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New Guidelines on Women’s Heart Risk

American Heart Association Warns of Heart Attack Risk for Women With Some Pregnancy Complications

Educating Women About Heart Risk

The new information about pregnancy complications and heart risk is “a big deal,” says guideline author Ileana L. Piña, MD, a professor of medicine and epidemiology and biostatistics at Case Western Reserve University in Cleveland.

“Your blood pressure may return to normal after pregnancy and your blood sugar may return to normal too, but don’t ignore these symptoms,” she says.

Some of the onus about getting the word out about pregnancy complications and heart risks falls on ob-gyns, says Mary Rosser, MD, PhD, an assistant professor in the department of obstetrics and gynecology and women’s health at Montefiore Medical Center in the Bronx, N.Y.

“We are seeing younger women and providing their primary care [and] we can make an impact,” she says.

“When I see patients with gestational diabetes, I say even though you are thin, you are still at risk for developing diabetes later on in life so you need to stay on top of this,” she says.

Other inflammatory diseases such as rheumatoid arthritis (RA) and lupus also place a woman at risk for heart disease, according to the updated guidelines.

Diseases like RA and lupus are more common in women and sometimes have heart disease manifestations.

Dietary Recommendations for Women

While the new guidelines cast a wider net to catch women at risk for heart disease, they also call for aggressive steps to control known risk factors such as high blood pressure and obesity.

For example, the guidelines call for less than 1,500 milligrams of salt per day for all women. Sugar is limited to five or fewer servings per week.

“We have a lot more data that the sodium content of food in America is too high and the prevalence of hypertension in this country is also high,” Piña says. “We believe that lowering sodium content can markedly lower blood pressure, particularly among African-American women whose hypertension is salt-sensitive."

As for sugar, “the high content of sugar in foods is more fodder for the current obesity epidemic and obesity is highly correlated with the onset of diabetes and metabolic syndrome,” she says. Metabolic syndrome is a cluster of risk factors linked to development of heart disease. ”Cutting down on sugar will aid in weight loss, lower blood sugar, and your cholesterol will also go down,” she says.

“It is a bit radical, especially the sodium intake,” says Suzanne Steinbaum, MD, director of women and heart disease at Lenox Hill Hospital in New York City.  Steinbaum reviewed the guidelines for WebMD but did not serve on the writing committee.

“The sugar issue is in response to the obesity epidemic and is a way to get women to pay attention to the effects of sugars on the metabolic syndrome and weight gain,” she says.

The updated guidelines also state that folic acid and antioxidant vitamins such as vitamin E, C, and beta-carotene should not be used to prevent cardiovascular disease in women. What’s more, hormone replacement therapy should not be used to prevent heart attacks or strokes.

“If you eat a healthy diet, you don’t need supplements,” Steinbaum  says. “Folic acid may reduce levels of homocysteine, but it does not seem to translate to a lower risk for heart disease.” Homocysteine is an amino acid in blood that had been linked to heart risk.


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