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Current Treatment Options in Cardiovascular Medicine
Erschienen in: Current Treatment Options in Cardiovascular Medicine 9/2019

01.09.2019 | Women’s Health (M Wood, Section Editor)

Addressing the Gap in Physician Preparedness To Assess Cardiovascular Risk in Women: a Comprehensive Approach to Cardiovascular Risk Assessment in Women

verfasst von: Nino Isakadze, MD, Puja K. Mehta, MD, Karen Law, MD, Mary Dolan, MD, Gina P. Lundberg, MD

Erschienen in: Current Treatment Options in Cardiovascular Medicine | Ausgabe 9/2019

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Abstract

Purpose of review

Increased recognition of risk factors and improved knowledge of sex-specific presentations has led to improved clinical outcomes for women with cardiovascular disease (CVD) compared to two decades ago. Yet, CVD remains the leading cause of death for women in the USA. Women have unique risk factors for CVD that continue to go under-recognized by their physicians.

Recent findings

In a nationwide survey of primary care physicians (PCPs) and cardiologists, only 22% of PCPs and 42% of cardiologists reported being extremely well prepared to assess CVD risk in women. A presidential advisory from the American Heart Association (AHA) and American College of Obstetrics and Gynecologist (ACOG) recommends that cardiologists and obstetricians and gynecologists (Ob/Gyns) collaborate to promote CVD risk identification and reduction throughout a woman’s lifetime.

