A new joint advisory from the American Heart Association (AHA) and the American College of Obstetricians and Gynecologists (ACOG) suggests that annual “well-woman” exams are not only a time for an obstetrician/gynecologist (ob/gyn) to assess a woman’s reproductive health but are also a “unique opportunity” to identify and manage cardiovascular disease risk factors.
The Presidential Advisory, published online May 4 in Circulation, spells out why this is important and makes four recommendations.
“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,” writing co-chair John J. Warner, MD, AHA president and executive vice president for Health System Affairs at University of Texas Southwestern Medical Center in Dallas, said in a statement issued with the advisory.
“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 fellow advisory report co-chair Haywood L. 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, North Carolina.
Cardiovascular disease is main cause of death in women, and 90% of women have at least one risk factor for disease, the advisory notes. Although morbidity and mortality in women with cardiovascular disease have improved significantly over the past two decades, women are still less likely to receive recommended diagnostic testing and therapies.
Ob/gyns are ideally placed to help women reduce their risk for cardiovascular disease, a process that needs to begin decades before the disease, because they are the primary caregivers for many women, especially those of reproductive age, the authors write.
Thus, “all well-woman visits, including the postpartum follow-up visit, should be considered an opportunity to focus on lifestyle choices that optimize cardiac health, including weight management, smoking cessation, physical activity assessment, nutritional counseling, and stress reduction,” they note.
This is especially important for women with pregnancy complications that confer an increased risk for premature cardiovascular events.
Sex Differences in Risk Factors
The advisory explains that in 2001, the monograph “Exploring the Biological Contributions to Human Health: Does Sex Matter?” from the Institute of Medicine (now the National Academy of Sciences) sparked initiatives that led to sex-based research and guidelines.
Nevertheless, many clinicians may not be aware of sex differences in prevalence of traditional cardiovascular risk factors, and women may receive less treatment, the authors note.
For example, only 29% of older women compared with 41% of older men have adequately managed blood pressure. Women with diabetes have a higher risk for developing cardiovascular disease than men with diabetes (19% vs 10%), but they are less likely to receive advice preventive treatment.
Women are also more likely to have nontraditional risk factors for cardiovascular disease, such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and treatment for breast cancer.
They also have female-specific cardiovascular disease risk factors, such as adverse pregnancy outcomes (gestational hypertension, preeclampsia, eclampsia, gestational diabetes, preterm delivery, low birthweight for gestational age), polycystic ovarian syndrome, and use of hormonal therapy or oral contraceptives in certain cases.
Four Recommendations
The advisory makes four recommendations for well-woman visits and collaboration between ob/gyns and cardiologists:
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Eating a healthy diet and being physically active should be discussed at every visit with an ob/gyn (and cardiologist) because a poor Western diet and lack of exercise are the root causes of cardiovascular disease and type 2 diabetes.
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Patients should regularly be asked to reply to questionnaires about traditional and nontraditional cardiovascular disease risk factors.
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Ob/gyns and cardiologists should make sure that a patient’s electronic medical record is collecting data from all physician visits, and certain data should trigger patient education and/or referral to a specialist.
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Ob/gyns and cardiologists should collaborate and share information.
For patient education material, the advisory report refers clinicians to websites including AHA Life’s Simple 7, AHA’s Go Red for Women, and ACOG’s patient page.
Brown and Warner had no relevant financial disclosures, and the disclosures of the other members of the writing group are listed with the article.
Circulation. Published May 10, 2018. Full text
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