Taking women's heart disease seriously

Key Points

Yet, cardiovascular diseases have not captured public awareness as much as the seventh-leading cause of death in women: breast cancer. The American Heart Association is trying to change that through its Go Red campaign.

In 2003, the AHA surveyed 1,000 women, and only 13 percent said they believed that heart disease and stroke were the greatest health threat.

"They are surprised to learn that heart disease is the leading cause of death," says Saltzman, whose active panel is about 800 patients. "I think they are more concerned about breast cancer because of the media attention. Also, since there are some cases of breast cancer in younger women in their 20s to 40s, they are more aware. Conversely, we hardly ever see heart disease until women are in their 50s."

But even with the most careful interventions and management, the patient must feel responsible for improving her own cardiovascular health.

"Knowledge is power," says Deborah Plate, DO, clinical associate director of the Akron General Center for Family Medicine in Akron, Ohio. "When you can tell a story that is real to a patient, that really rings a bell with them to be more proactive."

RISK ASSESSMENT

Education starts with patients understanding their risks. In 2007, the AHA updated its guidelines for cardiovascular disease prevention in women. The updated risk assessment classifies women patients as high-risk, at-risk, or optimal risk.

Saltzman's risk assessment starts with a detailed family and lifestyle history and blood test. She then sits at a computer with the patients to run a Framingham 10-year risk score for death or a myocardial infarction. If the score comes back as high-risk, then Saltzman usually stops there and begins to design a treatment. If the assessment comes back as at-risk, then Saltzman conducts a Reynolds risk model, which includes family history and C-reactive protein level.

"The good part about that is I can go over it with the patient there, but we can also print out the handout that shows what their risk assessment is," Saltzman says.

Leaving the office with a handout about her risk assessment is crucial because the patient likely will not remember much of the physician explanation and instructions due to the sensitivity of the topic, says Susan Bennett, MD, cardiologist and clinical director of the Women's Heart Program at the George Washington University Cardiovascular Center in Washington, D.C.

Bennett encourages each patient to schedule a follow-up visit with her primary care physician to discuss risk assessment and the findings, such as how the patient will control the blood pressure.