Cardiovascular health and the well-woman visit: providing more comprehensive care

Your patient, Diane, a 42-year-old female, is in for her annual well-woman visit. You were Diane’s OBGYN during all of her pregnancies; now, because she’s most comfortable in your practice, you serve as her primary care provider.

Since her last visit, Diane has resumed use of oral contraceptives and gained a few pounds. She reports feeling run-down, so you order thyroid testing to rule out deficiency. Diane had gestational diabetes, and because periodic screening is recommended, you also order glucose testing. Diane does not have a family history of heart disease; due to this and her age, you assume cardiovascular disease (CVD) risk is not a pressing concern.

Assessing Diane’s cardiovascular risk, however, could be an opportunity to provide more comprehensive care—and a 2018 advisory statement from the American Heart Association (AHA) and American College of Obstetricians and Gynecologists (ACOG) supports it.1

CVD: women are most at risk

The situation described above is all too common. Despite advances in gender-specific medicine, women are still less likely to receive guideline-recommended diagnostic testing and therapies, including cardiovascular screening.1

This is especially problematic with regard to CVD risk. Why? In the United States, CVD is the number-one killer of women, claiming more lives than all cancers combined.2 Even more alarming, more than half (64%) of women who die suddenly of heart disease have had no prior symptoms.

Yet despite these numbers, only 45% of women identify heart disease as the leading cause of death in women,1 and fewer than half of primary care physicians consider CVD to be a top concern in women, after breast health and weight.3 Recent AHA/ACOG recommendations aim to change these perceptions, through both screening and prevention efforts, noting that 90% of women have at least one risk factor for developing heart disease.1

The expanding role of OBGYNs

A majority of women consider their OBGYN to be their primary care physician, particularly during their childbearing years.1 According to the 2018 AHA/ACOG advisory statement, this is precisely why OBGYN partnership is essential to optimizing early identification and medication of risk factors for heart disease and stroke.1 Some of the key AHA/ACOG recommendations are provided below1:

  • Clinicians who provide care to women must take an active role in chronic disease prevention
  • OBGYNs should coordinate healthcare delivery with cardiologists to better assess patient needs and improve outcomes
  • Screening for CVD and cardiovascular risk factors should be enhanced
  • The annual well-woman visit provides an opportunity to assess and address CVD risk

CVD screening: guidelines for well-woman visits

To prevent atherosclerosis, the preferred approach is to begin early in a woman’s life. An optimal well-woman cardiovascular prevention visit should include1:

  • A thorough family history
  • Screening for and targeted review of both traditional and nontraditional cardiovascular risk factors (see table)
  • Lifestyle counseling to improve cardiovascular risk factors

Based on these recommendations, your patient Diane has two CVD risk factors for which testing may be necessary: gestational diabetes and the use of oral contraceptives.

Female sex and cardiovascular disease risk factors1

Uncovering hidden risk with cardiovascular testing

While routine lipid screening plays an important role in cardiovascular risk assessment, it may not adequately identify risk of adverse events. In fact, nearly 50% of all heart attacks and strokes occur in patients who have “normal” cholesterol levels.5

Some clinicians advocate for more advanced lipid testing, including the assessment of lipoprotein and apolipoprotein levels and the presence of inflammatory markers, in order to uncover previously unidentified risk. With advanced testing and deeper insights, you can take further action to help reduce your female patients’ cardiovascular risk.

Protect your patients’ heart health

Quest Diagnostics-Cleveland HeartLab Cardiometabolic Center of Excellence offers a number of solutions to help you protect your patients’ heart health, including routine lipid testing and advanced inflammatory and lipoprotein biomarker testing included in our Cardio IQ Advanced Lipid Panel with Inflammation.

Two of our recent webinars explore the essential role of OBGYNs in assessing cardiovascular risk:

Quest is committed to helping physicians identify cardiovascular risk for better patient outcomes.

 

References

  1. Brown HL, Warner JJ, Gianos E, at al. AHA/ACOG presidential advisory: promoting risk identification and reduction of cardiovascular disease in women through collaboration with obstetricians and gynecologists. Circulation. 2018;137:e843-e852.
  2. Benjamin EJ, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67-e492.
  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. Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2014;129(suppl 2):S74-S75]. Circulation. 2014;129(suppl 2):S49-S73.
  5. Sachdeva A, Cannon CP, Deedwania PC, et al. Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines. Am Heart J. 2009;157:111-117.

 

 

 

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