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Annual ob.gyn. visit a ‘powerful opportunity’ to talk heart health

 

Key clinical point: Cardiology, obstetrics, and gynecology providers should use a woman’s annual visit to her ob.gyn. to promote healthy lifestyle choices, screen for signs of cardiovascular disease and risk factors, and improve her overall cardiovascular health.

Major finding: Women are at greater risk than men are of cardiovascular mortality, hypertension, and hypercholesterolemia, and of developing diabetes mellitus–associated cardiovascular risk factors, with factors such as pregnancy, obesity, smoking status, mental health, and genetic risk factors also playing a role in cardiovascular health.

Study details: A joint advisory statement from the presidents of the American Heart Association and the American College of Obstetricians and Gynecologists.

Disclosures: Dr. Gianos is a consultant and/or on the advisory board for Regeneron. Dr. Wenger reports research grants from Gilead Sciences, the National Heart, Lung, and Blood Institute, Pfizer, and the Society for Women’s Health Research and is a consultant and/or on the advisory board for Amgen, AstraZeneca, Gilead Sciences, Janssen, and Merck.

Source: Brown HL et al. Circulation. 2018 May 10. doi: 10.1161/CIR.0000000000000582.


 

FROM CIRCULATION

Clinicians in the cardiology, obstetrics, and gynecology specialties should collaborate and use a woman’s annual visit to her ob.gyn. to promote healthy lifestyle choices, screen for signs of cardiovascular disease and risk factors, and improve her overall cardiovascular health, according to a joint advisory released by the presidents of the American Heart Association and the American College of Obstetricians and Gynecologists.

“Ob.gyns. are primary care providers for many women, and the annual ‘well woman’ visit provides a powerful opportunity to counsel patients about achieving and maintaining a heart-healthy lifestyle, which is a cornerstone of maintaining heart health,” John Warner, MD, president of the AHA and executive vice president for Health System Affairs at University of Texas Southwestern Medical Center in Dallas, said in a press release.

A doctor talking to her patient. javi_indy/ Thinkstock
The advisory noted that, because 90% of women have at least one modifiable risk factor for heart disease and a majority of women use their ob.gyn. as a primary care provider, clinicians in the obstetrics and gynecology fields can help identify traditional, nontraditional, and gender-specific cardiovascular risk factors in women during their annual well visits. Specifically, a woman’s risk for cardiovascular mortality is 20.9%, compared with 14.9% in men; men also are more likely to have adequate blood pressure management (41%) than are women (29%) after age 65 years. Cardiovascular risk associated with diabetes mellitus is also higher in women (19.1%), compared with men (10.1%), with diabetic women receiving less treatment for cardiovascular risk factors. At 47%, hypercholesterolemia is the “highest population-adjusted cardiovascular risk factor for women,” while obesity carries cardiovascular risks of physical inactivity, hypertension, insulin resistance, and dyslipidemia. The risk of cardiovascular complications is 25% higher for women who smoke than for men who smoke, and women who smoke and take oral contraceptives are at an increased risk of stroke.

“Traditional atherosclerotic cardiovascular disease (ASCVD) risk factors, such as hypertension, diabetes mellitus, hypercholesterolemia, and obesity, affect both sexes, but some may affect women differently and are considered to be more potent,” the authors wrote in their advisory.

The advisory also stated clinicians should be aware of ASCVD risk factors that are not specific to but are more prevalent in women, such as systemic lupus erythematosus, scleroderma, and rheumatoid arthritis.

“These disorders are highly prevalent among women who have an increased risk of coronary artery disease and other cardiovascular disease,” the authors wrote.

Gender-specific ASCVD risk factors for women include pregnancy complications such as gestational diabetes mellitus and low birth weight as estimated during gestation. Hypertension during gestation and preeclampsia carries a threefold to sixfold increased risk for subsequent hypertension while also carrying a twofold increased risk of stroke and ischemic heart disease. Non–pregnancy related risk factors included menopausal status, hormone use, polycystic ovarian syndrome, and functional hypothalamic amenorrhea.

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