This article is more than 5 years old. Information may no longer be current.
AHA: CVD risk reduction possible with cardiologist, OB-GYN collaboration
Click Here to Manage Email Alerts
A collaboration between cardiologists and OB-GYNs to assess a patient’s needs may improve outcomes by reducing the risk for CV morbidity and mortality, according to a presidential advisory from the American Heart Association and the American College of Obstetricians and Gynecologists published in Circulation.
“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, executive vice president for health system affairs at University of Texas Southwestern Medical Center in Dallas and co-chair of the writing committee, said in a press release.
CVD risk factors
Traditional atherosclerotic CVD risk factors such as diabetes, hypertension, obesity and hypercholesterolemia affect women differently compared with men in that it has a more potent effect. Smoking and physical inactivity have also been shown to be strong risk factors for atherosclerotic CVD.
Sex-specific atherosclerotic CVD risk factors are often related to hormonal or pregnancy influences, such as pregnancy complications and polycystic ovary syndrome, menopausal status and hormone use. Although these are established risk factors, they are not included in contemporary risk assessment tools, Haywood L. Brown, MD, immediate past president of the American College of Obstetricians and Gynecologists, F. Bayard Carter professor in the department of obstetrics and gynecology at Duke University Medical Center and co-chair of the writing committee, and colleagues wrote.
OB-GYNs are often the sole physician for many women, which can open the discussion for CV prevention.
“Because OB-GYNs are primary care providers for many women, the well-woman visit is the foundation of practice,” Brown and colleagues wrote. “The annual visit provides a powerful opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks.”
A well-woman CV prevention visit should start early in a woman’s life and include lifestyle counseling, a thorough family history and screening for and targeted review of CV risk factors, according to the advisory.
“All well-woman visits, including the postpartum follow-up visit, should be considered an opportunity to focus on lifestyle choices that optimize cardiac health, including weight management, smoking cessation, physical activity assessment, nutritional counseling and stress reduction,” Brown and colleagues wrote. “This is especially important for those with pregnancy complications that suggest an increased risk for premature cardiovascular events.”
Screening for abnormal glucose should be performed in women aged 40 to 70 years with obesity or overweight, a family history of diabetes or established CVD. Women with gestational diabetes should also be screened for diabetes.
Women aged at least 20 years and those with family history should have their cholesterol and other risk factors assessed every 4 to 6 years. Those with elevated lipids are recommended to undergo counseling to increase dietary fiber and decrease intake of saturated fats. Statins should be considered if a diet alone does not lower LDL to optimal levels.
BP should be screened at least once every 2 years for women aged at least 20 years and annually for women aged at least 40 years who have an increased risk for hypertension. Medical therapy would be considered for women without CVD or elevated risk for the disease and with BP measurements greater than 140 mm Hg/90 mm Hg.
Weighing a patient should be performed at every visit. Achieving behavioral change can be effective through a discussion of a patient’s progress regarding weight. Diet assessment can also be performed through food frequency questionnaires. It is recommended for women to perform 150 minutes per week of moderate-intensity physical activity, 75 minutes per week of vigorous-intensity aerobic physical activity or a combination of both levels. Women should also walk 10,000 steps per day.
Physicians should also assess smoking cessation and recommend behavioral interventions and pharmacotherapy for women who continue to smoke, according to the advisory.
Women should be monitored for mental health and stress, as depression is common in women after MI and stroke, according to the advisory.
Health assessment
The committee recommends assessing women using the AHA’s Life’s Simple 7, which defines CV health by four behavioral factors and three health factors.
Health care providers should be more aware of a woman’s CV risk factors from menarche to premenopause, pregnancy, and premenopause to postmenopause.
“OB-GYNs and cardiology providers can improve the cardiovascular health of women through enhanced collaboration,” Brown and colleagues wrote. “There is a significant opportunity to bridge the disciplines of cardiology and obstetrics and gynecology, including standardized protocols and enhanced cardiac screening. Shared information can be used to assess risk, initiate interventions and facilitate significant lifestyle changes. Care can be coordinated to minimize cardiovascular morbidity and mortality and to improve outcomes. By providing a platform for comprehensive well-woman care, primary prevention and early intervention, providers of women’s health can provide patient education, empowerment and motivation.” – by Darlene Dobkowski
Disclosures: Brown and Warner report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts