Duke Health Referring Physicians


Special Health Concerns for Midlife Women

When a midlife woman comes into your office for a new appointment, it is important to have a discussion about risk factors and chart overall health indicators. As hormonal changes occur during this time of life, women tend to gain weight, have less favorable lipid profiles, have increasing blood pressure, be more sedentary, and possibly become diabetic. As menopause arrives, cardiovascular risks mount.

“My advice is for primary care physicians to perform a head-to-toe physical and evaluate cardiovascular risk factors, in particular,” says Pamela Douglas, MD, a cardiologist at Duke. “Then, if needed, extensively counsel patients who would benefit from lifestyle interventions and who may need drugs to control risk factors.”

Douglas, who will be a moderator at the April 11 Midlife Matters conference at the Hilton North Raleigh, says that noting protective factors isn’t enough. A woman may have a high risk of heart disease but present with a low body mass index, for example. Furthermore, some risk factors can contribute to multiple diseases. For example, obesity and smoking are risk factors for both cancer and heart disease, which make the lifestyle-changes argument more compelling, Douglas says.

Guidelines are emerging to address this issue and take specific gender, ethnic, and genetic factors into account.

The American Heart Association (AHA) released a consensus statement in 2014 on the role of noninvasive testing for women with suspected ischemic heart disease (IHD) (Circulation. 2014;130:350-379). In that statement, IHD risk is stratified by age and different risk categories, which cumulatively increase risk levels. Patients with multiple cardiac risk factors, functional disability, or extensive comorbidity are placed in a moderately dangerous “Add 1 Risk” category, whereas those with peripheral arterial disease and longstanding poorly controlled diabetes are placed in a high-risk category.

In addition, the AHA and the American College of Cardiology jointly released guidelines in 2013 for preventing cardiovascular disease (Circulation. 2013;129;29:S49), and the AHA and American Stroke Association released guidelines on stroke prevention in women (Stroke. 2014;45:1545-1588).

The new equations are recommended for 40- to 79-year-olds and measure a person’s risk of having a heart attack or stroke within the next 10 years. A separate equation is available to estimate a person’s lifetime risk, which is a measurement that is recommended starting at age 20. To calculate 10-year risk, the equation uses race, gender, age, total cholesterol, HDL (good) cholesterol, blood pressure, use of blood pressure medication, diabetes status, and smoking status.

Notably, the guidelines have broadened the range of patients who would be considered eligible to receive lipid-lowering drugs, like statins, to prevent heart disease, Douglas says.