Risk Factors In Women Research Articles

Prepregnancy health status and the risk of preterm delivery.

Despite extensive evaluation, our understanding of risk factors for premature delivery is incomplete. To examine whether a woman's health status and risk factors before pregnancy are associated with a woman's risk of preterm delivery, independent of risk factors that occur during pregnancy. Prospective cohort of pregnant women in the San Francisco Bay area who delivered a singleton infant (n = 1619). Preterm delivery (<37 weeks' gestational age). Sociodemographic characteristics alone explained 13.0% of the risk of preterm delivery, whereas risk factors that occurred before pregnancy explained 39.8% and risk factors that occurred during pregnancy explained 47.1%. After we adjusted for sociodemographic characteristics, prepregnancy risk factors, and pregnancy risk factors, women who reported poor physical function during the month before conception were nearly twice as likely to experience a preterm delivery (odds ratio, 1.97; 95% confidence interval, 1.18-3.30) as women with better physical function. A broader focus on the health of women prior to pregnancy may improve rates of preterm delivery.

Identification of Women's Coronary Heart Disease and Risk Factors Prior to First Myocardial Infarction

To understand when women's coronary heart disease (CHD) and CHD risk factors are recognized prior to first myocardial infarction (MI). Medical record review of the 10 years prior to incident MI among women with a confirmed incident MI between January 1, 1996, and December 31, 2001, to determine the timing of CHD diagnosis as well as assessment and treatment for risk factors. One hundred fifty women had incident MIs during the study period. They made 8732 ambulatory visits and had 457 hospitalizations during the period of review (mean 9.1 years, range 6.2-10 years). Average age at incident MI was 74.7 years (SD 12.6, range 38.9-99.8 years). A CHD diagnosis prior to first MI was present in 52% (n = 78) of the women but was less common in those <70 years (p = 0.001). All but 3 women had one or more modifiable risk factors identified prior to their first MI. Treatment of recognized risk factors varied from 81% (antihypertension medications) to only 28% (drug therapy for abnormal lipid levels). Having a diagnosis of CHD was associated with an increased likelihood of having identified risk factors and receiving drug treatment for identified risk factors. Women with undiagnosed CHD (48%) and those with unrecognized or untreated risk factors for CHD, especially younger women, represent missed opportunities for prevention of cardiac events.

Lipoprotein (A) and Further Prothrombotic Risk Factors in Women with Unexplained Recurrent Miscarriage- Results of a Multicenter Case-Control Study.

Background The present study was performed to assess the association of prothrombotic risk factors and underlying conditions, e.g. smoking and obesity, with unexplained recurrent miscarriage (uRM) in white women.Methods and Results From 1998 to 2003, 133 Caucasian women aged 18–42 years (median 28 years) suffering from uRM were consecutively enrolled. In patients and 133 age-matched healthy controls prothrombotic risk factors (factor V (FV) G1691A, factor II (FII) G20210A, MTHFR T677T, 4G/5G plasminogen activator inhibitor (PAI)-1, lipoprotein (Lp) (a), protein C (PC), protein S (PS), antithrombin (AT), antiphospholipid/anticardiolipin (APA/ACA) antibodies) as well as associated environmental conditions were investigated. 70 (52.6%) of the patients had at least one prothrombotic risk factor compared with 26 control women (19.5%; p<0.0001). Body mass index (BMI; p=0.78) and smoking habits (p=0.44) did not differ significantly between the groups investigated. Upon univariate analysis the heterozygous FV mutation, Lp(a) > 30 mg/dL, increased APA/ACA and BMI > 25 kg/m2 in combination with a prothrombotic risk factor were found to be significantly associated with uRM. Associations of the heterozygous FII variant, MTHFR or 4G/4G PAI-1 genotypes, deficiency states of PC, PS and AT, as well as the combination of smoking with at least one prothrombotic risk factor did not reach statistical significance. In multivariate analysis, increased Lp(a) (odds ratio (OR): 4.7/95% confidence interval (CI): 2.0–10.7), the FV mutation (OR:3.8/CI:1.4–10.7), and increased APA/ACA (OR: 4.5/CI: 1.1–17,7) had independent associations with uRM.Conclusion In Caucasian women uRM is associated with the presence of elevated Lp(a) or further prothrombotic risk factors.

