Prevention of cardiovascular disease in women: Role of the obstetrician-gynecologist

Grimes, David A.

doi:10.1016/0002-9378(88)90207-4

Cited by 14 publications

(4 citation statements)

References 30 publications

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“…Primary care providers play a critical role in CVD prevention, and differences in how women access primary care may play a role in these disparities. OBGYN visits are a prime, and for some women perhaps the only, opportunity for CVD screening and prevention in younger women 33–34. This study’s findings suggest that improving hypertension recognition in OBGYN clinics may be an important strategy in reducing these disparities 35…”

Section: Discussionmentioning

confidence: 72%

Missed Opportunities in Cardiovascular Disease Prevention?

et al. 2011

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Younger women use both internal medicine and OBGYN clinics as primary sources of health care. However, the role of OBGYNs in cardiovascular disease (CVD) prevention is largely unexplored. The objective of this study is to examine rates of hypertension recognition in women under 50 who present with elevated blood pressures in family practice and internal medicine (Medicine) and OBGYN clinics, and to compare these rates across clinic type. The study’s population consisted of 34,627 non-pregnant women ages 18–49 with new-onset hypertension (defined as two consecutive visits with elevated blood pressures of SBP ≥140mmHg or DBP ≥90 mmHg with no prior hypertension history) from 2002–2006. Multivariate logistic regressions predicting the clinical recognition of hypertension (a recorded diagnosis of hypertension and/or an antihypertensive prescription by any provider within one year of the second elevated blood pressure) assessed the association between hypertension recognition and the clinic where the second elevated blood pressure was recorded. Analysis showed that hypertension was recognized in less than 33% of women with new-onset hypertension. Women whose second consecutive elevated blood pressure was recorded in OBGYN were less likely to be recognized as having hypertension within 12 months by any provider compared to women whose second consecutive elevated blood pressure was recorded in Medicine (OR=0.51;95% CI=(0.48, 0.54)). This study suggests that further attention be paid to identifying and treating CVD risk factors in women under 50 presenting in both Medicine and OBGYN, and that improved coordination across care settings has the potential to improve CVD prevention in young women.

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Section: Discussionmentioning

confidence: 72%

Missed Opportunities in Cardiovascular Disease Prevention?

et al. 2011

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“…Traditional risk factors for CVD include raised serum low density lipoprotein (LDL) cholesterol, elevated blood pressure, obesity, sedentary lifestyle, and cigarette smoking 10,11 .…”

Section: Role Of the Gynecologist In The Diagnosis Prevention And Mamentioning

confidence: 99%

Cardiovascular health and the menopause: the gynecologist as the patients' interface

2006

Climacteric

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The large decrease in estrogen following menopause appears to explain the dramatic increase in cardiovascular disease (CVD) in postmenopausal women. Gynecologists are well placed to play a primary role in the diagnosis, prevention and management of CVD in these patients; this role may include advice on lifestyle changes, and, if appropriate, prescribing preventative treatments such as hormone replacement therapy (HRT) and lipid-lowering drugs. The use of estrogen replacement therapy (ERT) to prevent CVD is supported by a number of observational studies. However, recently, large, randomized trials gave unexpected, conflicting data on the cardiovascular benefits of HRT, leading to confusion, and influencing both patient and clinical perceptions regarding the role of HRT postmenopause. These different outcomes may be due to differences in the HRT regimens, mean age and mean time from menopause at enrollment, duration of therapy, and patient selection bias in observational studies. A 'unified hypothesis' consistent with findings from all studies has now been developed: HRT initiated at the time of the menopause prevents CVD, whereas HRT initiated years after the menopause seems to increase CHD events. This knowledge is essential for gynecologists making clinical decisions regarding HRT use.

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“…Cardiovascular disease is the leading cause of mortality among women, exceeding deaths from all malignancies in women older than 60 years of age 1 . The incidence of arterial disease increases substantially in the postmenopausal period, and it is possible that the hypo‐oestrogenic state contributes to this.…”

Section: Introductionmentioning

confidence: 99%

A double‐blind, placebo controlled study of postmenopausal oestrogen replacement therapy and carotid artery pulsatility index

Jackson

Vyas

1998

BJOG

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Objective To determine whether postmenopausal oestrogen replacement therapy affects carotid artery Design A prospective double-blind placebo controlled trial.Setting University associated teaching hospital.Participants Twenty-eight postmenopausal women who were more than 12 months postmenopausal and who had not taken exogenous oestrogen.Interventions Independent randomisation to receive oral oestradiol(2 mg daily) or placebo for 20 to 24 weeks. Main outcome measuresInternal carotid artery Doppler pulsatility index, measured within one centimetre of the carotid bifurcation.Results Replicate data were available from 27 women. The mean pulsatility index decreased by -0.1 1 in 15 women receiving oestradiol, compared with a mean rise of 0.05 in the 12 women who received placebo (P = 0-006,95% CI for treatment difference 0.06-0.3 1).Conclusions Oestrogen replacement decreases postmenopausal carotid artery pulsatility index, probably reflecting decreased peripheral vascular resistance. This is a further mechanism whereby hormone replacement therapy may impart cardiovascular protection. pulsatility index.

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Prevention of cardiovascular disease in women: Role of the obstetrician-gynecologist

Cited by 14 publications

References 30 publications

Missed Opportunities in Cardiovascular Disease Prevention?

Missed Opportunities in Cardiovascular Disease Prevention?

Cardiovascular health and the menopause: the gynecologist as the patients' interface

A double‐blind, placebo controlled study of postmenopausal oestrogen replacement therapy and carotid artery pulsatility index

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