WOMEN'S HEALTH
May 23, 2018

The Heart of a Woman

Given that pregnancy and menopause place extra burdens on women's hearts, OB-GYNs need to be on the front lines of women's heart health.

Over 90 percent of women have at least one risk factor for heart disease, yet too few approach heart disease as a significant health concern and, according to the American Academy of Obstetrics and Gynecology (ACOG) and the American Heart Association (AHA), the same is true of women's primary care physicians. The two organizations have joined forces to solve this problem.

“As the leading healthcare providers for women, OB-GYNs provide care that goes far beyond reproductive health and are in a unique position to screen, counsel and educate patients on heart health,” said Haywood L. Brown, the outgoing president of the American College of Obstetricians and Gynecologists (ACOG) and a professor in the department of obstetrics and gynecology at Duke University Medical Center. “By acknowledging and discussing the risks and communicating steps women can take to reduce their odds of developing heart disease. OB-GYNs have a powerful opportunity to be the secret weapon in the fight against heart disease.”

Pregnancy is essentially a stress test for women, and complications like preterm delivery, preeclampsia and gestational diabetes can also increase cardiovascular risk.

Women tend to use their pregnancy checkups or annual “well woman” visits as their primary point of care, making those visits a valuable opportunity for women and their doctors to discuss heart health. Visits to their obstetrician/gynecologists — OB-GYNs — are “a powerful opportunity to counsel patients about achieving and maintaining a heart-healthy lifestyle,” said John Warner, president of the AHA and a co-author of the advisory, in a statement.

Women's heart risks are different from those in men. “Pregnancy is essentially a stress test for women,” the authors write, and pregnancy complications like preterm delivery, preeclampsia and gestational diabetes can increase cardiovascular risk. Menopause, too, stresses the cardiovascular system. Even the common risk factors for heart disease, like high blood pressure, high cholesterol, obesity and diabetes affect women differently than men.

All of this makes OB-GYN visits a good place for women to discuss topics such as weight, nutrition, stress and physical activity with their doctors. When women come in for a gynecological checkup, Brown says, they should be counseled about ways to modify their lifestyles to reduce heart risk and then followed-up at subsequent visits. “Many women don’t see a cardiologist or internist until there is a problem,” he added. “This partnership [between OB-GYN and patient] is key. It’s about early intervention and early counseling.”

There has been a concerning rise in maternal mortality, particularly over the last decade, explained Lisa Hollier, the new president of ACOG and a co-author on the paper. The group is focused on reducing preventable maternal mortality, particularly the 25 percent of maternal deaths attributable to cardiovascular causes.

The advisory is published in Circulation.

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