The AHA Guidelines and Scientifi c Statements Handbook

Table 12.2 Selected Recommendations Based on Risk Status

Population Recommendation

All women Lifestyle change including smoking cessation. Heart-healthy eating,
regular physical activity, weight management.

Women with CVD or stroke* Rehabilitation program#

All women Lipids and lipoproteins – LDL-C <100 mg/dl, HDL-C >50 mg/dl, and
triglycerides <150 mg/dl. Encouraged through lifestyle approaches.

High-risk women LDL-C lowering drug therapy should be initiated simultaneously with
lifestyle interventions.

Very high-risk women with CHD LDL-C reduction to <70 mg/dl may be reasonable and may require LDL-
lowering drug combination.

High-risk women¶ 75–325 mg of aspirin daily, unless contraindicated, with clopidogrel
substituted if aspirin intolerance is present.

Healthy women 81 mg daily or 100 mg every other day of aspirin in women ≥ age 65
should be considered if the blood pressure is controlled and the benefi t
for ischemic stroke and myocardial infarction prevention outweighs the
risk of gastrointestinal bleeding and hemorrhagic stroke.

Healthy women < 65 years of age Aspirin should be considered for when the benefi t for ischemic stroke
prevention outweighs the adverse effect of therapy.

Healthy women < 65 years of age Routine use of aspirin in is not recommended to prevent myocardial
infarction.

Hormone replacement therapy (neither hormone therapy nor
selective estrogen receptor modulators) in all postmenopausal
women

Not recommended for the prevention of CAD or stroke – identifi ed as

not useful/effective; may be harmful.

All adult women** Antioxidant vitamin supplements (vitamins E, C, and beta carotene) and
folic acid (with or without vitamin B6 and B12), are not recommended
for the primary and secondary prevention of cardiovascular disease.

• To include recent acute coronary syndrome or coronary intervention, new-onset or chronic angina, recent cerebrovascular event, peripheral arterial disease, or
  current or prior symptoms of heart failure and a left ventricular ejection fraction below 40% [3,10–13].

  Cardiovascular or stroke rehabilitation or a physician-guided home or community-based exercise training program – to include women with a recent acute coronary

  
  

syndrome or coronary intervention, new-onset or chronic angina, recent cerebrovascular event, peripheral arterial disease, or current or prior symptoms of heart
failure and a left ventricular ejection fraction below 40% [11–14].
¶ After percutaneous intervention with stent placement or coronary artery bypass grafting within previous year and in women with noncoronary forms of CVD, use

current guidelines for aspirin and clopidogrel. [20]
** Folic acid supplementation should be used in the childbearing years to prevent neural tube defects. [4]
CVD indicates cardiovascular disease; MI, myocardial infarction.