Summary

We suggest a comprehensive approach to identify unique and traditional risk factors for CVD in women, address the gap in physician knowledge, and improve cardiovascular care for women.
Literatur
1.
Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67–e492.CrossRef
2.
Aggarwal NR, Patel HN, Mehta LS, Sanghani RM, Lundberg GP, Lewis SJ, et al. Sex differences in ischemic heart disease: advances, obstacles, and next steps. Circ Cardiovasc Qual Outcomes. 2018;11(2):e004437.CrossRef
3.
• Gu Q, Burt VL, Paulose-Ram R, Dillon CF. Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999-2004. Am J Hypertens. 2008;21(7):789–98. Gu et al. shows that women with hypertension, despite being on similar treatment regimens as men achieve blood pressure control at a significantly lower rate compared with men, while compliance and treatment rates are higher in women.CrossRef
4.
• Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study) was a large, international, case-control study designed to determine the importance of risk and protective factors for CHD worldwide. Study showed that hypertension and diabetes had higher population attributable risk in women compared to men.CrossRef
5.
Peters SA, Huxley RR, Woodward M. Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Diabetologia. 2014;57(8):1542–51.CrossRef
6.
Huxley RR, Peters SA, Mishra GD, Woodward M. Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2015;3(3):198–206.CrossRef
7.
Njolstad I, Arnesen E, Lund-Larsen PG. Smoking, serum lipids, blood pressure, and sex differences in myocardial infarction. A 12-year follow-up of the Finnmark Study. Circulation. 1996;93(3):450–6.CrossRef
8.
Wenger NK. Women and coronary heart disease: a century after Herrick: understudied, underdiagnosed, and undertreated. Circulation. 2012;126(5):604–11.CrossRef
9.
Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, et al. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation. 2016;133(9):916–47.CrossRef
10.
Mosca L, Linfante AH, Benjamin EJ, Berra K, Hayes SN, Walsh BW, et al. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005;111(4):499–510.CrossRef
11.
Bairey Merz CN, Andersen HS, Shufelt CL. Gender, cardiovascular disease, and the sexism of obesity. J Am Coll Cardiol. 2015;66(18):1958–60.CrossRef
12.
• Leifheit-Limson EC, D'Onofrio G, Daneshvar M, Geda M, Bueno H, Spertus JA, et al. Sex differences in cardiac risk factors, perceived risk, and health care provider discussion of risk and risk modification among young patients with acute myocardial infarction: the VIRGO Study. J Am Coll Cardiol. 2015;66(18):1949–57. The VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) showed that among adults aged 18 to 55 hospitalized for an acute myocardial infarction there was sex disparity in prior discussion with healthcare providers about modification of cardiovascular risk factors despite similar risk profile, specifically women were 20% less likely to report such discussions.CrossRef
13.
Dhawan S, Bakir M, Jones E, Kilpatrick S, Merz CN. Sex and gender medicine in physician clinical training: results of a large, single-center survey. Biol Sex Differ. 2016;7(Suppl 1):37.CrossRef
14.
Lewis BG, Halm EA, Marcus SM, Korenstein D, Federman AD. Preventive services use among women seen by gynecologists, general medical physicians, or both. Obstet Gynecol. 2008;111(4):945–52.CrossRef
15.
Morgan MA, Lawrence H 3rd, Schulkin J. Obstetrician-gynecologists’ approach to well-woman care. Obstet Gynecol. 2010;116(3):715–22.CrossRef
16.
Shaw LJ, Pepine CJ, Xie J, Mehta PK, Morris AA, Dickert NW, et al. Quality and equitable health care gaps for women: attributions to sex differences in cardiovascular medicine. J Am Coll Cardiol. 2017;70(3):373–88.CrossRef
17.
• Brown HL, Warner JJ, Gianos E, Gulati M, Hill AJ, Hollier LM, et al. 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. This advisory paper calls for counceling for healthy lifestlye and behavious in the care of all women as well as using well-women exam as an opportunity for early detection and modification of CVD risk factors. The paper discusses importance of bridging the gap between ob-gyn and cardiology which are important pillars of Women's health. Authors also address need for creation and use of templetes for comprehensive CV risk assessment in women. Implementation of consumer devices, apps, and social media networks to educate and empower women was also encouraged by the authors.
18.
