番茄社区

LAS VEGAS -- A simple, one-page survey answered during a visit to the gynecologist could cut cardiovascular deaths in women, according to a study presented here.

Of the 500 women who filled out the questionnaire at a single site, 13% had three or more cardiovascular risk factors that many were unaware of, Sudhir Mungee, MD, at the University of Illinois College of Medicine in Peoria, and colleagues reported at the Society for Cardiovascular Angiography and Interventions (SCAI) meeting.

This is important because for 20% of the women their gynecologist was their only primary care physician, Mungee said.

"In this present state of medicine, if you were to ask women to name their biggest cause of death, more than 55% will say breast cancer," Mungee told 番茄社区. "But cardiovascular disease mortality is 10 times higher than all cancers combined."

And it's preventable, but women see heart disease as a man's disease, he said.

"It used to be a man's disease until 1987, but then the curves separated. For the 35 to 44 age group, cardiovascular mortality increases 1% every year in women. Every minute, one woman dies of cardiovascular disease in this country and that is simply because of lack of awareness, non-personalization of risk factors, and not getting effectively screened," he said.

The pilot ob/gyn screening program is a collaboration between SCAI's Women in Innovations program and Abbott Vascular's Women's Heart Health Initiative. It was launched in October 2010.

Mungee and his group distribute the surveys to local ob/gyns and pick them up when they are filled out. In the future, this could perhaps be done electronically, he said in an interview.

The screening tool contains questions about traditional risk factors, such as cholesterol, blood pressure, smoking, weight, and family history. But it also asks women about pain in their chest, legs, jaw, and neck, as well as pregnancy complications.

The 2011 American Heart Association pregnancy guidelines said that pregnancy complications, such as preeclampsia, are almost equivalent to a failed stress test.

"We know that if a woman had been preeclamptic, her risk of early and more severe coronary artery disease is greater," Mungee said. "If she had a small birthweight baby, the increased risk could be as much as eight times greater."

Those same women decades later need three different blood pressure medications, "which could have been addressed much earlier had they known about the pregnancy risk," he said.

The new AHA guidelines recommend that physicians ask women about their pregnancy complications.

The screening tool also asks women whether they are menopausal, have had their ovaries or uterus removed, or are on hormone replacement therapy.

The current study is the experience of a single institution, but nationally, more then 3,000 women have been screened by this method. Data on about 2,200 women were presented in March at the American College of Cardiology meeting by Jennifer Yu, MD, of Mount Sinai Medical Center in New York.

In that study, which covered 10 sites over 2 years, 87% of the women had cardiovascular risk factors, 42% had symptoms, and many were unaware of their risk factors.

In most cases, women are referred to their primary care physician. In the more serious cases, they are referred to a cardiologist.

In the current study by Mungee and colleagues, the univariate analysis showed that menopausal women (P<0.0001), women who've undergone oophorectomy (P=0.002), and those who've had a hysterectomy (P=0.0002) were likely to have more CVD risk factors.

As the number of positive gynecological histories increased, so did the number of cardiovascular risk factors.

"The message we want to give with this survey is that we want to create awareness, empower women to manage their health," Mungee concluded. "We also want to empower the community and hopefully take it to a national level."

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