Do physicians tailor their recommendations for breast cancer risk reduction based on patient’s risk?

To investigate how physicians tailor their recommendations for breast cancer prevention and risk reduction. Cross-sectional, mail survey. Random sample of primary care physicians in California (N = 822). Six standardized patient scenarios were used to assess how women's breast cancer risk factors influence physicians' recommendations for screening mammography, counseling about lifestyle behaviors, genetic testing, the use of tamoxifen, prophylactic surgery, and referral to a breast specialist. Over 90% of physicians endorsed mammography for all of the scenarios. Similarly, approximately 80% of physicians endorsed counseling about lifestyle factors for all of the scenarios. Five-year risk of developing breast cancer and family history were both strongly associated with each of the 6 recommendations. Importantly, however, physicians were more likely to endorse the discussion of genetic testing, the use of tamoxifen, and prophylactic surgery for women with a family history of breast cancer compared with women at a higher risk of developing breast cancer but without a family history. Obstetrician-gynecologists were more likely to endorse most of these practices compared with internists. Mammography and counseling about lifestyle behaviors are widely endorsed by physicians for breast cancer prevention and risk reduction. Whereas physicians are generally able to tailor their recommendations for prevention and risk reduction based on risk, they may perhaps underutilize genetic evaluation and newer therapeutic options for primary prevention for women who are at high risk of developing breast cancer but do not have a family history.

Socio‐cultural influences on Chinese women's attendance for cervical screening

Compared with other countries, Hong Kong has a relatively high rate of cervical cancer. Much of this morbidity should be avoidable with cervical screening, but uptake rates for screening in Hong Kong are low. In programmes to promote cervical screening attendance, it is essential that aspects of the socio-cultural system be taken into account to provide appropriate preventive health strategies. This paper outlines an investigation of the cultural and social factors contributing to Chinese women's attendance for cervical screening. A mixed methods design was employed, combining and comparing two data sets. The initial data set was drawn from 10 focus groups involving both screened and unscreened Chinese women (n = 54). The second data set was drawn from a total population of Hong Kong doctors, and involved face-to-face semi-structured interviews (n = 28). Thematic analysis of the data from women indicated that the social factors of cost, educational base, knowledge of risk, the social value of early detection and cultural issues such as modesty and embarrassment contributed to screening attendance. The doctors perceived a cultural tendency towards fatalism, as well as seeing the gender, interpersonal and interprofessional skills of the practitioner to be important in influencing levels of Chinese women's shyness and discomfort, and hence affecting attendance. The lay and practitioner data sets varied in the perceptions of women's pain, embarrassment and risk factors. Programmes providing services for Chinese women need to ensure that the philosophy of the staff and the approach and materials used are culturally relevant. Recommendations are that nurses equipped with relevant social and cultural knowledge of population groups should have a central role in health promotion and screening services.

The Excess of Strokes in Female Patients after CEA is due to their Increased Thromboembolic Potential—Analysis of 775 Cases

Introduction. Women suffer an excess of complications following arterial surgery, including an increased stroke risk following CEA. In order to investigate this further we studied men and women's thromboembolic potential following CEA. Method. Analysis of prospectively collected data on 775 consecutive CEAs performed between October 1995 and October 2001, to identify the number of microembolic events detected following CEA. Results. Overall women had a 2.2 fold increase in the number of postoperative emboli detected (95% CI 1.2–3.3). Of those patients with significant numbers of postoperative emboli (>25), 68% were female against 22% for men ( p=0.009). In order to prevent progression onto postoperative thrombotic stroke 9.7% of women were treated with intravenous Dextran-40 therapy, as opposed to only 2.7% of men ( p=0.013). There were no significant differences between men and women's preoperative risk factors and/or factors relating to their operation. Conclusion. It is possible that women's excess of postoperative complications following arterial surgery is related to their apparent increased thromboembolic potential following acute arterial injury.

