By Rebecca Bowers

EXECUTIVE SUMMARY

With cardiovascular disease now the leading cause of death for women, the American Heart Association and the American College of Obstetricians and Gynecologists have issued a joint advisory to help women lower their risk factors for heart disease and stroke.

  • According to the Centers for Disease Control and Prevention, heart disease killed 289,758 women in 2013, representing about one in every four female deaths.
  • By talking with women about heart-healthy habits such as never smoking or smoking cessation, healthy diet, increased activity, weight control, blood pressure management, cholesterol control, and blood sugar reduction, women’s health providers can help women take steps to fight heart disease.

With cardiovascular disease now the leading cause of death for women, the American Heart Association (AHA) and the American College of Obstetricians and Gynecologists (ACOG) have issued a joint advisory to help women lower their risk factors for heart disease and stroke.1 According to the Centers for Disease Control and Prevention, heart disease killed 289,758 women in 2013, representing about one in every four female deaths.2

“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,” noted John Warner, MD, president of the American Heart Association. Warner also serves as executive vice president for health system affairs at University of Texas Southwestern Medical Center in Dallas.

Although efforts have been made to improve heart disease awareness, research indicates that just 45% of women identified heart disease as the leading cause of death.3 Such low awareness is a concern, since 90% of women possess at least one heart disease risk factor. If women’s health providers can reach patients earlier with information such as how to instill AHA’s Life’s Simple seven health habits (stop smoking, eat a healthier diet, become active, lose excess weight, control blood pressure, control cholesterol, and lower blood sugar), they have the opportunity to become the “secret weapon” in fighting heart disease, states Haywood Brown, MD, ACOG immediate past president and F. Bayard Carter Professor in the department of obstetrics and gynecology at Duke University Medical Center in Durham, NC.

“As the leading healthcare 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,” said Brown in a press statement. By talking about the risks and actions women can take to reduce their risk, OB-GYNs can help women fight heart disease, he said.

Review the Risk Factors

Although hypertension, diabetes mellitus, hypercholesterolemia, and obesity are risk factors that affect men and women, some factors may have a different impact on women. After age 65, research indicates that women are more likely to have hypertension than men. Just 29% of elderly women have their blood pressure managed adequately, compared to 41% of men.4 In addition, women have a greater cardiovascular risk from diabetes mellitus than men do: 19.1% vs. 10.1%, respectively.5

The highest population-adjusted cardiovascular risk for women is high cholesterol, at 47%.1

In the United States, two out of every three women are either obese or overweight, so clinicians must counsel patients on the effect added weight has on cardiovascular health. Additional weight increases the risk for hypertension, dyslipidemia, physical inactivity, and insulin resistance.6 Although physical activity can lessen such risks, about 25% of U.S. women say they get no regular activity.7

Enhance Screening

The new advisory calls for enhanced cardiovascular disease and cardiovascular risk factor screening in women. By taking a full patient history, clinicians can identify important information about a patient’s risk factors, leading to appropriate referrals.

Use questionnaires to address diet, physical activity, depression screening, and lifestyle choices. Review your chart templates to see that key areas are addressed, such as hereditary risk factors, smoking cessation, and mental health. By reviewing risks, patients are reminded of the importance of healthful lifestyle adherence.

Visit ACOG’s Patient Education FAQs (https://bit.ly/2L8tOKA) for patient information on heart-healthy topics such as physical activity, weight control, smoking cessation, blood pressure management, and diabetes.

REFERENCES

  1. Brown HL, Warner JJ, Gianos E, et al. Promoting risk identification and reduction of cardiovascular disease in women through collaboration with obstetricians and gynecologists; A presidential advisory from the American Heart Association and the American College of Obstetricians and Gynecologists. Circulation 2018;137:e843-e852.
  2. Xu J, Murphy SL, Kochanek KD, Bastian BA. Deaths: Final data for 2013. Natl Vital Stat Rep 2016:64:1-119.
  3. Bairey Merz CN, Andersen H, Sprague E, et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: The Women’s Heart Alliance. J Am Coll Cardiol 2017;70:123-132.
  4. Benjamin EJ, Virani SS, Callaway CW, et al; Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation 2018;137:e67-e492.
  5. Peters SA, Huxley RR, Woodward M. Diabetes as risk factor for incident coronary heart disease in women compared with men: A systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Diabetologia 2014;57:1542-1551.
  6. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014;129(25Suppl 2):S102-S138.
  7. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;129(25Suppl 2):S76-S99.