The Management of Women of Childbearing Age With High BMI, Diabetes, Hypertension

Michael J. Bloch, MD

In this video, Michael J. Bloch, MD, discusses cardiovascular disease in women, including a woman's premenopausal life and its impact on cardiovascular disease risk post-menopausally and the management of women of childbearing age with high BMI, diabetes, and/or hypertension. 

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Michael Bloch, MD:

My name is Dr Michael Bloch. I'm a vascular medicine specialist from Reno, Nevada.

Consultant360: What are recent trends in cardiovascular disease among women of childbearing age?

It's an interesting question, actually. The incidence of cardiovascular events among women of childbearing age is going up, but going up from a very low level. So really, women of childbearing age have a very low risk of cardiovascular disease. But one of the reasons that we're interested in talking about cardiovascular health in women of childbearing age is that those effects, the effects of cardiovascular risk factors, are going to be amplified down the road in their postmenopausal years, where most women who are prone to cardiovascular events are going to have those events.

C360: Why do you believe a woman's premenopausal life and its effects on cardiovascular risk post-menopausally is clinically important and understudied?

As I mentioned, the risk in the premenopausal years is not that high. But we know that as women live longer and longer, we're seeing that there are actually more cardiovascular events in women than in men. May be delayed a little bit further into the lifespan, but the risk of cardiovascular events in older women, it's the number one cause of death. Major cause of morbidity in women who are postmenopausal. We know that atherosclerosis, which is the primary cause of cardiovascular events in older women, that process begins during the childbearing years. The first things that happen are endothelial dysfunction, inflammation, and early plaque formation, all of which happen in the premenopausal years. So, what happens to you in those childbearing years is going to definitely affect your cardiovascular risk in your postmenopausal years.

Most women who have those silent killers, as we call them, high sugars, high blood pressure, abnormal cholesterol, and overweight, aren't going to have any symptoms. And so many women aren't that concerned about their cardiovascular risk during their childbearing age. But as we talked about earlier, that risk begins to accumulate during your childbearing years, and controlling those risk factors when you're younger, so mostly with lifestyle, but occasionally with medications, will allow you to treat those a lot easier, your cardiovascular risk a lot easier when you're post-menopausal.

C360: What are your recommendations for treating women of childbearing age with high BMI, diabetes, and/or hypertension?

We really want to identify those risk factors. We want women to appreciate the importance of those risk factors in their future cardiovascular risk and begin to treat them earlier. The idea would be that you don't necessarily need, for example, to take as many medicines if you could identify high blood pressure early and treat it as opposed to waiting until the post-menopausal years when it may be a more severe presentation of hypertension.

C360: What are some ways a patient, obstetrician, and cardiovascular specialist can work together to take a multidisciplinary approach?

Yeah, it's a really important question. This has really changed over the decades I've been in practice. I think there's a general realization that for most women of childbearing age, their women's health specialist is going to be the only provider that they are likely to see. And so those women health specialists have a unique opportunity to not just screen for cancer and offer gynecologic and obstetric care, but also to identify and treat these cardiovascular risk factors. They are going to be the person who needs to identify the patient's high blood pressure, their abnormal sugars, their abnormal cholesterol, and make sure that we understand the importance of that later in life.

And so our women's health specialists I think do a great job in this country of identifying those risk factors and treating them. There are unique cases where patients will actually have established cardiovascular disease as a pre-menopausal woman. That's fairly uncommon, but in those situations, there are a lot of questions that come around pregnancy risk, and oral contraceptive use, where it is important that we have open communication between the cardiovascular specialist that that patient may be seeing and their women's health specialist.

C360: Is there anything else you'd like to add?

I just want to emphasize that cardiovascular risk is not static. Cardiovascular risk accumulates over the course of a woman's life. So it is really important that we identify cardiovascular risk factors and treat them early in life, and that there are important milestone events in a woman's life that they may not realize are important for their future cardiovascular risk, things like hypertension and pregnancy, gestational diabetes. Women recognize the acute issues that are associated with them, but may not always recognize that they are very highly associated with future cardiovascular risk.

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