Preventing CVD in Women: Common Questions and Answers

Cardiovascular disease (CVD) is the most common cause of mortality in the United States. Women have unique risk factors for CVD, including pregnancy, hormones, autoimmune disorders, and psychological stress. Most risk calculators underestimate the risk of CVD in women; therefore, it is essential that physicians have a heightened awareness of risk-enhancing factors. A thorough history of adverse pregnancy conditions, hormonal factors, autoimmune diseases, and psychological stress, including adverse social determinants of health, should be documented in the electronic health record. A risk assessment using the Atherosclerotic Cardiovascular Disease Risk Calculator should be routinely performed, and those with borderline (5% to less than 7.5%) and intermediate (7.5% to less than 20%) risk should undergo lifestyle modification counseling and shared decision-making regarding the initiation of a statin, aspirin, or antihypertensive therapy. Women with gestational diabetes mellitus should be screened at four to 12 weeks postpartum with a two-hour oral glucose tolerance test, and, if normal, the test should be repeated every one to three years. Women with hypertensive disorders of pregnancy should be assessed within three months of delivery, and CVD risk assessment should occur annually thereafter. Because women with a history of adverse pregnancy conditions have higher rates of traditional CVD risk factors that emerge at younger ages, earlier and more frequent monitoring should be considered. Optimizing management of mood disorders, traditional CVD risk factors, and autoimmune diseases and considering the effects of social determinants of health are essential. Lifestyle modification counseling should include guidance to adhere to a plant-based diet that is mostly vegetables, fruits, legumes, nuts, whole grains, and fish; 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise weekly; and tobacco cessation.