Heart Screenings for Women Should Be as Routine as Pap Tests
Taken from the November/December 2013 issue of the Women's Health Activist Newsletter.
The Centers for Disease Control and Prevention (CDC) estimate that 800,000 Americans die every year from CVD.i The risks to men are more widely known, with the result that CVD is often thought of more primarily a threat to men…but nothing could be farther from the truth. CVD claims women and men in nearly equal numbers.
The statistics about women’s heart disease are startling:
- Every 90 seconds, a woman suffers a heart attack, and heart disease is the number one cause of death among women in the U.S.
- CVD claims the lives of one in three U.S. women.
- CVD and stroke claim twice as many women’s lives as all types of cancer combined.
- CVD is the leading cause of death among both African American and White women.
- Almost half of African American women over age 20 (48.9 percent) have some form of CVD.
- CVD is the leading cause of death among Latinas: nearly 30 percent of Latinas die of heart disease.ii,iii
Perhaps even more startling is the fact that the vast majority of heart disease is preventable — as much as 80 percent of CVD can be prevented through life-style changes.1 We know the disease’s risk factors and the best strategies for treating people at-risk for CVD. We also know the costs associated with not preventing heart disease: U.S. cardiovascular expenditures are the highest in the world, constituting 17 percent of the nation’s overall health expenditures.iv
Heart disease is a health crisis on a collision course with demographic trends — the situation is going to get worse, unless we act now. With the aging of the Baby Boomers and the expected increase in the Hispanic American population, almost half (40.5 percent) of the American population is projected to have some sort of CVD by 2030.2 The resulting financial costs will be staggering:
- CVD’s total direct medical costs (for treatment and care) will triple, rising from $273 billion in 2010, to $818 billion in 2030.
- Indirect costs (like those due to lost productivity) will more than double, rising from $172 billion in 2010, to $276 billion in 2030.v
As staggering as the monetary costs are, the personal costs — including the early deaths of hundreds of thousands of Americans — are equally great. We cannot easily quantify the shattering emotional and economic impact on a family due to the loss or disability of a parent to CVD.
Most CVD Is Preventable
The answers to the rising CVD epidemic are complex, since CVD’s risk factors include smoking, poor diet, high cholesterol and blood pressure, obesity, physical inactivity, family history, and lack of access to preventive health care. The key to preventing heart disease is early detection of an individual’s risk factors and implementing lifestyle and behavioral changes that can significantly reduce one’s risk.
The good news is that the Affordable Care Act (ACA) ensures women’s access to free preventive services (like screenings for blood pressure, cholesterol, and blood glucose) as well as tobacco cessation programs.vi Because of the ACA, when an in-network provider conducts these services, insurance plans must pay for them without cost-sharing, co-payments, co-insurance, or deductibles. The ACA should increase women’s ability to identify their risk factors and both prevent and control CVD — thereby improving their overall health and that of their families and communities as well.
Although screening for CVD risk factors is now covered, providers still need to actively discuss CVD and screen for it in their female patients. This is particularly critical for primary care providers like Obstetrician-Gynecologists (OB-GYNs) who women often view as their primary care doctors. Yet, OB-GYNs may not always think to screen their patients or remind their patients to visit a primary care doctor and obtain screenings. Under the ACA, OB-GYNs are considered to be “primary care physicians” (PHP), which means women can make appointments without needing a referral. Many women are expected to use their OB-GYNs as their PHP, but OB-GYNs may not be used to routinely talking about CVD with patients who are not pregnant.vii
All women, regardless of where they receive their primary care, should be screened for cardiovascular disease as part of preventive care covered by the ACA. We need to ensure that women know their risk factors and what they can do to prevent CVD. We need to ensure that doctors who have the most intimate relationship with patients (like OB-GYNs) are at the forefront of early diagnosis — regardless of the provider’s specialty. Cardiovascular screenings have to start getting equal billing with Pap tests, particularly since the risk of developing CVD far outweighs the risk of cervical cancer.
