Women and Heart Disease > Treatment

An integrated, comprehensive approach to risk factor reduction can be extremely helpful, as there is significant overlap among various risk factors, conditions, and management strategies. For example, diet modification can address obesity, dyslipidemia, and hypertension. Therefore, an approach of overall healthfulness can go a long way toward risk modification.

Obesity

Obesity is a growing problem in the US. According to the National Health and Nutrition Examination Survey (NHANES), the prevalence of obesity among adults rose from 22.9% in 1988-1994 to 30.4% in 1999-2002. The problem is also starting at an earlier age. According to the Centers for Disease Control, the prevalence of overweight among children aged 6 to 11 increased from 4.2% in 1963-1965 to 15.8% in 1999-2002. In adolescents aged 12 to 19 years, the prevalence of overweight increased from 4.6% to 16.1%.

A weight-loss program is crucial for reducing cardiac risk in obese patients. Diet modification and increased physical activity are the most desirable and effective methods of reducing and maintaining a patient's weight. However, poor eating and exercise habits can be very difficult to break, and patients usually require a great deal of education, motivation, and counseling as well as a clear and realistic strategy for addressing their obesity.

Current National Heart, Lung, and Blood Institute/National Institute of Diabetes and Digestive Kidney Diseases guidelines for the identification and treatment of overweight and obesity are available at: http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm.

Patient Education, Reassurance, and Motivation

Risk Factor Modification

Angina Management 

Hypertension

Lifestyle changes that can lower blood pressure include healthy diet, weight loss, stress management, and increased physical activity. If lifestyle changes alone prove unsuccessful at controlling a patient's blood pressure, pharmacologic therapy should be employed. Many antihypertensive drugs are available and fall into 1 of the following categories:

• Diuretics
• Beta-blockers
• Calcium-channel blockers
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers
• Adrenergic inhibitors

Many patients require at least 2 medications to effectively control their blood pressure.

Dyslipidemia

Treatment of dyslipidemia should include both efforts to correct hypercholesterolemia (ie, lowering low-density lipoprotein cholesterol, total cholesterol, and triglycerides) as well as increasing high-density lipoprotein cholesterol.

 Dyslipidemia can be managed through:

• Diet - decreasing/eliminating saturated fat and trans-fatty intake while increasing monosaturated fat and soluble fiber intake
• Aerobic exercise, which can decrease hypercholesterolemia and increase HDL
• Weight loss
• Smoking cessation
• Pharmacologic treatment - statins are generally the agents of first choice for treating hyperlipidemia. Other drug classes include bile acid sequestrants, nicotinic acid, fibric acids, and lipoprotein antioxidants

Smoking

Cigarette smoking is associated with myriad health risks and diseases. It greatly increases and compounds cardiovascular risk and reduces patients' lifespans. Therefore, smoking cessation should be initiated universally across all patient populations.