Reinventing the role of the gynecologist

In addition, if the risk assessment shows the score is less than 7.5% and your patient has a personal history of preeclampsia, preterm delivery, placental abruption, gestational diabetes mellitus, polycystic ovarian syndrome, or metabolic syndrome, or a family history of early cardiac death, she should be considered for aggressive risk factor modification in conjunction with management by a medical provider with expertise in cardiovascular disease prevention.

Although the 10-year risk assessment cannot be calculated for women less than 40 years of age, a lifetime cardiovascular risk can be calculated using the app. Thus for women less than 40 years of age with a lifetime cardiovascular risk of greater than 45%, we recommend aggressive risk factor modification. For women less than 40 years of age with a lifetime cardiovascular risk that does not exceed 45%, with a personal history of preeclampsia, preterm delivery, placental abruption, gestational diabetes mellitus, polycystic ovarian syndrome, or metabolic syndrome, or a family history of early cardiac death, aggressive risk factor modification should be considered in conjunction with management by a medical provider with expertise in cardiovascular disease prevention.

Once we assess risk and fully understand the metabolism of our patients, we can educate them about the pathophysiology of vascular disease and its prevention, with a focus on stress management, nutritional prudence, and appropriate exercise.

It is critical that patients understand that they are at risk for a future cardiovascular event and that their risk is real and quantifiable. This represents a paradigm shift not only in gynecologic care but also cardiac care. Too often patients adjust their behavior with their first cardiac event, be that angina or a myocardial infarction. We now have the opportunity to provide our patients the opportunity to modify their lives in their reproductive years, and thus significantly reduce their chance of ever experiencing a cardiac event.

As providers of women’s health, we must evolve to meet the needs of our patients. We have the opportunity to provide early intervention to reduce the most common causes of morbidity and mortality among our patients.

Dr. Jaspan is chairman of the department of obstetrics and gynecology at the Einstein Health Care Network and associate professor of obstetrics and gynecology at Thomas Jefferson University in Philadelphia. Dr. Shipon is cofounder of the Heart Center of Philadelphia at Jefferson and director of cardiovascular rehabilitation at Jefferson University Hospitals and Methodist Hospital in Philadelphia. Dr. Jaspan and Dr. Shipon said they had no relevant financial disclosures.