Our expert is Nanette Kass Wenger, MD, MACC, MACP, FAHA, Emerita Professor of Medicine in the Division of Cardiology at the Emory University School of Medicine and a Consultant to the Emory Heart and Vascular Center. She has authored and co-authored more than 1500 scientific and review articles and book chapters.
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CARDIOVASCULAR DISEASE (CVD) IS USA’S LEADING CAUSE OF DEATH FOR WOMEN
One in four women will die of CVD, and to put this in perspective, the annual CVD mortality for women is double that of all forms of cancer combined. Two in three women in the USA have at least one coronary risk factor, and this percentage increases with age. Since 2000, CVD mortality for men and women has declined, but there is one startling exception. In this period, women aged 35 to 54 have seen their rate of CVD mortality increase by 1% per year. This reverses a 40-year favorable trend. However, a more positive trend for all women is, as of 2013, for the first time since 1984, fewer women have died annually of CVD than men. This is a case where women want to be Number Two!
PREGNANCY IS AN EARLY PREDICTOR OF FUTURE CVD RISK
Some complications of pregnancy can be indicators of subsequent increased cardiovascular risk. All of the following are warning signs for future CVD risk: preeclampsia, gestational diabetes, pregnancy-induced hypertension, preterm delivery and low-for-estimated-gestational-age birth weight. Pregnancy can be viewed as a stress test for CVD problems. Preeclampsia and gestational hypertension indicate a three- to six-fold risk of subsequent hypertension and a doubled risk for ischemic heart disease and stroke. These women as well as their health care providers should be aware of their increased risk and of the need for coronary risk assessment and of taking preventive steps early.
WHEN PRESCRIBING ORAL CONTRACEPTIVE THERAPY, DO A RISK FACTOR ASSESSMENT
In the 1980s and early 1990s, we were told that hormone replacement therapy (HRT) cured everything from wrinkles to dementia. However, large scale clinical trials in the 1990s showed that not only was HRT not helpful for CVD prevention, it actually increased the risk of blood clots, heart disease and stroke according to the U.S. Preventive Services Task Force. HRT is not an appropriate treatment for the prevention of any chronic disease.
HRT for control of menopausal symptoms should emphasize the lowest effective dose for the shortest time.
However, in the case of a healthy woman, oral contraceptive therapy results in very little additional risk. It’s a different story in the case of smokers and those with hypertension. The CVD risk of oral contraceptive therapy is seven-fold greater for smokers than for non-smokers, and women who are already hypertensive are twice as likely to experience an increase in blood pressure.
SYSTEMIC AUTOIMMUNE DISORDERS ARE A RISK FACTOR FOR CORONARY HEART DISEASE
CHD is the leading cause of morbidity and mortality among women with systemic lupus erythematosus. Further, there is a two- to three-fold increase in myocardial infarction and CVD mortality in women with rheumatoid arthritis. Psoriasis also increases CV risk. For these women, the adverse outcomes warrant screening for coronary risk factors and intervention as needed.
PROVIDERS AND PATIENTS NEED GREATER AWARENESS OF CHD.
Currently only 54 percent of US women recognize that heart disease is their leading cause of death. This lack of awareness is greatest in the highest-risk populations, that is, women from racial and ethnic minorities. Compounding this, too many healthcare providers are unaware of the high CVD mortality rates for women. This lack of awareness translates into suboptimal application of preventive interventions, less appropriate diagnostic testing, less adherence to evidence-based cardiovascular guidelines and consequent poorer outcomes for women. Take the time to educate your patients about CHD.
The full article was just published in the Journal of Women’s Health. If you wish to read more, just click on the following: http://online.liebertpub.com/doi/full/10.1089/jwh.2015.5467
Wenger, Nanette K. Juggling Multiple Guidelines: A Woman's Heart in the Balance. Journal of Women's Health. March 2016;25(3):213-221. doi:10.1089/jwh.2015.5467.