Cardiovascular health management: preventive assessment

Abstract

Cardiovascular disease (CVD), the leading cause of death among men and women, represents a significant women's health concern. While the majority of cardiovascular prevention guidelines are similar for men and women, there is growing appreciation that there may be sex differences in the magnitude of relative and absolute benefits and harms of preventive interventions. For instance, while aspirin is associated with a reduction in the risk of CVD events in both men and women, the specific types of benefit appear to differ by sex, with some evidence that aspirin therapy lowers myocardial infarction risk in men (but not women), and ischemic stroke risk in women (but not men). Sex-specific risk assessment may be particularly well established in a primary prevention setting Race, education, waist circumference,waist/hip ratio, typical angina, family history of CAD, high stress, lipids,fasting blood sugar, anemia, insulin, insulin resistance (Homeostasis Model Assessment,HOMA) are particularly important in women together wit peculiar risk facors related to pregnancy, early menopause, autoimmunal diseases and hypoestrogenism. Comparing to men the most predicting CV risk factors appear to be older age, hypertension, history of diabetes, history of smoking, higher triglycerides, and lower Glomerular filtration rate. Regardig Lipoprotein A in the Women's Health Initiative and the Juppiter trial cohorts of women Lp(a) was associated with CVD only among those with high levels of total cholesterol. Further, improvement in risk prediction was minimal in independent validation samples, suggesting that routine screening for Lp(a) may have limited utility in women in primary prevention. The carotid intima-media thickness(cIMT) is widely used to define vascular age. The cIMT tends to be thinner in women than in men, although the evidence to support this finding is controversial . Unfortunately it is only a surrogate marker for atherosclerosis, whereas CT derived coronary calcification as well as, also in our experience, breast artery calcifications, appear to be a valid index of early atheroscerosis. Finally C Reactive Protein appear to be an interesting marker in women in specific situation in our experience.