Pasternak RC, Abrams J, Greenland P, Smaha LA, Wilson PW, Houston-Miller N. 34th Bethesda Conference: task force #1—identification of coronary heart disease risk: is there a detection gap? J Am Coll Cardiol. 2003;41(11):1863–74.CrossRef
19.
20.
Gaudineau A, Ehlinger V, Vayssiere C, Jouret B, Arnaud C, Godeau E. Factors associated with early menarche: results from the French Health Behaviour in School-aged Children (HBSC) study. BMC Public Health. 2010;10:175.CrossRef
21.
• Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;2019. 2019 ACC/AHA primary CVD prevention guidelines provide alorithms for CVD risk stratification and relay recommendations on clinical management of patients in different risk categories. Guidline emphasizes importance of clinician patient shared decision making while establishing treatment plan. In addition, incorporation of the risk enhancing factors, which include female specific and female predominant risk factors in risk assessment is recommended in intermediate risk patients. Use of coronary artery calcium scoring to refine risk category is also recommended in patients with intermediate cardiovascular risk if decision regarding treatment is not established.
22.
• Spector TD. Rheumatoid arthritis. Rheum Dis Clin N Am. 1990;16(3):513–37. In 1990 Dr. Spector reported that rheumatoid arthritis is two to tree times more common in women. It is assumed that the risk for the higher incidence may be related to sex hormones. Pregnancy and oral contraceptive pills may be protective or may delay and modify course of the disease.
23.
Mason JC, Libby P. Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions. Eur Heart J. 2015;36(8):482-9c.CrossRef
24.
Stamatelopoulos KS, Kitas GD, Papamichael CM, Chryssohoou E, Kyrkou K, Georgiopoulos G, et al. Atherosclerosis in rheumatoid arthritis versus diabetes: a comparative study. Arterioscler Thromb Vasc Biol. 2009;29(10):1702–8.CrossRef
25.
Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger TA Jr, Jansen-McWilliams L, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol. 1997;145(5):408–15.CrossRef
26.
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. Circulation. 2018;2018:CIR0000000000000625.
27.
• Saha KR, Rahman MM, Paul AR, Das S, Haque S, Jafrin W, et al. Changes in lipid profile of postmenopausal women. Mymensingh Med J. 2013;22(4):706–11. Saha et al. showed that postmenopausal women have a more atherogenic lipid profile compared to reproductive age group. Authors reported statistically significant increase in total cholesterol and LDL cholesterol and reduction in HDL cholesterol in menopausal women compared to pre-menopausal women.PubMed
28.
Shaw LJ, Bairey Merz CN, Pepine CJ, Reis SE, Bittner V, Kelsey SF, et al. Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol. 2006;47(3 Suppl):S4–S20.CrossRef
29.
Wellons M, Ouyang P, Schreiner PJ, Herrington DM, Vaidya D. Early menopause predicts future coronary heart disease and stroke: the Multi-Ethnic Study of Atherosclerosis. Menopause. 2012;19(10):1081–7.CrossRef
30.
Anderson SA, Barry JA, Hardiman PJ. Risk of coronary heart disease and risk of stroke in women with polycystic ovary syndrome: a systematic review and meta-analysis. Int J Cardiol. 2014;176(2):486–7.CrossRef
31.
Conway GS, Agrawal R, Betteridge DJ, Jacobs HS. Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome. Clin Endocrinol. 1992;37(2):119–25.CrossRef
32.
Kaaja RJ, Greer IA. Manifestations of chronic disease during pregnancy. JAMA. 2005;294(21):2751–7.CrossRef
33.
Banerjee M, Cruickshank JK. Pregnancy as the prodrome to vascular dysfunction and cardiovascular risk. Nat Clin Pract Cardiovasc Med. 2006;3(11):596–603.CrossRef
34.
Wenger NK. Recognizing pregnancy-associated cardiovascular risk factors. Am J Cardiol. 2014;113(2):406–9.CrossRef
35.
Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974.CrossRef
36.
Vaught AJ, Kovell LC, Szymanski LM, Mayer SA, Seifert SM, Vaidya D, et al. Acute cardiac effects of severe pre-eclampsia. J Am Coll Cardiol. 2018;72(1):1–11.CrossRef
37.
Heida KY, Velthuis BK, Oudijk MA, Reitsma JB, Bots ML, Franx A, et al. Cardiovascular disease risk in women with a history of spontaneous preterm delivery: a systematic review and meta-analysis. Eur J Prev Cardiol. 2016;23(3):253–63.CrossRef
38.
Emerging Risk Factors C, Erqou S, Kaptoge S, Perry PL, Di Angelantonio E, Thompson A, et al. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. 2009;302(4):412–23.CrossRef
39.
Shlipak MG, Simon JA, Vittinghoff E, Lin F, Barrett-Connor E, Knopp RH, et al. Estrogen and progestin, lipoprotein(a), and the risk of recurrent coronary heart disease events after menopause. JAMA. 2000;283(14):1845–52.CrossRef
