• Her father or brother below age 55 or her mother or sister below age 65 have had a heart attack, stroke, angioplasty or bypass surgery.
  • She is over 55 years old. (After age 65, the death rate increases sharply for women)
  • She smokes or is exposed to second-hand smoke every day.
  • Her blood pressure is over 135/85 mm Hg. Optimal blood pressure is 120/80 mm Hg. Drug therapy is indicated when blood pressure is >140/90 mm Hg, or an even lower blood pressure in the setting of chronic kidney disease or diabetes (> 130/90 mm Hg).
  • She does not exercise for at least 30 minutes that includes moderate–intensity physical activity, like taking a brisk walk, on most days. For weight control, women need to exercise for 60–90 minutes with moderate–intensity activity on most days.
  • She has diabetes. After age 45, diabetes affects many more women than men. If diabetic, aim to achieve glycosylated hemoglobin (HbA1c) level less than 7%.
  • Her HDL (High Density Lipoprotein or “good” cholesterol) is less than 50mg/dL.
  • LDL goals are dependent upon risk. The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches: LDL–C <100mg/dL; HDL–C >50mg/dL; triglycerides <150mg/dL and non–HDL–C (total cholesterol minus HDL cholesterol) <130 mg/dL. If a woman is at high risk or has hypercholesterolemia, intake of saturated fat should be <7% and cholesterol intake <200 mg/d. For diabetic women, LDL should be <100. For vascular disease and very high risk women, LDL should be<70. HDL of 60 mg/dL is considered cardioprotective. One can raise HDL by taking in 2–3 tbsps of olive oil daily, quitting smoking, getting regular aerobic exercise and maintaining a healthy weight.
  • She is overweight by 20 pounds or more (More than one–third of women are more than 20 pounds overweight.)
  • Either natural or through surgery, early menopause, before the age of 40 is associated with increased risk for cardiovascular disease.
  • Taking birth control pills greatly increases risk of heart attack and stroke, especially after age 35.
  • She has a high demand/low control job with sustained high levels of stress. Stress is a normal part of life.
  • A healthy diet consists of eating fruits, vegetables and whole grain high–fiber foods (aim for 5 servings of vegetables and 2 servings of whole fruit daily); eating fish, especially oily fish, at least twice a week; limiting saturated fat to < 10% of energy, and if possible to <7%, cholesterol to <300 mg/dL. Limiting alcohol intake to no more than 1 drink per day; limiting sodium intake to <2.3 g/d (approximately 1 tsp salt) and avoiding all trans–fatty acids (listed as “hydrogenated oil” in the ingredients section)
  • Pregnant and lactating women should avoid eating fish potentially high in methylmercury.
  • Having at least three of a cluster of symptoms that are listed below put her at risk:

o High blood sugar >100 mg/dL after fasting

o High triglycerides, at least 150 mg/dL

o Low HDL (<50 mg/dL in women)

o Blood pressure of 130/85 or higher

o Waist >35 inches (Waist measurement of 35 inches or more or waist–to–hip ratio greater than 0.80 is a predictor of high triglycerides and low HDL levels).