A statin or cholesterol-lowering drug should be considered instead of hormone replacement therapy as the first line of drug therapy for lowering high blood levels of cholesterol in postmenopausal women. Hormone replacement therapy is an option for postmenopausal women, but treatment should be individualized and considered with other health risks. In women, the optimal level of triglycerides may be lower (150 mg per dL [1.7 mmol per L] or less), and the optimal level of high-density lipoprotein cholesterol may be higher (at least 45 mg per dL [1.15 mmol per L]).
At each office visit, strongly encourage patients and their family members to stop smoking. If complete cessation is not achievable, a reduction in intake is beneficial as a step toward cessation. Provide counseling, nicotine replacement and other pharmacotherapy as indicated in conjunction with behavioral therapy or a formal cessation program.
Because diabetes increases a woman's risk of heart disease three to seven times, it is imperative to increase efforts to identify women who are at risk of coronary disease and provide them with effective treatment. Encourage use of the American Diabetes Association diet (less than 30 percent fat, less than 10 percent saturated fat, 6 to 8 percent polyunsaturated fat, less than 300 mg per day of cholesterol). Encourage regular physical activity and a low-calorie diet to lose weight. Pharmacotherapy with oral agents or insulin should be used when indicated.
Use of oral contraceptives is relatively contraindicated in women 35 years old or over who smoke. Women with a family history of premature heart disease should have lipid analysis before taking oral contraceptives. Women with significant risk factors for diabetes should have glucose testing before taking oral contraceptives. If a women develops hypertension while using oral contraceptives, she should be advised to stop taking them.
Beta blockers should be started within hours of hospitalization in women with an evolving myocardial infarction without contraindications. If not started acutely, treatment should begin within a few days of the event and continue indefinitely.
Start ACE inhibitors early during hospitalization for myocardial infarction unless hypotension or other contraindications exist. Continue indefinitely for all women with left venticular dysfunction or symptoms of congestive heart failure; otherwise, ACE inhibitors may be stopped at six weeks. Discontinue ACE inhibitors if a woman becomes pregnant.