated. If the blood pressure remains
elevated, consult your physician for pharmacotherapy.
Lipids/Lipoproteins. In healthy women with fewer than 2 coronary risk
factors, the LDL cholesterol (bad cholesterol) should be < 160 mg/dL (optimal
< 130 mg/dL). With more than 2 risk factors, the LDL goal is < 130 mg/dL. A
lifestyle approach including diet, weight management, avoidance of smoking,
and exercise is the initial approach, with drug therapy guided by your physician
for LDL levels that do not respond to lifestyle alterations.
Diabetes. Women with diabetes should maintain good blood glucose control.
The American Diabetes Association diet is recommended, with a goal LDL of <
100 mg/dL for all patients with diabetes. Blood pressure control is of particular
importance. Regular physical activity is recommended, and a low calorie diet
if weight loss is needed. Your physician will prescribe pharmacotherapy with
oral agents or insulin as needed. Blood pressure control is of particular importance.
Discuss these guidelines with your physician. Coronary preventive interventions
are safe and effective.
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Created: 12/5/2000  - Nanette K. Wenger, M.D., M.A.C.P., F.A.C