Heart Disease in Women: What Not To Do

Finally, in the American Heart Association's latest guideline & recommendations, they also developed a short list of those interventions that are not useful/effective and/or may cause harm, rather than prevent heart disease in women.  Obviously, some of these recommendations are rather controversial.  Maybe not so obvious, unless you've been reading my recent rants, all these recommendations are subject to change in the future once new information comes out suggesting not so much a fad (outlier), but rather a trend in another direction.

For those older than 65 years of age, aspirin may be useful in the otherwise healthy once blood pressure is controlled.  But, routine aspirin is not recommended to prevent heart attacks in healthy women <65 years old due to the greater risk of bleeding in the brain or from the intestinal tract.  Now, this is where you need to read closely, because the AHA then slips in the recommendation that aspirin may be reasonable for women <65 years old, if they want to prevent an ischemic stroke.

While I agree this seems somewhat two-faced and clearly very confusing, current scientific literature points to the use of aspirin as being effective at preventing strokes in young women (<65 years old) but ineffective in preventing heart attacks in the same age group.  Balance your stroke risk against your risk for bleeding in the brain and/or stomach, and clearly it's now an individual decision, not the broad stroke of the paintbrush that we're used to using.

While proven to prevent spinal tube defects, the AHA states that folic acid has not been proven to prevent heart disease when used in isolation or in combination with vitamins B6 & B12.  They also conclude that the preponderance of evidence shows that antioxidant vitamin supplements, eg vitamin E, C & beta carotene, have no demonstrable benefit for the 1o & 2o prevention of heart disease in women.

And while hormone therapy, including selective estrogen-receptor modulators, are useful in treating debilitating menopausal symptoms, the AHA concluded that they should not be used solely for the 1o & 2o prevention of heart disease in women.  If you've been following my posts, you'll realize that this recommendation is not without controversy.  But again, I reserve the right to change my mind when confronted with new evidence to the contrary.  So even as we strive to practice cost-effective, evidence-based medicine, let's be sure that we bend & sway with the winds of change.