Visits to OB/GYN should include heart health talk: Experts

More than 50 percent of women consider their OB/GYN to be their most important doctor – if they can only get to one checkup, that’s the priority, according to a joint advisory from the American College of Obstetricians and Gynecologists and the American Heart Association published in Circulation.

But OB/GYN problems aren’t what kill most women -- heart disease is still the No. 1 killer. More than 90 percent of women have at least one risk factor for heart disease – and many don’t know it.

“OB/GYN doctors can be a “secret weapon” for improving the heart health of women," said Dr. Stacey Rosen, MD, a cardiologist, co-author of the advisory and vice president of The Katz Institute for Women's Health at Northwell Health. "We know that 90 percent of women have at least one risk factor for heart disease and that 80 percent of heart disease is preventable through a heart-healthy lifestyle.

"The annual 'well woman' visit is an ideal opportunity to include a heart disease risk assessment throughout a women’s lifespan.”

Even women who know the traditional risk factors for heart disease – high blood pressure and cholesterol, and diabetes — don’t know that they affect women differently than men, according to the rare joint advisory, which pointed out several instances:

-- The risk of dying of heart disease is greater for women than men (21 percent vs. 15 percent)

-- Diabetic women have twice the risk for heart disease as diabetic men

-- Cardiovascular risk for women who smoke is 25 percent greater than for male smokers

-- Women over 65 are more likely to have high blood pressure than men -- only 30 percent of women that age have adequate blood pressure control

-- High cholesterol gives women the highest boost in cardiovascular risk -- 47 percent

-- After a heart problem, women are 55 percent less likely than men to participate in needed cardiac rehabilitation exercise programs

Only 45 percent of women know that heart disease is the leading cause of female death – what’s even stranger is that fewer than half of primary care doctors (39 percent ) consider heart disease to be their “top concern” with female patients, the report says. Like women themselves, they’re more likely to be worried about breast health and weight management, since it affects so many diseases, according to the advisory.

Women’s hearts are put to a real-world test during the ordinary health milestones of their lives. Pregnancy and all its complications are first up: pre-term delivery, preeclampsia (high blood pressure and signs of damage to another organ system, most often the liver or kidneys during pregnancy), and gestational diabetes all increase risk. Preeclampsia and hypertension during pregnancy, for instance, increases women’s risk of heart disease threefold to sixfold at the time, with a twofold risk of having heart disease later. Menopause and its hormone changes have their own challenges for the heart.

Given all this, should OB/GYNs use their annual appointments to educate women about heart disease? The experts say it seems straightforward to them -- it’s all about the value of collaborative care between OB-GYN specialists and cardiologists.

What is the main message?

According to the current AHA president, Dr. John Warner, “AHA’s Go Red For Women and Woman’s Day conducted a survey of just over 1,000 women across the U.S. back in the Fall … The survey also indicated that heart health was the least likely topic to be discussed during a woman’s OB/GYN visit. … OB/GYNs are a useful resource for heart health, particularly during a woman’s pregnancy years.”

What took so long?

“The advisory represents the American Heart Association’s promise to convene experts and deliver innovative solutions – action – that will enrich the quality of care,” Dr. Warner said. “Heart disease is often silent, hidden, and misunderstood. For so long we thought about heart disease as largely a man’s disease, but we now know sex plays a significant role when it comes to how heart disease presents, and some risk factors are more prevalent in women than men. In fact, one woman dies of heart disease every 80 seconds, but there is some good news: heart disease is 80 percent preventable."

At the OB/GYN, what are things to ask about?

Family history of heart disease is important. Talk about your level of exercise, how well or badly you eat, how to keep a healthy weight, and let the doctor calculate your 10-year and lifetime risk for heart disease – yes, they can do that with your history and cholesterol level.

“It’s important to talk about lifestyle and behaviors we recommend through AHA’s 'Life’s Simple 7': get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar and stop smoking,” counseled Dr. Suzanne Steinbaum, director of Women's Cardiovascular Prevention, Health and Wellness at The Mount Sinai Hospital. Additionally, she said, “In women, the risk factor of depression is so important to talk about.”

What do cardiologists think is the most important thing OB-GYNs can do?

“To be aware that cardiovascular disease is her greatest health threat … The sooner we know, the sooner we can act.” Steinbaum said.

Dr. Eugenia Gianos, co-author of the advisory and co-clinical director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Health, added, “The most important thing that OB/GYNs can do is to recognize cardiovascular risk (whether genetic, lifestyle or poor risk factor control), and to either work with them to improve or connect them to the right resources for risk improvement.”

So, what should women do?

Talk with your OB-GYN about heart health, even if you have to be the one to bring it up! According to Rosen, all women need to ask their doctors “am I at risk for heart disease” and “what can I do to lower that risk?"

The general advice on cardiac risk applies to everyone: eat a healthy diet, exercise, don’t smoke. But remember, the risk factors specific to women: pregnancy difficulties (high blood pressure, gestational diabetes, preterm delivery), polycystic ovarian syndrome, reproductive hormones, hormonal contraceptives, etc. Great improvements have been made in the last two decades for cardiac health. OB/GYN visits and collaboration with cardiologists can be key to getting those improvements to women, so they can live longer, healthier lives.

Sunny Intwala, M.D., is a third-year Cardiology fellow affiliated with Boston University School of Medicine and a Clinical Exercise Physiologist who works in the ABC News Medical Unit.