Search

Cardiovascular and reproductive health of women have been going hand in hand since the dawn of time, yet links have been poorly studied. Still, once basis of their connections started to be established, it depended on local regional abilities and level of progressive thinking to afford women comprehensive care beyond the “bikini medicine”. Further research identified different associations rendering more conditions sex-specific and launching therefore a slow, yet initial turn around in clinical trials’ concept as the majority of global cardiovascular guidelines rely on the results of research conducted on a very modest percentage of women and even less on the women of color. Currently, the concept of women’s heart centers varies depending on the local demographics’ guided needs, available logistics driven by budgeting and societal support of a broad-minded thinking environment, free of bias for everyone: from young adults questioning their gender identity, via women of reproductive age both struggling to conceive or keep working part time when healthy and line of work permits it during pregnancy, up to aging and the elderly. Using “Investigate-Educate-Advocate-Legislate” as the four pillars of advancing cardiovascular care of women, we aimed to summarize standing of women’s health in Serbia, present ongoing projects and propose actionable solutions for the future.

Although over 500,000 women die from coronary heart disease each year in the United States, recent studies indicate that males with heart disease receive more aggressive treatment than females. Women suffer angina as their chief symptom more often than men, but are referred for noninvasive tests less frequently than men. In addition, when noninvasive testing indicates coronary heart disease, women are less likely than men to be referred for invasive tests and coronary bypass surgery. It is possible that diagnostic tests are less accurate in women; this would account for decisions to order special diagnostic tests less frequently for female patients. But, if this is not the case, women with heart disease may be receiving poorer medical care than men. Gender-related differences in the diagnosis and treatment of coronary heart disease were assessed among men and women who had suffered a heart attack. These patients were enrolled in a drug trial evaluating the use of a medication for a type of abnormal heart function. Of the 2,231 participants, 389 were women. Twenty-six percent of the men and 24 percent of the women had angina prior to their heart attacks, with 19 percent of the men and 18 percent of the women having angina at least three weeks prior to the attack. The frequency of angina attacks and treatments for them were similar in both sexes, however women reported greater disability resulting from angina. Men were more likely to undergo diagnostic cardiac catheterization than women (27.3 percent versus 15.4 percent), and were more likely to have bypass surgery (12.7 percent versus 5.9 percent). These differences were consistent when evaluating only patients who had a prior heart attack and only those with a history of angina. When controlling for other factors, men were twice as likely to receive these tests and treatments than women, despite the similarities of their conditions. These results indicate that men with heart disease receive cardiac catheterization and bypass surgery more often than women with similar levels of disease. Whether this means that these treatments are overused in men or underused in women is unknown. Further research must assess the outcomes of diagnostic tests and treatments in female patients with coronary heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Background Studies derived from continuous national surveys have shown that the prevalence of diagnosed diabetes mellitus in the US is increasing. This study estimated the prevalence in 2004 of self-reported diagnosis of diabetes and other conditions in a community-based population, using data from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD). Methods The initial screening questionnaire was mailed in 2004 to a stratified random sample of 200,000 households in the US, to identify individuals, age ≥ 18 years of age, with diabetes or risk factors associated with diabetes. Follow-up disease impact questionnaires were then mailed to a representative, stratified random sample of individuals (n = 22,001) in each subgroup of interest (those with diabetes or different numbers of risk factors for diabetes). Estimated national prevalence of diabetes and other conditions was calculated, and compared to prevalence estimates from the National Health and Nutrition Examination Survey (NHANES) 1999–2002. Results Response rates were 63.7% for the screening, and 71.8% for the follow-up baseline survey. The SHIELD screening survey found overall prevalence of self-reported diagnosis of diabetes (either type 1 or type 2) was 8.2%, with increased prevalence with increasing age and decreasing income. In logistic regression modeling, individuals were more likely to be diagnosed with type 2 diabetes if they had abdominal obesity (odds ratio [OR] = 3.50; p < 0.0001), BMI ≥28 kg/m2 (OR = 4.04; p < 0.0001), or had been diagnosed with dyslipidemia (OR = 3.95; p < 0.0001), hypertension (OR = 4.82; p < 0.0001), or with cardiovascular disease (OR = 3.38; p < 0.0001). Conclusion The SHIELD design allowed for a very large, community-based sample with broad demographic representation of the population of interest. When comparing results from the SHIELD screening survey (self-report only) to those from NHANES 1999–2002 (self-report, clinical and laboratory evaluations), the prevalence of diabetes was similar. SHIELD allows the identification of respondents with and without a current diagnosis of the illness of interest, and potential longitudinal evaluation of risk factors for future diagnosis of that illness.

Approximately 52 million American women will reach the menopausal transition during the next ten years, up to 2014; half will live more than one third of their lives postmenopause. Since cardiovascular disease (CVD) risk represents the greatest health risk for postmenopausal women, this life-stage is an ideal time for clinicians to review CVD risk and develop strategies to prevent or manage risk factors. In this light, a novel marker for CVD, high-sensitivity C-reactive protein, may provide a useful tool to help clinicians assess risk, particularly in patients at intermediate or incremental risks by traditional risk-factor assessment of hypertension, hyperlipidemia, smoking, obesity, diabetes, sedentary lifestyle, and a family history of early heart disease.

3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy for older patients at high risk of cardiovascular events is supported by data from randomized clinical trials and observational data, including the Cardiovascular Health Study, an LDS Hospital/University of Utah cohort study, and a study from New York Medical College. Randomized trials such as the Scandinavian Simvastatin Survival Study, the Cholesterol and Recurrent Events trial, the Heart Protection Study,and the Prospective Pravastatin Pooling Project included large numbers of elderly patients and uniformly sup- port safety and event reduction in these groups.Although debate continues over the appropriateness of treating elderly persons and the strength of data to support a decision to treat,it is clear that older patients have the highest absolute risk of events and the potential to show the greatest benefit. [ABSTRACT FROM AUTHOR]

While Managing Acute-Care Issues, family physicians are challenged daily to recognize and treat modifiable risk factors for coronary heart disease (CHD) and to educate patients on the importance of risk reduction. Time constraints and the imperatives of immediate issues make the challenge of identification and treatment of CHD risk difficult. A stunning number of family medicine patients present with 1 or more of the following CHD risk factors: low-density lipoprotein cholesterol (LDL-C) =130 mg/dL (33% of American adults), total cholesterol =200 mg/dL (45%), hypertension (33%), tobacco use (21%), sedentary lifestyle (69%), excessive body weight (body mass index =25; 67%), diabetes (8%), or pre-diabetes (26%). The objective of comprehensive therapeutic interventions in CHD, from diet and lifestyle changes, to smoking cessation, to medications, is to prevent new (primary prevention) or recurrent (secondary prevention) cardiovascular events, with the ultimate goal of preventing disability and death. Family physicians have the distinct advantage of seeing patients' health status from a global perspective, giving them a greater opportunity to recognize risk and initiate preventive interventions. Although therapeutic efforts have been directed traditionally at patients with established CHD and asymptomatic patients at high risk for cardiac events, new data are emerging that suggest that earlier, more aggressive treatment increases clinical benefit. This article (1) reviews the importance of reaching target goals for LDL-C and other biomarkers of risk in the primary and secondary prevention of CHD, and (2) addresses dosing issues and other practical methods of identifying and treating family medicine patients who are at risk.

The prevalence of heart disease and hypertension are increased in postmenopausal women. Gynecologists who have the role of primary care clinicians need to be aware of these risks and recognize cardiovascular problems in their patients.