Efectos-vecindario sobre la salud reproductiva de la mujer chilena

Fecundity rates have decreased considerably in Latin America, due to a higher contraceptive use and better family planning programs. To determine whether neighborhood level socioeconomic variables have an independent effect on reported modern contraceptive use, over and above the effect of individual level measures of socioeconomic status and reproductive health behavior. Multilevel logistic models determined the effects of individual and neighborhood dimensions (socioeconomic status, urbanization, quality of public health facilities) on contraceptive use among 509 women aged 15 to 49 years living in 85 neighborhoods within the Region of Bio Bio, Chile. After adjustment for women's individual socioeconomic characteristics and other risk factors, less favorable neighborhood socioeconomic characteristics were significantly associated with lower rates of modern contraceptive use. Changes in the quality of facilities for family planning at the neighborhood level may enhance modern contraceptive use.

Risk and risk assessment in pregnancy – do we scare because we care?

Objective : to assess whether being labelled ‘high-risk’ affects women's psychosocial state in pregnancy. Design : prospective, cross-sectional, non-experimental, case–control study. Setting : a large city in Germany. Participants : women between 22 and 41 weeks gestation were identified at antenatal classes and invited to participate in the study. Of the 147 women who were given a questionnaire, 82% (1 2 2) responded but only 75% (1 1 1) were eligible for inclusion in the study. Of these 111 women, 57 were classified as ‘labelled high-risk’ and 54 as ‘no-risk’ according to the risks documented in their antenatal records. Measurements : women's psychosocial state was assessed using a validated, anonymous, self-completed questionnaire, the Abbreviated Scale for the Assessment of Psychosocial State in Pregnancy (Goldenberg et al. 1997). Analysis of covariance (ANCOVA) was performed to test the effect of the risk label on psychosocial state. The effect of other variables, such as parity or education, was also tested. Findings : the effect of the risk label on psychosocial state after adjusting for age was statistically significant ( R 2=0.07, F=7.59, df=1, p=0.001). No significant differences were found for the other independent variables. The data showed that a large number of women had one or more risk factors and that 71% were booked for obstetrician-led care. A high variability in obstetrician's documentation of women's risk factors was also found. Conclusion : the data suggest that labelling women to be ‘at risk’ may negatively affect their psychosocial state. The findings highlight the need to re-evaluate the risk catalogue in the German antenatal record ( Mutterpass) as well as the German maternity guidelines ( Mutterschaftsrichtlinien). Although this study was conducted within the German system of antenatal care, the findings raise questions about the effects of risk labelling in maternity care wherever it is practised. Further research is needed to assess women's psychosocial state in a more representative sample, to explore women's experiences and satisfaction with the practice of risk assessment and to investigate the reasons for the high variability in documenting women's risk factors.

Military Women's Risk Factors for and Symptoms of Genitourinary Infections during Deployment

Symptoms of vaginitis and urinary tract infections are miserable, distracting, and significantly affect women's quality of life. Among civilian women, these symptoms account for 10.5 million office visits per year. To examine the scope of the problem for military women during deployment situations, surveys were sent to randomly selected Army and Navy units. Of 841 women who completed the anonymous survey and had been deployed, vaginal infections were experienced by 30.1% and urinary tract infections by 18.4% of them during deployment. Vaginal symptoms were consistent with symptoms associated with the three most common vaginal infections (candida, bacterial, and trichomonas vaginitis). A variety of risk factors, both behavioral and situational, significantly differentiated women with and without infections. Urinary tract infections and vaginal infections are common during deployment situations where resources for self-care and appropriate primary health care for women are scarce or unavailable. One solution is a self-diagnosis and treatment kit for deployed military women.

Measuring perceptions of synergistic circulatory disease risk due to smoking and the oral contraceptive pill.

There is evidence that the oral contraceptive pill (OCP) and smoking contribute independently to risk of circulatory disease. There is mixed evidence that the combined risk may be greater than the sum of these factors operating in isolation. Little is known about how the general population views the risks from OCP use, singly and in combination with smoking. Previous attempts at assessing whether the public views risks as operating synergistically have generally found evidence for subadditive models, where the combined risk is less than the sum of factors operating in isolation. However, concerns have been expressed over the validity of the measures of risk perception used. Therefore, this study used three distinct methods of measurement to assess the extent to which 241 undergraduate students perceive the risks of smoking and the OCP separately and combined, for circulatory disease. For all three methods, respondents read each of four vignettes describing information about a woman's risk factors (with high and low levels of both OCP and smoking), and then estimated risk of circulatory disease using one of the three risk measures. The three measures produced similar ratings. Consistent with the epidemiological evidence, information about smoking had more impact on estimates of overall risk than did information about the OCP For all three measures, responses were consistent with an additive model of risk from smoking and the OCP. This convergence of results from different methods suggests that all three methods of measurement employed, which all had a large number of response options, may be valid.

