CHICAGO – Cardiologists and ob.gyns. teamed up for a pilot project of the Women’s Cardiovascular Health Initiative aimed at improving primary cardiovascular prevention in middle-aged women.
An ob.gyn. is often the primary care physician for many middle-aged women, Dr. Jennifer Yu explained at the conference. The goal was to upgrade cardiovascular screening and education in ob.gyn. practices, without distracting ob.gyns. from their focus on reproductive health, and to direct at-risk women to specialized care as needed.
The project, sponsored by the nonprofit Cardiovascular Research Foundation, was implemented at 10 community-based ob.gyn. clinics around the country. Patients completed a one-page questionnaire addressing traditional and gestational cardiovascular risk factors and any current symptoms.
During a recent 2-year period, 2,234 middle-age women visiting these 10 clinics for routine ob.gyn. care completed the one-page survey and had their blood pressure measured. The payoff was substantial: 87% of the women turned out to have cardiovascular risk factors, and 42% had cardiovascular symptoms. In many cases, the women were unaware of their risk factors or the potential significance of their cardiovascular symptoms, according to Dr. Yu of Mount Sinai Medical Center, New York.
The project addresses the misconception that coronary artery disease is mainly a man’s disease, she said. Heart disease also is the No.1 cause of death in women, and cardiovascular mortality among women in the 35- to 44-year-old age group is rising by 1% annually.
The mean age of participants was 53 years; 56% were postmenopausal, and 27% of the postmenopausal women were on hormone replacement therapy.
The most prevalent cardiovascular symptoms included claudication in 10%, palpitations in 14%, exertional chest pain in 8%, resting chest pain in 10%, and shortness of breath in 35%.
Most of the women reported being sedentary; 14% had high blood pressure, 21% were hypercholesterolemic, and 7.5% had diabetes.
A history of gestational diabetes was reported by 8.8%, a history of gestational hypertension by 10%, and preeclampsia by 7.6%.
About 76% of the women had another primary care provider besides their ob.gyn. Those women were more likely to be aware that they had cardiovascular risk factors than were the 6% who indicated they had no primary care provider and the 18% who said their ob.gyn. is their primary care provider.
Among women with elevated blood pressure, 13% with a non–ob.gyn. primary care physician were unaware that they had high blood pressure, compared with 22% of hypertensive women with an ob.gyn. as their primary care physician and 27% of those with no primary care provider.
Similarly, 31% of women with a non–ob.gyn. primary care provider were unaware they were hypercholesterolemic, as were 38% of those whose ob.gyn. was their primary care physician and 51% of women with no primary care provider.
Of diabetic women with a non–ob.gyn. primary care provider, 18% didn’t know they had diabetes or were unaware of the associated cardiovascular risk. This was the case for 19% of diabetic women with an ob.gyn. primary care provider and 26% of women without a primary care provider.
One-quarter of the screened women were subsequently referred to another health care provider, typically a cardiologist, endocrinologist, or primary care physician.
The questionnaire was developed in consultation with leaders from the American College of Cardiology, the American Congress of Obstetricians and Gynecologists, and the Society of Cardiovascular Angiography and Interventions – Women in Innovations. The pilot screening was funded by Abbott Vascular. Dr. Yu reported having no financial conflicts.