40.
Davidson MH, Ballantyne CM, Jacobson TA, Bittner VA, Braun LT, Brown AS, et al. Clinical utility of inflammatory markers and advanced lipoprotein testing: advice from an expert panel of lipid specialists. J Clin Lipidol. 2011;5(5):338–67.CrossRef
41.
Langsted A, Nordestgaard BG. Antisense oligonucleotides targeting lipoprotein(a). Curr Atheroscler Rep. 2019;21(8):30.CrossRef
42.
Ballantyne CM, Hoogeveen RC, Bang H, Coresh J, Folsom AR, Heiss G, et al. Lipoprotein-associated phospholipase A2, high-sensitivity C-reactive protein, and risk for incident coronary heart disease in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2004;109(7):837–42.CrossRef
43.
Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195–207.CrossRef
44.
Lakoski SG, Cushman M, Criqui M, Rundek T, Blumenthal RS, D'Agostino RB Jr, et al. Gender and C-reactive protein: data from the Multiethnic Study of Atherosclerosis (MESA) cohort. Am Heart J. 2006;152(3):593–8.CrossRef
45.
Khera A, McGuire DK, Murphy SA, Stanek HG, Das SR, Vongpatanasin W, et al. Race and gender differences in C-reactive protein levels. J Am Coll Cardiol. 2005;46(3):464–9.CrossRef
46.
Tracy RP, Lemaitre RN, Psaty BM, Ives DG, Evans RW, Cushman M, et al. Relationship of C-reactive protein to risk of cardiovascular disease in the elderly. Results from the Cardiovascular Health Study and the Rural Health Promotion Project. Arterioscler Thromb Vasc Biol. 1997;17(6):1121–7.CrossRef
47.
Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282(22):2131–5.CrossRef
48.
Larsson A, Hansson LO, Akerfeldt T. Weight reduction is associated with decreased CRP levels. Clin Lab. 2013;59(9–10):1135–8.PubMed
49.
Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation. 1995;92(8):2157–62.CrossRef
50.
Lamina C, Meisinger C, Heid IM, Lowel H, Rantner B, Koenig W, et al. Association of ankle-brachial index and plaques in the carotid and femoral arteries with cardiovascular events and total mortality in a population-based study with 13 years of follow-up. Eur Heart J. 2006;27(21):2580–7.CrossRef
51.
Hecht H, Blaha MJ, Berman DS, Nasir K, Budoff M, Leipsic J, et al. Clinical indications for coronary artery calcium scoring in asymptomatic patients: expert consensus statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2017;11(2):157–68.CrossRef
52.
Lakoski SG, Greenland P, Wong ND, Schreiner PJ, Herrington DM, Kronmal RA, et al. Coronary artery calcium scores and risk for cardiovascular events in women classified as “low risk” based on Framingham Risk Score: the Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med. 2007;167(22):2437–42.CrossRef
53.
Kavousi M, Desai CS, Ayers C, Blumenthal RS, Budoff MJ, Mahabadi AA, et al. Prevalence and prognostic implications of coronary artery calcification in low-risk women: a meta-analysis. JAMA. 2016;316(20):2126–34.CrossRef
54.
Shaw LJ, Min JK, Nasir K, Xie JX, Berman DS, Miedema MD, et al. Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium. Eur Heart J. 2018;39(41):3727–35.CrossRef
55.
Lange S, Trampisch HJ, Haberl R, Darius H, Pittrow D, Schuster A, et al. Excess 1-year cardiovascular risk in elderly primary care patients with a low ankle-brachial index (ABI) and high homocysteine level. Atherosclerosis. 2005;178(2):351–7.CrossRef
56.
Pimple P, Hammadah M, Wilmot K, Ramadan R, Al Mheid I, Levantsevych O, et al. Chest pain and mental stress-induced myocardial ischemia: sex differences. Am J Med. 2018;131(5):540–7 e1.CrossRef
57.
Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27(23):2763–74.CrossRef
58.
Rozanski A, Gransar H, Kubzansky LD, Wong N, Shaw L, Miranda-Peats R, et al. Do psychological risk factors predict the presence of coronary atherosclerosis? Psychosom Med. 2011;73(1):7–15.CrossRef
59.
Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med. 2004;66(6):802–13.CrossRef
60.
Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P, et al. Socioeconomic status and cardiovascular outcomes: challenges and interventions. Circulation. 2018;137(20):2166–78.CrossRef
Metadaten
Titel
Addressing the Gap in Physician Preparedness To Assess Cardiovascular Risk in Women: a Comprehensive Approach to Cardiovascular Risk Assessment in Women
verfasst von
Nino Isakadze, MD
Puja K. Mehta, MD
Karen Law, MD
Mary Dolan, MD
Gina P. Lundberg, MD
Publikationsdatum
01.09.2019
Verlag
Springer US
Erschienen in
Current Treatment Options in Cardiovascular Medicine / Ausgabe 9/2019
Print ISSN: 1092-8464
Elektronische ISSN: 1534-3189
DOI
https://doi.org/10.1007/s11936-019-0753-0

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