Interrelationships among circulating interleukin-6, C-reactive protein, and traditional cardiovascular risk factors in women.

Interleukin-6 (IL-6) and C-reactive protein (CRP) are markers of systemic vascular inflammation that herald atherothrombosis and may have important interrelationships with traditional cardiovascular risk factors. We conducted a cross-sectional analysis among 340 apparently healthy women enrolled in the Women's Health Study. In unadjusted analyses, higher levels of IL-6 and CRP were seen with increasing body mass index (BMI), systolic and diastolic blood pressure, and smoking exposure. IL-6 levels were related to the frequency of alcohol intake (P=0.002) and showed an inverse relationship with exercise frequency and hormone replacement therapy (P<0.0001 for both). CRP levels increased with hormone replacement therapy (P=0.0002). Associations among IL-6, CRP, and lipid levels were minimal. Overall, mean levels of IL-6 and CRP increased with increasing numbers of clinical risk factors (P<0.0001). In multivariate analyses, independent relationships were seen between levels of IL-6 and age, BMI, smoking, systolic blood pressure, alcohol use, presence of diabetes, and frequency of exercise. CRP was associated with age, BMI, systolic blood pressure, high density lipoprotein, smoking, and hormone replacement therapy in adjusted analyses. Plasma levels of IL-6 and CRP are independently related to several clinical cardiovascular risk factors in women.

Osteoporosis screening by community pharmacists: use of National Osteoporosis Foundation resources.

To assess the feasibility of establishing an osteoporosis screening program in rural community pharmacies based on information and resources provided by the National Osteoporosis Foundation (NOF), to survey primary care providers regarding the usefulness of this screening program, and to recommend strategies for pharmacists interested in working with patients at risk for osteoporosis. Pharmacists and/or nurses enrolled women 65 years of age and older into the study, measured calcaneal bone density, administered a questionnaire to ascertain subjects' osteoporosis risk factors, and provided NOF literature to subjects. With their agreement, women's bone mass data and risk factor assessments were provided to primary care providers along with NOF's Physician's Guide to Prevention and Treatment of Osteoporosis. These providers were surveyed as to whether they found this information useful. Five independent community pharmacies in rural Wisconsin. We enrolled and tested 133 women. Of these, 122 (92%) agreed to have information mailed to their primary health care providers. These 57 providers were surveyed and 24 (42%) responded; of these 24, 20 (83%) found the information they received useful. A community pharmacy-based osteoporosis screening program using NOF materials was well accepted by physicians. NOF resources and recommendations can provide a strong foundation for such programs.

Postmenopausal Hormone Therapy and Cardiovascular Disease

Letters18 December 2001Postmenopausal Hormone Therapy and Cardiovascular DiseaseFrancine Grodstein, ScD, JoAnn E. Manson, MD, and Meir J. Stampfer, MDFrancine Grodstein, ScDHarvard Medical School and Harvard School of Public Health; Boston, MA 02215Search for more papers by this author, JoAnn E. Manson, MDHarvard Medical School and Harvard School of Public Health; Boston, MA 02215Search for more papers by this author, and Meir J. Stampfer, MDHarvard Medical School and Harvard School of Public Health; Boston, MA 02215Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-12-200112180-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate Dr. Kessler's attempt to further clarify the complicated decisions relating to HRT in postmenopausal women. However, we would like to stress that all such attempts (including our own) must be interpreted with great caution. Calculations such as those presented by Dr. Kessler will vary substantially depending on the individual woman's risk factors and assume that the relative risks applied are perfectly accurate and valid. In particular, the relative risk associated with 0.3 mg of estrogen and stroke in the Nurses' Health Study is based on relatively few stroke cases and thus is unstable (that is, the ...

From evidence to practice: factors affecting the specialist breast nurse's detection of psychological morbidity in women with breast cancer.

