Aspirin is thought to be beneficial due to its anti-clotting effect on the blood and anti-inflammatory properties. Evidence has existed for an inflammatory process contributing to the formation of plaque. However, regular use of low-dose aspirin does not appear to prevent first heart attacks in women younger than 65, as it does in men.

In March of 2005, the Women’s Health Study, which was supported by the National Institutes of Health’s National Heart, Lung, and Blood Institute and the National Cancer Institute, concluded that for women over 65, taking low-dose aspirin every other day does appear help reduce the risk of heart attack; however, the findings do not apply to women between the ages of 45 and 64. The risk of ischemic stroke was reduced for all women in the study.

It is very important for men and women to weigh the risk and benefits of taking aspirin and to consult with their doctor. Aspirin can increase the risk of getting kidney disease, ulcers, liver disease, and hemorrhagic stroke. Therefore, aspirin should only be considered after talking with your physician. Above all, women, like men, should adopt the well-proven approaches that reduce the risk of heart disease—eating for heart health, getting regular physical activity, maintaining a healthy weight, not smoking, and controlling high cholesterol, high blood pressure, and diabetes.

Reducing weight and exercising regularly can alter several risk factors associated with heart disease:

• Blood cholesterol levels may improve.
• Blood pressure levels may be lowered.
• Blood sugar levels may be better controlled, which is especially important if you have diabetes.

Inactive people have almost twice the risk of developing heart disease, but even mild to moderate exercise can make a big difference. For people trying to lose and/or maintain weight, physical activity is a crucial element in achieving those goals. If you have had a heart attack, exercise can improve your chances of survival. Of course, it is important to consult your physician before starting a new exercise program or dramatically increasing activity level to determine the type and amount of exercise that would be most appropriate.

Lifestyle changes can have a significant impact on preventing coronary heart disease; however, they cannot guarantee that you will not be affected. The impact will vary depending on a number of factors, including the degree to which the lifestyle changes are incorporated into one's life, heredity, and if heart-related medications are needed (diuretics for high blood pressure, for example). The following are the most important heart-healthy lifestyle changes:

• Engage in frequent aerobic exercise.
• Eat a diet low in total fat and saturated fat.
• Stop smoking.
• Avoid excessive use of alcohol.

Heart disease does seem to run in some families. If your parents or grandparents have a history of high blood cholesterol, high blood pressure, diabetes mellitus, or are overweight, then there is greater chance that you will have these same heart disease risk factors.

Also, if close family members (parents, grandparents, siblings) have suffered heart attacks before the age of around 50, this also increases your heart disease risk. Although we cannot change our family history, modifications can always be made in diet, exercise, stress management, and other lifestyle factors that affect heart disease risk.

Various medications can also be used to reduce the risk of heart attack or coronary heart disease. Among these are beta-blockers, which reduce the workload on the heart by decreasing heart rate and blood pressure, aspirin and other anti-coagulants, which reduce the tendency for the blood to clot, nitroglycerin and calcium channel blockers, which can increase the blood flow to the heart by helping blood vessels relax and expand, and antihypertensives, used to lower blood pressure.

Surgery is an option for those victims of coronary heart disease who cannot be helped via lifestyle changes or medication. There are several types of heart surgery, including coronary angioplasty and coronary artery bypass. Coronary angioplasty involves inserting a catheter into a leg artery and threading it up into the partially blocked coronary artery. Then, a balloon at the tip of the catheter is inflated, which compresses the plaque against the wall of the artery and allows more blood to flow through. Coronary artery by-pass, on the other hand, allows blood to flow around the blocked artery by grafting a blood vessel (usually, part of a leg vein) to create a alternate route for the blood to flow.

The only certain way to diagnose and measure the extent of CHD is through the use of coronary angiography, which your physician will order if coronary artery disease is suspected. In this method, a tube is inserted into an arm or leg artery and then navigated up into the main arteries supplying blood to the heart. A dye is then released from the tube, and the blood vessels and heart are then filmed as the heart pumps.

The picture taken, or angiogram, will show blockages caused by the thickening of the inside walls of the coronary arteries. This thickening is known as atherosclerosis. Other methods to diagnose CHD include electrocardiograms, stress tests, and nuclear scanning. One new non-invasive tool may replace many of the angiographies in the near future. It is called an ultrafast CT exam. The scan can detect the mineral calcium that is found in plaque, the substance that blocks the arteries.

