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FIT Insights

Power in Numbers

OB/GYN & Cardiology Join in the Fight for Women

Heart disease is the leading cause of death among American women, particularly younger women,1 yet an estimated 45 percent of women don’t know that2. Even more concerning, less than half of primary care providers consider cardiovascular disease (CVD) a significant health concern in women2. It follows, then, that women are also less likely than men to receive guideline-based evaluation and therapies.

To help address these gaps, the American Heart Association (AHA) and American College of Obstetricians and Gynecologists (ACOG) recently released a joint advisory calling for a proactive approach to identify and manage CVD risk factors in women3. Many women see their obstetrician/gynecologists (OB/GYN) as their primary physician during the childbearing years, which is an important time for CVD risk assessment and primary prevention.  In addition to traditional cardiovascular risk factors, reproductive milestones such as pregnancy and menopause – along with pregnancy complications such as preeclampsia and gestational diabetes and hypertension – can also affect heart health. Thus, this relationship makes those visits “a powerful opportunity to counsel patients about achieving and maintaining a heart-healthy lifestyle, which is a cornerstone of maintaining heart health,” according to Dr. John Warner, AHA president. Furthermore, unlike other specialty appointments, annual well-woman visits must be covered by most private health plans without charging the patient a copayment or deductible. For this reason, an annual trip to the OB/GYN may the only access to health care for many. With free women’s clinics, these yearly well-woman visits may even be more accessible than appointments with general practitioners.

What should a well-woman visit include? The experts recommend a thorough family history to screen for CVD risk factors and lifestyle counseling, which importantly, should start with young women. Though CVD has traditionally been considered a disease of men and older women, it can actually start developing in earlier years, so counseling young women maximizes opportunities to prevent or slow progression of atherosclerosis. Additionally, providers should screen for sex-specific risk factors such as polycystic ovary syndrome and fertility therapy as well as obstetric CVD risk factors such as preeclampsia, gestational diabetes and hypertension, preterm delivery, low-for-gestational age birth weight.  These CVD risks are commonly found in women. In fact, among pregnant women, 30-40% have one risk factor that can lead to long-term health problems and another 20-30% carry a predictor of CVD risk3.

The advisory also provides recommendations on how physicians can use both low- and high-tech solutions to standardize protocols and enhance screening processes3 despite the reality of limited examination time with patients.  Platforms for sharing medical records are key to providing integrated patient care. Software algorithms designed to analyze screening data can help trigger patient education and specialty referrals.

As the fight against heart disease in women continues, enhanced collaboration between cardiology and OB/GYN is a much-needed strategy. There is power in numbers.

Author

Hena Patel, MD

Dr. Hena Patel, is a Fellow in Training at Rush University Medical Center in Chicago, IL. She will be pursuing additional training in advanced cardiac imaging. Her interests include women’s heart disease, prevention, and cardiovascular disease in South Asians.

Reference

  1. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jime?nez MC, Jordan LC, Judd SE, Lack- land D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O’Flaherty M, Pa- laniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2018 up- date: a report from the American Heart Association [published correction appears in Circulation. 2018;137:e493]. Circulation. 2018;137:e67–e492. doi: 10.1161/CIR.0000000000000558.
  2. Bairey Merz CN, Andersen H, Sprague E, Burns A, Keida M, Walsh MN, Greenberger P, Campbell S, Pollin I, McCullough C, Brown N, Jenkins M, Redberg R, Johnson P, Robinson B. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women’s Heart Alliance. J Am Coll Cardiol. 2017;70:123–132. doi: 10.1016/j.jacc.2017.05.024.
  3. Brown HL, Warner JJ, Gianos E, Gulati M, Hill AJ, Hollier LM, Rosen SE, Rosser ML, Wenger NK; on behalf of the American Heart Association and the American College of Obstetricians and Gynecologists. 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. DOI: 10.1161/ CIR.0000000000000582.