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CVD risk calculation crucial to long-term health for midlife women

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PHILADELPHIA — Cardiovascular disease risk assessment should be a key part of the discussion between health care providers and women as they go through midlife, the menopausal transition and beyond, according to a speaker here.

CVD remains a leading cause of death and disability in women; however, mortality rates in women are trending down, according to Beth L. Abramson, MD, MSc, FRCP, FACC, associate professor of medicine at the University of Toronto and director of the Cardiac Prevention and Rehabilitation Centre and Women’s Cardiovascular Health at St. Michael’s Hospital, said during her presentation.

Recent data from the American Heart Association suggest that during the last 30 to 40 years mortality rates are slightly lower among women than men. However, the data also show no reduction in mortality among women younger than 55 years.

“I think part of this is societal changes. We need to be aware of this because there will be an explosion of CV issues at midlife and beyond that we will start to see in the next decade or so,” Abramson said. “[CVD] is an equal opportunity killer, and the risk certainly increases after menopause. Our job as health care providers and menopause experts is to address that risk as women go through midlife and beyond to reduce death statistics.”

Traditional risk factors for CVD include, but are not limited to, age, sex, smoking status, blood pressure, family history and cholesterol levels.

“Those are the old indicators, but what are the new indicators? Everything old is new again,” Abramson said. “A woman at midlife not only needs to deal with her quality of life, but also needs to deal with her future risk.”

Abramson explained that she believes health care providers are taught to underestimate risk in women.

“We need to calculate [the risk]. We need to, as health care providers, assess risk,” she said. “We need to know that risk factors are synergistic. A patient has a family history, they’re smoking, they’re cholesterol is a little high, each individual risk factor increases risk assessment scores. It is important to calculate risk when you are seeing a womaan in your office, and as menopausal practitioners it is part of the overall health question.”

According to Abramson, it is important that health care providers discuss preventive care with their patients even before midlife.

“We need to approach women at risk at midlife to have long-term prevention,” she said. “When you’re seeing your perimenopausal and postmenopausal woman in your office, your goal is to make her feel well and live long for a vibrant life. There’s a lot of data on prevention. We’re not here for a 4-year clinical trial or even a 10-year follow-up, which are really important, but we’re here for the long-term health and vibrancy of our female patients.”

Reference:

Abramson BL. Dyslipidemia and the postmenopausal woman: Calculating cardiovascular disease risk. Presented at: Annual Meeting of the North American Menopause Society; Oct. 11-14, 2017; Philadelphia.

Disclosure: Abramson reports she is a consultant and is on the advisory board for Novartis and Sanofi and is on the speaker’s bureau for Amgen Inc., Boehringer Ingelheim and Servier.