One in ten American women and one in six American men 45 to 64 years of age has some form of heart disease, and this increases to one in five women and one and three men over 65. Heart disease is the leading cause of death in the United States.

Coronary heart disease (CHD) is the most common form of heart disease, affecting approximately 13.2 million Americans.

Coronary heart disease is the single greatest cause of death for both men and women in the United States. Every year more than 479,000 Americans die of CHD.

Each year there are more than 1.2 million heart attacks in the United States. Of these 340,000 are sudden, causing the patient to die at home or in an emergency room .

Coronary heart disease is caused when fatty plaques accumulate along the walls of the coronary arteries, narrowing them and thereby reducing blood flow to the heart. This process is referred to as atherosclerosis. Over time, the heart muscle that is "starved" of oxygen and nutrients carried by the blood, begins to weaken, and parts of it may even die.

Until very recently, blood pressure and cholesterol levels were the only measurements taken to help determine someone's risk of heart disease. While these are still considered standard tests to predict a patient's heart attack or stroke risk, physicians have learned that many people with heart disease have normal cholesterol and blood pressure. Realizing this, other indicators of heart disease have been studied and new tests are being developed to better predict who may suffer from heart disease.

One of the newer tests measures levels of high-sensitivity C-reactive protein (hs-CRP). Studies have shown that hs-CRP is associated with inflammation in the bloodstream and high levels may indicate higher risk of heart disease. Statins may lower hs-CRP, but currently there are no studies to indicate that lowering hs-CRP changes the risk of developing heart disease. University of Maryland is participating in a large trial to help answer that question. hs-CRP is elevated by obesity, metabolic syndrome (a cluster of risk factors including low HDL cholesterol, high triglycerides, high blood pressure, central obesity [waist > 40 inches in men or > 35 inches in women], impaired glucose [> 100], or the presence of small, dense LDL).

Having any 3 of these factors indicates metabolic syndrome, also known as Syndrome X or pre-diabetes. Other factors that increase hs-CRP are inflammatory conditions such as arthritis, asthma or illnesses. A hs-CRP less than 1 is considered low risk. A hs-CRP > 3 and < 10 is considered high risk of developing heart disease. A hs-CRP > 10 is likely due to another inflammatory condition.

Another new blood test is the PLAC blood test. This test measures an enzyme in the blood called lipoprotein-associated phospholipase A2 (Lp-PLA2). The enzyme measured in the PLAC test is thought to be related to plaque in the arteries that can build up and cause heart problems. Like the test for CRP, the PLAC test can help determine who is at greater risk for heart disease. Someone with high levels of CRP or PLA2 may be at higher risk for heart disease, even if cholesterol levels are normal. As with hs-CRP, there are no randomized clinical trials to suggest that lowering PLAC will decrease the risk of heart disease.

There are several other tests that help determine risk of developing heart disease. These include measurements of lipoprotein particles. There are ample clinical trials with statistically significant evidence that changing LDL particle size from small, dense to large "fluffy" does reduce the risk of heart disease. The size of the LDL can be measured directly with one of three commercially available tests (VAP, NMR, or Berkeley HeartLabs) or indirectly through laboratory tests called Apo-B. Similarly, the size of the HDL cholesterol can be measured. Small HDL are not beneficial. One can have an adequate "total" HDL (> 40) but still not have the protection unless the HDL is large, called HDL2.

Lipoprotein (a) is another cholesterol abnormality that may suggest higher risk of heart and vascular disease. This is a chromosomal abnormality that is inherited by 50 percent of the offspring of a parent with the disorder. Generally, this is tested once to determine its presence. If one does not have it upon testing, they will never develop the disorder. If one does have elevations in lipoprotein (a), it can be treated with prescription medications. Lipoprotein (a) is more likely to cause plaquing in arteries than large LDL. This disorder can easily be determined through blood testing.

One more test that can be measured is homocysteine. This is a byproduct of protein metabolism. When elevated, homocysteine is very inflammatory to the artery lining. Elevations are associated with increased blood clotting and heart attacks. It is treated with vitamins and prescription strength folic acid. Talk with a physician to find out more about these tests and to learn more about your risk for heart disease.