Table 1.

Guide to Risk Reduction for Women

Lifestyle FactorsGoal(s)ScreeningRecommendations
Cigarette smoking1. Complete cessation. 2. Avoid passive cigarette smoke.1. Ask about current smoking status and exposure to others’ cigarette smoke as part of routine evaluation. 2. Assess total exposure to cigarette smoke (pack-years) and prior attempts at quitting. 3. Evaluate readiness to stop smoking.1. At each visit, strongly encourage patient and family to stop smoking. If complete cessation is not achievable, a reduction in intake is beneficial as a step toward cessation. 2. Reinforce nonsmoking status. 3. Provide counseling, nicotine replacement, and other pharmacotherapy as indicated in conjunction with behavioral therapy or a formal cessation program.
Physical activity1. Accumulate ≥30 min of moderate-intensity physical activity on most, or preferably all, days of the week. 2. Women who have had recent cardiovascular events or procedures should participate in cardiac rehabilitation, a physician-guided home exercise program, or a comprehensive secondary prevention program.1. Ask about physical activity (household work as well as occupational and leisure-time physical activity) as part of routine evaluation. 2. In women with symptoms that suggest CVD or in previously sedentary women >50 y old with ≥2 risk factors for CVD, consider a stress test* to establish safety of exercise and to guide the exercise prescription.1. Encourage a minimum of 30 min of moderate-intensity dynamic exercise (eg, brisk walking) daily. This may be performed in intermittent or shorter bouts (≥10 min) of activity throughout the day. 2. Women who already meet minimum standards may be encouraged to become more physically active or to include more vigorous activities. 3. Incorporate physical activity in daily activities (eg, using stairs). 4. Muscle strengthening and stretching exercises should be recommended as part of an overall activity program. 5. Recommend medically supervised programs for women who have had a recent MI or revascularization procedure.
Nutrition1. AHA Step I Diet in healthy women (≤30% fat, 8–10% saturated fat, and <300 mg/d cholesterol). 2. AHA Step II Diet in women with CVD or if a further reduction in cholesterol is needed (≤30% fat, <7% saturated fat, and <200 mg/d cholesterol). 3. Limit sodium chloride (salt) intake to 6 g/d. Women with high blood pressure may require further restriction. 4. Total dietary fiber intake of 25–30 g/d from foods. 5. Consume ≥5 servings of fruits and vegetables per day.1. Assess nutritional habits as part of a routine evaluation in all women. 2. Consider formal dietary assessment in women with hyperlipidemia, diabetes, obesity, and hypertension.1. Encourage a well-balanced and diversified diet that is low in saturated fat and high in fiber. 2. Use skim milk instead of milk with a higher fat content. 3. Diets rich in antioxidant nutrients (eg, vitamin C, E, and beta-carotene) and folate are preferred over nutritional supplements. Note: Daily supplements of 0.4 mg of folic acid are recommended for women of child-bearing age to help prevent neural tube defects. 4. Limit alcohol intake to ≤1 glass of alcohol per day. (1 glass=4 oz wine, 12 oz beer, or 11/2 oz 80-proof spirits.) Pregnant women should abstain from drinking alcohol.
Weight management1. Achieve and maintain desirable weight. 2. Target BMI (weight in kilograms divided by height in meters squared) between 18.5 and 24.9 kg/m2 (BMI of 25 kg/m2=110% of desirable body weight). 3. Desirable waist circumference <88 cm (<35 inches) in women with a BMI of 25–34.9 kg/m2.Measure patient’s weight and height, calculate BMI, and measure waist circumference as part of a periodic evaluation. Note: BMI and waist circumference are used for diagnosis, and measurement of height and weight are used for follow-up.1. Encourage gradual and sustained weight loss in persons whose weight exceeds the ideal weight for their height. 2. Formal nutritional counseling is encouraged for women with hypertension, hyperlipidemia, or elevated glucose levels associated with overweight. 3. The recommended weight gain during pregnancy is 25–35 lb if the patient’s prepregnancy weight is normal. Adjust for multiple gestation and prepregnancy weight (eg, overweight women should gain 15–25 lb, obese women, <15 lb).