Cardiovascular Risk Assessment During Ob/Gyn Visits Presidential Advisory (AHA, ACOG 2018)

American Heart Association and American College of Obstetricians and Gynecologists

Reviewed and summarized by Medscape editors

June 07, 2018

Guidelines on cardiovascular risk assessment during ob/gyn visits were released on May 10, 2018, by the AHA and ACOG.[1,2]

A new joint advisory from the American Heart Association (AHA) and the American College of Obstetricians and Gynecologists (ACOG) suggests that annual "well-woman" exams are not only a time for an obstetrician/gynecologist (ob/gyn) to assess a woman's reproductive health but are also a "unique opportunity" to identify and manage cardiovascular disease risk factors.

Many women see their ob/gyn as their sole physician, and this presents a unique opportunity to leverage this relationship to optimize risk reduction initiatives, reduce long-term healthcare costs, and provide comprehensive well-woman care.

All well-woman visits, including the postpartum follow-up visit, should be considered an opportunity to focus on lifestyle choices that optimize cardiac health, including weight management, smoking cessation, physical activity assessment, nutritional counseling, and stress reduction. This is especially important for those with pregnancy complications that suggest an increased risk for premature cardiovascular events.

All patients with diabetes mellitus, prediabetes, or metabolic syndrome should receive lifestyle counseling, which has been shown to have even better outcomes than medical therapy. Women with gestational diabetes mellitus should be screened for diabetes mellitus post partum and receive counseling on increased risk and periodic screening based on current guidelines.

Lifestyle guidance should be given to all patients with elevated blood pressures. Causes of hypertension to assess include obesity, excess sodium intake, low-fiber diets, physical inactivity, excess alcohol intake, and sleep apnea. Women without cardiovascular disease or elevated risk for cardiovascular disease should be treated with medical therapy if their blood pressure measurements are >140/90 mm Hg. However, if they have established cardiovascular disease or an elevated cardiovascular risk such as a 10-year risk >10%, treatment should begin at blood pressures >130/80 mm Hg.

The advisory makes four recommendations for well-woman visits and collaboration between ob/gyns and cardiologists:

  1. Eating a healthy diet and being physically active should be discussed at every visit with an ob/gyn (and cardiologist) because a poor Western diet and lack of exercise are the root causes of cardiovascular disease and type 2 diabetes.

  2. Patients should regularly be asked to reply to questionnaires about traditional and nontraditional cardiovascular disease risk factors.

  3. Ob/gyns and cardiologists should make sure that a patient's electronic medical record is collecting data from all physician visits, and certain data should trigger patient education and/or referral to a specialist.

  4. Ob/gyns and cardiologists should collaborate and share information.

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