Know Your Risk Factors — 5 Simple Questions to Ask
Women — even younger women — can take control of their cardiovascular health by knowing their risk factors and what they can do to protect themselves. Every woman should ask her primary health care provider (regardless of their specialty), the following five questions; the answers will help assess her risk and guide her prevention efforts:
- Based on my family history, what is my risk of heart disease? Heart disease tends to run in families and is thought to have some genetic component.
- What is my Body Mass Index? The risk of CVD increases along with one’s BMI; a person with a BMI over 25 is considered to be “overweight” and at heightened risk for CVD.
- Which cardiovascular screening tests do I need? Depending on one’s age and overall health, the typical tests include: blood pressure, HDL (“good” cholesterol), LDL (“bad” cholesterol), triglycerides, fasting glucose , and waist circumference.
- Should I take a daily aspirin? Only your doctor can advise as to whether you are a good candidate for aspirin therapy to reduce the clumping action of platelets — possibly lowering your risk of heart attack or stroke.
- What can I do to lower my risk of CVD? As noted, most CVD can be prevented through lifestyle changes. So, if you smoke, ask your doctor to recommend a smoking cessation program. Talk honestly about your activity level and some guidance on easy exercises you can do for 30 minutes a day. Discuss your diet and whether you eat enough fruits and vegetables, and if your salt consumption might contribute to elevated blood pressure. If you’re overweight, can your doctor recommend a successful weight loss program or nutritionist to help? Would you benefit from medications to lower cholesterol or high blood pressure? Finally, ask if you need to begin to see a cardiologist or other specialist.
No woman should leave her doctor’s office, any doctor’s office, until she has the answers to these five questions, knows her risks, and is provided with her own personalized prevention strategy for CVD. While it is a physician’s responsibility to make sure that every woman’s heart is receiving the proper medical attention, in the end, prevention of CVD is in every woman’s hands. We must inform and empower ourselves to obtain the answers we need about our cardiovascular health and to act upon our doctors’ recommendations and make the necessary changes to our lives that are proven to lower our risk of developing CVD.
To learn more about women and CVD and its risk factors, and to find resources to help you lead a heart-healthy lifestyle and prevent heart disease, see www.sistertosister.org.
Susan Gurley is the Executive Director, and Beth Tomasello is the Director of Strategic Initiatives, of the Sister to Sister Foundation, the first organization with a mission dedicated solely to women's heart disease prevention and education.
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1. The CDC says, “Preventable (avoidable) deaths are defined as those from ischemic heart disease, stroke, chronic rheumatic heart disease, and hypertensive disease in people under age 75, although changes in health habits and the health care system can reduce death among all ages.” CDC, Preventable Deaths from Heart Disease and Stoke: Improving Care Can Save More Lives, Atlanta: CDC, 2013. Available online at: http://www.cdc.gov/vitalsigns/HeartDisease-Stroke.
i. CDC, Preventable Deaths from Heart Disease and Stoke: Improving Care Can Save More Lives, Atlanta: CDC, 2013. Available online at: http://www.cdc.gov/vitalsigns/HeartDisease-Stroke.
ii. National Heart, Lung, and Blood Institute, How Does Heart Disease Affect Women? Rockville MD: National Institutes of Health, 2011. Available online at: http://www.nhlbi.nih.gov/health/health-topics/topics/hdw
iii. Go Red for Women Editors, Heart Disease at a Glance, Dallas: American Heart Association (AHA), no date. Available online at: https://www.goredforwomen.org/about-heart-disease/facts_about_heart_dise...
v. American Heart Association, “Forecasting the Future of Cardiovascular Disease in the United States: A Policy Statement from the American Heart Association,” Circulation 2011; 123: 933-944. Available online at: http://circ.ahajournals.org/content/123/8/933
vi. HealthCare.gov, “What are my preventive care benefits?,” CMS, no date,.https://www.healthcare.gov/what-are-my-preventive-care-benefits/.
vii. Society of Cardiovascular Angioplasty and Interventions (SCAI). Women in Innovations News: SCAI WIN OB/GYN Patient Screening Project Launches Second Phase, March 21, 2013. Available online at: http://www.scai.org/WIN/News/detail.aspx?cid=6270068c-4a5b-40ef-a4c9-dd1c0100dd14.