What are the latest recommendations for women's health care?

Latest Recommendations for Women's Health Care

Cardiovascular disease prevention should be the cornerstone of women's health care, as it remains the leading cause of morbidity and mortality for women in the United States and worldwide. 1 This requires comprehensive risk assessment and targeted interventions across a woman's lifespan.

Cardiovascular Disease Risk Assessment

Risk Classification

Women should be classified into three risk categories 1:

• High Risk: Those with established coronary heart disease, cerebrovascular disease, peripheral arterial disease, abdominal aortic aneurysm, end-stage/chronic kidney disease, diabetes mellitus, or 10-year predicted CVD risk ≥10%
• At Risk: Those with ≥1 major risk factors (smoking, hypertension, dyslipidemia, obesity, poor diet, physical inactivity, family history of premature CVD)
• Ideal Cardiovascular Health: Those with optimal risk factors and healthy behaviors

Unique Female Risk Factors

Several risk factors are unique to women and require special attention 1:

• Pregnancy complications: Preeclampsia, gestational diabetes, and pregnancy-induced hypertension significantly increase future CVD risk
• Menopause: Associated with increased cardiovascular risk
• Autoimmune disorders: Systemic lupus erythematosus and rheumatoid arthritis confer higher CVD risk in women

Hypertension Management

• Follow the 2017 hypertension guidelines for women, which are the same as for men 1
• For pregnant women with chronic hypertension, prescribe low-dose aspirin from the 12th week of gestation until delivery 1
• Consider calcium supplementation for pregnant women with low dietary calcium intake (<600 mg/day) to prevent preeclampsia 1
• Women with history of preeclampsia should be evaluated 6 months to 1 year postpartum and beyond childbearing age 1

Atrial Fibrillation Management

• Use the CHA2DS-VASc Calculator to determine ischemic stroke risk 1
• Oral anticoagulation is recommended for women with a CHA2DS-VASc score ≥2 1
• Oral anticoagulation in women <65 years with AF alone (no other risk factors) is not recommended 1

Lipid Management

• Hypercholesterolemia imparts the highest population-adjusted cardiovascular risk for women at 47% 1
• Statin therapy benefits are similar for women and men 1
• Use gender-specific Pooled Cohort Risk Equations for risk assessment 1

Diabetes Management

• Diabetes confers a greater cardiovascular risk for women than men: 19.1% versus 10.1% 1
• Both type 1 and type 2 diabetes increase ASCVD risk more in women than in men 1
• Be aware that diabetic women are less likely than diabetic men to be treated for cardiovascular risk factors 1

Hormone Therapy

• Hormone replacement therapy is not recommended for primary or secondary prevention of stroke in postmenopausal women 1
• The Women's Health Initiative trials do not support hormone therapy for prevention of cardiovascular disease, dementia, or other chronic diseases 2
• However, hormone therapy is effective for treating moderate to severe vasomotor symptoms in early menopause (before age 60) for women without contraindications 2

Oral Contraceptives

• Assess cardiovascular risk factors before prescribing oral contraceptives 3
• Oral contraceptives may be harmful to women with additional stroke risk factors such as cigarette smoking or prior thromboembolic events 1
• The risk of vascular disease is positively associated with the amount of estrogen and progestogen in oral contraceptives 3
• Use preparations containing the lowest estrogen content appropriate for the individual patient 3

Cancer Screening

• Breast cancer screening recommendations have evolved over time, with the U.S. Preventive Services Task Force updating guidelines in 2009 1
• Older women and Black women have experienced the largest increases in recent use of clinical breast examinations and Pap tests, though disparities persist 4

Lifestyle Recommendations

• Smoking cessation: Women should be advised not to smoke and to avoid environmental tobacco smoke 1
• Physical activity: ≥150 min/week moderate intensity, ≥75 min/week vigorous intensity, or combination 1
• Diet: Follow a DASH-like diet with increased fruits, vegetables, and whole grains 1, 2
• Weight management: Target a body mass index <25 kg/m² 1

Implementation Considerations

• Recognize that many women consider their OB/GYN to be their primary care physician, particularly during childbearing years 1
• Collaboration between cardiologists, primary care physicians, and OB/GYNs is essential for comprehensive women's health care 1
• Address socioeconomic and racial disparities in preventive care access and utilization 4
• Consider personalized preventive medicine approaches, which have shown positive health outcomes and improved health management 5

The latest evidence emphasizes the importance of early risk factor identification and modification throughout a woman's lifespan, with special attention to female-specific risk factors and conditions. A coordinated approach between healthcare providers is essential to optimize women's health outcomes.