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Objectives
- To recognize the unique opportunity for reproductive
health professionals to evaluate and manage cardiovascular risk in women and the importance of reproductive history in this evaluation
- To discuss strategies to successfully incorporate
cardiovascular disease prevention into routine care of women
- To summarize recommended approaches to the
prevention of cardiovascular disease in women, including tools to successfully motivate patients in facing the challenge of adopting healthier behaviors
3
Age-adjusted Death Rates for
American Women: U.S. 2006
39.0 32.
41.0 41.
14.1 14.
18.1 11.
CHD Stroke Lung Cancer* Breast Cancer*
Black/African American White Hispanic Asian
44
Source: Adapted from American Heart Association 2010
- CDC/National Center for Health Statistics, Health Data Interactive, 2005- 2007
Per 100, Population
Cardiovascular Disease Prevention in Ob/Gyn Practice Over the Lifespan
- C.R. is a 22-year-old Latina who presents for
postpartum check. She was diagnosed with
gestational diabetes.
- D.H. is a 35-year-old Asian-American woman
who presents to discuss contraception. She is
overweight, and asks for dietary and exercise
advice.
- A.D. is a 56-year-old African American woman
who presents for routine preventive care. Her
sister, who is 59, just had a heart attack, and she
asks how she can reduce her risk.
6
Cultural Competency: Considering the Diversity of Patients
- In addition to race/geographic/ethnic origin, other facets of diversity should be considered, including: - Age, language, culture, literacy, disability, frailty socioeconomic status, occupational status, and religious affiliation
- The root causes of disparities include variations and lack of understanding of health beliefs, cultural values and preferences, and patients’ inability to communicate symptoms in a language other than their own
- Clinicians also should be familiar with patients’ socioeconomic status, which may make attaining a healthy lifestyle and using medications more difficult
Source: Mosca 2011^7
Common Diagnoses In Ob/Gyn That Increase Lifetime Cardiovascular Disease (CVD) Risk
• Pregnancy-induced Hypertension,
Gestational Diabetes (GDM), Polycystic
Ovary Syndrome (PCOS)
• Hypertension (HTN), Diabetes,
Hyperlipidemia
• Smoking, Overweight/Obesity, Unhealthy
Diet, Lack of Exercise
Source: Mosca 2011, Wild 2010^9
Diagnoses in Obstetrics and Gynecology: Impact on CVD Risk in Selected Studies
10
Relative Risk of Subsequent CVD
Sources : Shah 2008, Wild 2010, Hannaford 1997
1.71 1.74^ 1.
Gestational DM Preeclampsia PCOS*
- Polycystic Ovary Syndrome
12
Pregnancies Middle Age
Population with complicated pregnancies Healthy population Threshold for vascular or metabolic disease
Age
Vascular Risk Factors
Source FACP : Sattar & Greer, 2002;. Adapted from Deborah Ehrenthal, MD,
Excursions into Metabolic
Syndrome During Pregnancy
