“Traditionally, people think of OB/GYN and cardiology as separate fields, but now we’re talking about assessing risk across the lifespan, and that really requires multidisciplinary, longitudinal care and thinking,” said Dr. Molly Siegel, an obstetrician-gynecologist and maternal-fetal medicine specialist at Massachusetts General Hospital. “One of the most remarkable things about this is that so many associations are coming together to think about the whole of women’s lives in this way. »
This was the first coordinated effort between societies to establish a framework for women’s heart health.
According to the American Heart Association and the Centers for Disease Control, cardiovascular disease remains the leading cause of death among women worldwide, causing more than 400,000 deaths annually in the United States.
In February, the American Heart Association predicted that six in 10 American women will suffer from at least one type of cardiovascular disease by 2050.
Although heart health is more often associated with later stages of life, the report predicts that almost a third of women aged 20 to 44 will have cardiovascular disease by 2050, compared to fewer than one in four currently.
“Women make up more than half the population, and their heart health must be part of daily care in medicine,” Dr. Mariell Jessup, chief scientist and physician for the American Heart Association, said in a news release Monday.
The framework describes distinct life stages marked by major biological changes specific to women, such as menstruation. pregnancy and menopause. Each step is presented as a window of opportunity to prevent, detect and manage cardiovascular disease in women and girls.
The first stage is marked by the first period, around 8 to 15 years old. The second stage is where regular ovulatory and hormonal cycles are established and pregnancy usually occurs, from late adolescence until around age 44. The third stage is perimenopause, between the ages of 45 and 51, followed by the fourth stage at postmenopause, between the ages of 51 and older.
Pregnancy, whenever it may occur, is identified in the framework as a biological “stress test” where previously unrecognized cardiovascular risks may arise due to the intense hormonal, emotional and physical changes a woman goes through.
Siegel said she specializes in “high-risk” pregnancy care, meaning she works with patients who have complications requiring additional care during pregnancy. She said many of these complications are linked to cardiovascular disease.
“What we observe is an explicit description of how health patterns and, to some extent, health-related behaviors early in life may be linked to outcomes later in life,” she said. “When we think about pregnancy, it’s important that these obstetric complications are reported to a primary care physician or cardiologist, so that they are flagged as things to watch out for for the patient’s future health.”
Siegel also noted that the framework encourages pediatricians to look for early signs of cardiovascular risk during puberty, such as irregular periods, heavy flow, first period before age 10, or mental health issues such as eating disorders.
For postmenopausal women, the framework recommends that clinicians monitor menopausal symptoms that may also indicate cardiovascular risk, such as sleep disturbances or mood changes.
Postmenopausal women over the age of 50 are at greatest risk of heart attack, stroke, or heart failure due to low levels of estrogen (a hormone that helps prevent heart disease, but decreases during menopause). However, Siegel said, these conditions can be avoided with attention and action early in life.
“The framework came out this week, so I don’t know if it has changed systems of care yet, but I hope it will encourage collaboration across disciplines to work toward bridging these timelines,” she said.
“Don’t think of them as isolated clinical encounters – for example, you see your GP, your pregnancy doctor, your cardiologist – and instead think long-term across the lifespan to help improve patients’ cardiovascular outcomes.
Chloe Craft can be contacted at chloe.craft@globe.com.
Gn Health
