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The American Heart Association is issuing new guidelines to prevent heart disease and stroke in women. There's new advice about daily aspirin, diet and vitamin supplements and exercise. But as NPR's Richard Knox reports, the big change is that the Heart Association says women need to think about reducing their risk when they're young.

RICHARD KNOX: Dr. Lori Mosca of New York Presbyterian Hospital says it's hard to overstate the problem of heart disease in women.

Dr. LORI MOSCA (New York Presbyterian Hospital): Every year, more women die of cardiovascular disease than men. And it's interesting, because this is a fact that is known by only one in five physicians.

KNOX: It's little known because for decades, women were left out of major heart studies. But Mosca, who chaired the guideline panel, says times have changed. There's a lot of new research on women's heart risks. Take the role of aspirin. For years, the Heart Association has urged men and women who have already had a heart attack - or those at very high risk of one - to take a daily low-dose aspirin tablet. But it recommended aspirin to prevent a first heart attack only for healthy men over age 45. Now experts urge many more women and their doctors to consider a daily dose of baby aspirin.

Dr. MOSCA: Low-dose aspirin maybe beneficial for stroke prevention in women, and there may also be a benefit for the heart for women over the age of 65.

KNOX: But there's a caveat. Nobody at risk of stomach bleeding or with uncontrolled blood pressure should take daily aspirin - neither should younger, healthy women, says Dr. Michael Pignon(ph) of the University of North Carolina.

Dr. MICHAEL PIGNON (University of North Carolina): If you're a healthy 50-year-old woman who wants to do everything to protect her health and you don't have a lot of risk factors for a cardiovascular disease, then taking aspirin for you is more likely to cause you harm than benefit, and you shouldn't do it.

KNOX: Because of the bleeding risk. The Heart Association tells women not to bother taking many dietary supplements touted for preventing heart disease such as folic acid and vitamin E, C and beta-carotene. There's no good evidence that they work. But women should eat fish at least twice a week. And women who've been diagnosed with heart disease should consider a daily capsule of Omega-3 fatty acids like the ones found in oily fish. The guidelines raise the bar n how much exercise women should get to lose weight or sustain weight loss - an hour to an hour and a half of brisk walking or other moderate activities on most days.

That sounds daunting, but you don't have to get all that exercise at once. Dr. Roger Blumenthal of Johns Hopkins University urges his patients to strap on a $20 pedometer and aim to take 5,000 steps during workdays.

Dr. ROGER BLUMENTHAL (The Johns Hopkins University): For weekend days, the guidelines are that if you're trying to lose weight, you should really be aiming for 10,000 steps a day, which is about the equivalent of four miles.

KNOX: Blumenthal says the new guidelines mark a shift in the way of looking at the risk of heart attack and stroke. Before now, doctors have generally look at older women's risks. Now, experts urge women to start much earlier and take a longer view.

Dr. BLUMENTHAL: People need to look beyond the next 10 years, especially if they're in their 30s or 40s. They need to look at the 20 and 30-year risk, because the health habits we have when we're in our adolescence and young adulthood clearly determine whether or not we're going to develop a heart attack or stroke.

KNOX: The emphasis on lifetime risk reduction is beginning with women, but experts say men should take it to heart, too.

Richard Knox, NPR News.

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