妇产科诊所是心脏病风险筛查的理想场所

小丫

2012-4-18
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. w  Y; h+ H$ s" x0 m5 t5 d芝加哥(EGMN)——纽约西奈山医学中心的Jennifer Yu博士在美国心脏病学会(ACC)科学年会上报告称，由心脏病医生和妇产科医生合作完成的女性心血管健康行动试点项目结果表明，社区妇产科诊所是女性心脏病筛查的理想场所。
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; O' m9 o2 F" M: T2 {. g( [) X妇女心血管健康行动旨在促进中年女性心血管疾病初级预防。鉴于妇产科医生常常是中年女性的初级保健医生，该试点项目试图在不影响妇产科医生生殖保健主要工作的前提下，在妇产科诊所开展心血管疾病筛查和教育，并根据需要将心血管风险女性转诊至专业机构接受治疗。这一由非盈利组织心血管研究基金会(CRF)赞助的试点项目在美国10家社区妇产科诊所内实施，患者只需填写一页问卷，主要涉及常规和妊娠期心血管风险因素以及目前症状情况。
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在最近2年期间，共计2,234例在这10家诊所进行日常妇产科保健的中年女性完成了问卷调查和血压测量。受试者平均年龄53岁，56%为绝经后女性，其中27%接受激素替代治疗。结果显示：87%的女性存在心血管危险因素，42%具有心血管症状。但在许多情况下，这些女性并没有意识到风险因素或心血管症状的潜在意义。该项目纠正了关于冠状动脉疾病主要是男性疾病的误解。实际上，心脏病同样是女性的第一死因，35~44岁女性心血管病病死率每年提高1%。
9 ^- A( _( @) o: M$ \最常见的心血管症状包括跛行(10%)、心悸(14%)、劳力性胸痛(8%)、静息性胸痛(10%)以及呼吸短促(35%)。大多数受试者属于久坐人群，患有高血压、高脂血症和糖尿病的比例分别为14%、21%和7.5%。妊娠糖尿病史、妊娠高血压史和先兆子痫史女性分别占8.8%、10%和7.6%。
% ]+ L2 R& n! `约76%的女性除妇产科医生外还有其他初级保健医生，18%称妇产科医生就是她们的初级保健医生，而6%的女性没有初级保健医生，前者意识到自己存在心血管疾病危险因素的比例较大。
在血压升高的女性中，上述3类女性没有意识到自己患有高血压的比例分别为13%、22%和27%；高脂血症女性中不知道自己患病的比例分别为31%、38%和51%；而糖尿病患者中不知道患有糖尿病或没有意识到相关心血管风险的比例分别为18%、19%和26%。1/4的受试女性随后转诊至其他医生，通常为心血管、内分泌或初级保健医生。
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* H2 \$ c) I3 Z0 N  g; m. r' S调查问卷的设计征询了美国心脏病学会(ACC)、美国妇产科医师协会(ACOG)以及美国心血管造影和介入学会女性创新(SCAI-WIN)专家的意见。筛查由雅培公司血管部资助。Yu博士报告无相关利益冲突。

小丫

OB/GYN SCREENING MAY HELP DETECT HEART DISEASE RISK
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March 25, 2012

CHICAGO (March 25, 2012)

小丫

Screening for Heart Disease in Women

< Mar. 28, 2012 > -- Women at risk for heart disease don&#39;t always realize it, and a new study suggests the perfect person to help assess that risk: the OB/GYN.
"It often doesn&#39;t occur to women that they could have a heart problem until their symptoms are very advanced, so we have to think differently and be creative about how we identify, educate and treat women at risk," says Roxana Mehran, M.D., at Mount Sinai Medical Center in New York City.
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, Q  U. l  F' @4 N0 y! eMany women still assume that heart disease is a problem only for men. But heart disease, stroke, and other forms of cardiovascular disease are the leading cause of death in women in the U.S.
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* t8 ~$ m4 ]5 l# @! N* C" N- |Two-year study
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For the study, the researchers tracked more than 2,200 women at 10 OB/GYN clinics who were screened for heart disease from January 2010 to January 2012. Nearly half of the women had gone through menopause.
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' J  C$ v+ ^* O( m' CThe women completed a survey that asked about their heart disease risk factors and any current symptoms of heart disease they had. The clinic staff took each woman&#39;s blood pressure.
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! u# J" b" [( m: C+ u7 qThe researchers found that 69 percent of the women had risk factors for heart disease, such as obesity or type 2 diabetes. Forty-two percent had symptoms of heart disease. About 20 percent said they couldn&#39;t remember if they&#39;d ever had their blood pressure checked before. A higher percentage said they had never been checked for high cholesterol or high blood sugar.

Primary doctor
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Among the participants, 18 percent said they considered their OB/GYN doctor to be their primary health care provider.
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, H3 ?3 A, i& \2 M  \6 q"Ob/gyn practices have an incredible opportunity to make an impact on heart disease in women by screening, educating and directing women to the right providers," Dr. Mehran says. "So we hope to see continued research in this area."

About a quarter of the women in the study were referred to other doctors for a closer look at or treatment of heart disease risk factors.

Dr. Mehran says that more research is needed to find out if the heart disease screenings actually help women either prevent or better manage their heart disease.

The study was presented this week at the annual meeting of the American College of Cardiology in Chicago.
0 Z* Q6 J9 W$ V5 t4 S0 _For more information on health and wellness, please visit health information modules on this website.
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What&#39;s Your Risk?

9 }) e* P# S0 W4 |  {2 sTo find out if you&#39;re at risk for heart disease, get your blood cholesterol and blood pressure checked. The higher either of them is, the greater your risk for heart disease or heart attack. A lipoprotein profile blood test will measure the fats in your blood: total cholesterol, LDL ("bad") cholesterol, HDL ("good") cholesterol, and triglycerides.

In general, you&#39;re at low risk if your total cholesterol is less than 200 mg/dL; LDL, less than 100 mg/dL; HDL, greater than 40 mg/dL (but preferably greater than 60); and triglycerides, less than 150 mg/dL.
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2 [5 ^) c- Z7 s6 U8 D" {! oNormal blood pressure is 119/79 or lower. If your reading is 120 to 139 for the top number and 80 to 89 for the lower number, you have pre-hypertension. This means you are likely to develop high blood pressure in the future. High blood pressure, or hypertension, is 140/90 or higher.

But your lipoprotein profile tells only part of the story. Your doctor will figure out your risk by also including other information, such as your medical history and family history of heart disease. If your risk is high, you may need cholesterol-lowering medication. Your doctor may advise you to make diet and lifestyle changes before he or she prescribes medication.

: a' K& P+ E4 i) s6 FMost women can prevent heart disease by making lifestyle changes that can reduce their risk.
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& g2 q3 V% g! b6 I5 Y- }Always talk with your health care provider to find out more information.
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1 j. {9 X$ x1 M. qOnline Resources
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(Our Organization is not responsible for the content of Internet sites.)

American College of Cardiology - OB/GYN Screening May Help Detect Heart Disease Risk

3 U, [1 u5 U9 pAmerican Heart Association - Women and Heart Disease

' l1 s7 c6 ~8 r9 O( N, m1 rNational Heart, Lung, and Blood Institute - What Is High Blood Pressure?