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

 

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.

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.

 

“Pregnancy is essentially a ‘stress test’ for women, and these adverse pregnancy outcomes can be used to identify women who are at an increased risk for ASCVD, even in those for whom the conditions resolve after delivery,” the authors said.

To reduce or prevent these issues, the authors recommended ob.gyn. clinicians perform a “thorough family history, screening for and targeted review of cardiovascular risk factors (including those unique to women), and lifestyle counseling to improve cardiovascular risk factors with the goal of preventing future cardiovascular events.”

“The American College of Cardiology/American Heart Association guidelines for the assessment of cardiovascular risk find it reasonable to screen adults free of cardiovascular disease for risk factors such as smoking, hypertension, diabetes mellitus, total cholesterol, and high-density lipoprotein cholesterol every 4-6 years between the ages of 20 and 79 years to calculate their 10-year cardiovascular risk,” they wrote.

Regarding diabetes care, clinicians should screen for abnormal glucose levels in overweight or obese patients aged between 40 and 70 years and schedule lifestyle counseling for any patients with prediabetes (HbA_1c = 5.7%-6.4%), diabetes mellitus (HbA_1c greater than 6.4%), gestational diabetes, or metabolic syndrome.

 

Cholesterol and other traditional risk factors associated with hyperlipidemia should be checked every 4-6 years and patients with elevated lipids should receive counseling on lowering their saturated fat intake and adding more dietary fiber. Statins are also an option for patients where diet does not lower lipids to appropriate levels, but authors noted “women of childbearing age need to be specifically counseled to not become pregnant while taking a statin.” The advisory also recommended speaking with patients about engaging in “150 min/wk of moderate-intensity physical activity, 75 min/wk of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity” as well as offering counseling and options for women who want to quit smoking.

The authors noted that only 45% of women consider heart disease a “leading cause of death” and most primary care providers do not see cardiovascular disease as a top health concern for women, focusing on risk factors such as weight and breast health.

“As the leading health care providers for women, ob.gyns. provide care that goes far beyond reproductive health and are in a unique position to screen, counsel, and educate patients on heart health. By acknowledging and discussing the risks and communicating steps women can take to reduce their odds of developing heart disease, ob.gyns. have a powerful opportunity to be the secret weapon in the fight against heart disease,” Haywood L. Brown, MD, past president of the ACOG and F. Bayard Carter Professor in the department of obstetrics and gynecology at Duke University, Durham, N.C., said in a press release.

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.

 

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.

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.

 

“Pregnancy is essentially a ‘stress test’ for women, and these adverse pregnancy outcomes can be used to identify women who are at an increased risk for ASCVD, even in those for whom the conditions resolve after delivery,” the authors said.

To reduce or prevent these issues, the authors recommended ob.gyn. clinicians perform a “thorough family history, screening for and targeted review of cardiovascular risk factors (including those unique to women), and lifestyle counseling to improve cardiovascular risk factors with the goal of preventing future cardiovascular events.”

“The American College of Cardiology/American Heart Association guidelines for the assessment of cardiovascular risk find it reasonable to screen adults free of cardiovascular disease for risk factors such as smoking, hypertension, diabetes mellitus, total cholesterol, and high-density lipoprotein cholesterol every 4-6 years between the ages of 20 and 79 years to calculate their 10-year cardiovascular risk,” they wrote.

Regarding diabetes care, clinicians should screen for abnormal glucose levels in overweight or obese patients aged between 40 and 70 years and schedule lifestyle counseling for any patients with prediabetes (HbA_1c = 5.7%-6.4%), diabetes mellitus (HbA_1c greater than 6.4%), gestational diabetes, or metabolic syndrome.

 

Cholesterol and other traditional risk factors associated with hyperlipidemia should be checked every 4-6 years and patients with elevated lipids should receive counseling on lowering their saturated fat intake and adding more dietary fiber. Statins are also an option for patients where diet does not lower lipids to appropriate levels, but authors noted “women of childbearing age need to be specifically counseled to not become pregnant while taking a statin.” The advisory also recommended speaking with patients about engaging in “150 min/wk of moderate-intensity physical activity, 75 min/wk of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity” as well as offering counseling and options for women who want to quit smoking.

The authors noted that only 45% of women consider heart disease a “leading cause of death” and most primary care providers do not see cardiovascular disease as a top health concern for women, focusing on risk factors such as weight and breast health.

“As the leading health care providers for women, ob.gyns. provide care that goes far beyond reproductive health and are in a unique position to screen, counsel, and educate patients on heart health. By acknowledging and discussing the risks and communicating steps women can take to reduce their odds of developing heart disease, ob.gyns. have a powerful opportunity to be the secret weapon in the fight against heart disease,” Haywood L. Brown, MD, past president of the ACOG and F. Bayard Carter Professor in the department of obstetrics and gynecology at Duke University, Durham, N.C., said in a press release.

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.

 

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.

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.

 

“Pregnancy is essentially a ‘stress test’ for women, and these adverse pregnancy outcomes can be used to identify women who are at an increased risk for ASCVD, even in those for whom the conditions resolve after delivery,” the authors said.

To reduce or prevent these issues, the authors recommended ob.gyn. clinicians perform a “thorough family history, screening for and targeted review of cardiovascular risk factors (including those unique to women), and lifestyle counseling to improve cardiovascular risk factors with the goal of preventing future cardiovascular events.”

“The American College of Cardiology/American Heart Association guidelines for the assessment of cardiovascular risk find it reasonable to screen adults free of cardiovascular disease for risk factors such as smoking, hypertension, diabetes mellitus, total cholesterol, and high-density lipoprotein cholesterol every 4-6 years between the ages of 20 and 79 years to calculate their 10-year cardiovascular risk,” they wrote.

Regarding diabetes care, clinicians should screen for abnormal glucose levels in overweight or obese patients aged between 40 and 70 years and schedule lifestyle counseling for any patients with prediabetes (HbA_1c = 5.7%-6.4%), diabetes mellitus (HbA_1c greater than 6.4%), gestational diabetes, or metabolic syndrome.

 

Cholesterol and other traditional risk factors associated with hyperlipidemia should be checked every 4-6 years and patients with elevated lipids should receive counseling on lowering their saturated fat intake and adding more dietary fiber. Statins are also an option for patients where diet does not lower lipids to appropriate levels, but authors noted “women of childbearing age need to be specifically counseled to not become pregnant while taking a statin.” The advisory also recommended speaking with patients about engaging in “150 min/wk of moderate-intensity physical activity, 75 min/wk of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity” as well as offering counseling and options for women who want to quit smoking.

The authors noted that only 45% of women consider heart disease a “leading cause of death” and most primary care providers do not see cardiovascular disease as a top health concern for women, focusing on risk factors such as weight and breast health.

“As the leading health care providers for women, ob.gyns. provide care that goes far beyond reproductive health and are in a unique position to screen, counsel, and educate patients on heart health. By acknowledging and discussing the risks and communicating steps women can take to reduce their odds of developing heart disease, ob.gyns. have a powerful opportunity to be the secret weapon in the fight against heart disease,” Haywood L. Brown, MD, past president of the ACOG and F. Bayard Carter Professor in the department of obstetrics and gynecology at Duke University, Durham, N.C., said in a press release.

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.