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, 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., using stairs.

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