Name:
Primary Prevention Recommendations for Women
Description:
Primary Prevention Recommendations for Women
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T00H05M04S
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's The Heart Board Review and other online resources available only through accesscardiology.com. >> Primary prevention is certainly one of the major ambitions for cardiologists. And indeed, guidelines have been published, but I think that we're missing the need to define how women need to be treated somewhat differently because of some other risk factors than men in relationship to primary prevention.
Hi, Dr. Bernie here, and welcome to Practice Impact Extra. In June 2019, the American College of Cardiology and the American Heart Association published their Guidelines and Recommendations for the Primary Prevention of Cardiovascular Disease in JACC. These guidelines provide a comprehensive resource, really a good one. It's really a one-stop shop into guidelines. The guidelines, however, are not gendered, which really reflects the scientific database used in these studies and trials in which women are clearly underreported.
However, we know cardiovascular disease remains the leading cause of morbidity and mortality in the United States in women with 1 in 4 women dying of cardiovascular disease. So, I really wanted to make you aware of what the study and the key points were noted in the Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women, and that was published in JACC in May of 2020, and there are about eight key points.
The first is that there exists unique -- unique risk factors related to female sex. That includes pregnancy-associated conditions such as hypertension, gestational diabetes, pre-term birth, loss of pregnancy, increased risk of dyslipidemia, insulin resistance, and diastolic dysfunction. Identification of such pregnancy-related conditions may help identify young women with lower risk scores to allow for earlier monitoring of cardiometabolic factors and management.
What about premature menopause, menopause before the age of 40? Clearly another key risk factor. Polycystic ovarian syndrome is associated with cardiometabolic factors including obesity, abnormal glucose control, diabetes, elevated blood pressure, and dyslipidemia. There are sex-related differences in traditional risk factors. Hypertension is more prevalent in the obese, diabetics, and in particularly non-Hispanic Black women.
Sex-related differences in cardiovascular medications exists. Particularly, medication may differ in their efficacy by sex. Women of childbearing age need modification of medication for management of cardiovascular disease and risk factors. Particularly, satins, ACEs, and ARBs are not recommended in pregnancy or planned pregnancy. Women are at greater risk for stroke in the setting of atrial fibrillation compared to men. The first choice of anticoagulation that should be considered is a NOAC as compared to vitamin K antagonists and should be considered for women with CHADS-VASc scores of less than 3.
The guidelines did not have recommendations regarding menopausal hormone therapy replacement, and researchers continue to investigate the potential benefits. I think that providers need to really review each woman's risk factor profile and discuss with the patients when menopausal therapy is considered. And finally, there's an updated recommendation relating to the need to identify the psychosocial factors such as depression, anxiety, acute and chronic emotional stress.
These are more prevalent in women and associated with an increase in cardiovascular disease risk. A pretty long list of key points, but I wanted to give you my thoughts. Cardiovascular disease is preventable. These updated recommendations for primary prevention in women can identify those unique risks in women, affording better assessment and treatment, resulting in significantly improved cardiovascular outcomes in women.
I want to thank you again for joining me, and see you next time on Practice Impact Extra. >> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features. To subscribe or learn more, please visit accesscardiology.com.