Psychological morbidity is high for women with breast cancer and is often undetected and untreated. Encouragingly, there are well-evaluated strategies to help improve psychological outcomes, but the challenge remains as to how to transfer these to routine care settings. The National Health and Medical Research Council (NHMRC) National Breast Cancer Centre used evidence-based psychosocial clinical practice guidelines and breast cancer treatment guidelines to develop a comprehensive specialist breast nurse (SBN) model of care and conducted a feasibility study to observe its implementation in diverse clinical conditions. Seven SBNs at four Australian cancer treatment centres implemented the model of care to support 196 women with a new diagnosis of early or locally advanced breast cancer. The SBN role in detecting women's psychological difficulties is reported here. Two months after diagnosis, 36% of women had a likely psychological disorder on the General Health Questionnaire 12-item (GHQ12) version. The SBNs detected as many as 85% and as few as 20% of high GHQ12 scorers, depending upon a woman's psychosocial risk factors and consultation factors. Few women were referred to psychological services, suggesting other barriers to care. More specific communication skills training, psychological symptom screening questionnaires and better access to psychological services may help the implementation of the model of care.

The military environment: risk factors for women's non-fatal assaults.

Little is known regarding environmental exposures for non-fatal violence toward women in the workplace. We sought to identify factors associated with non-fatal physical assault occurring to women during military service. A cross-sectional telephone survey of a national sample of 558 women veterans who served in Vietnam and subsequent eras of military service was conducted; 537 women were interviewed. Twenty-three percent experienced non-fatal physical assault during military service. Rates of assault were consistent across eras of service. Military environmental exposures, including sexual harassment allowed by officers (P < 0.0001) and unwanted sexual advances while on duty (P < .0001) and in sleeping quarters (P < 0.0001), were independent risk factors for assault. Environmental factors in the military workplace, including leadership behavior, appeared to promote violence toward military women. Such occupational factors can be identified and should be eliminated.

Hispanic and Anglo college women's risk factors for substance use and eating disorders.

This study investigated the role of temperament style (Novelty Seeking and Harm Avoidance) of Hispanic American and Anglo college women in moderating and mediating the relationship between family addiction/family functioning and offspring problem behaviors. The sample was comprised of 67 Hispanic American and 770 Anglo undergraduate women. Findings of this study indicate that the processes of risk that lead to substance use and eating disorders follow different routes for Hispanic American and Anglo women. Novelty Seeking and Harm Avoidance were found to be important factors in both moderating and mediating the effects of parental drinking and family dysfunction for both Hispanic and Anglo college women.

Leisure-time physical activity and coronary risk factors in women.

Evidence that physical activity is cardioprotective in women is not as strong as that observed in men. Furthermore, the extent to which exercise protects against coronary heart disease via its influence on classical risk factors remains unclear. This study examines the relationship between reported physical activity, a range of coronary heart disease risk factors and a 10-year predicted coronary heart disease risk score. A cross-sectional study of 14,077 female employees aged 30-64 years who were screened between 1988 and 1991 was employed. Measurements included systolic and diastolic blood pressure, body mass index, serum total cholesterol, high-density lipoprotein cholesterol, total cholesterol:high-density lipoprotein cholesterol ratio, low-density lipoprotein cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein a and fasting blood glucose. Participants were divided into three groups according to reported average frequency of vigorous leisure-time physical activity, that is zero, one to two, or three or more episodes per week. Increasing activity frequency was associated with lower systolic and diastolic blood pressure, total cholesterol, total cholesterol:high-density lipoprotein cholesterol ratio, triglycerides and body mass index (all P < 0.001), low-density lipoprotein cholesterol (P = 0.003), apolipoprotein B (P = 0.04) and blood glucose (P = 0.01) and higher high-density lipoprotein cholesterol (P < 0.001) and apolipoprotein A1 (P = 0.03). There was no association with lipoprotein a. After controlling for possible confounders, these relationships remained statistically significant except for apolipoprotein B and glucose. The odds ratios for being in the top quintile of predicted 10-year coronary heart disease risk for individuals in each category of activity were 1.0 (inactive), 0.70 (one to two episodes of activity per week) and 0.77 (three or more episodes of activity per week). Women engaging in vigorous, leisure-time physical activity have a less atherogenic coronary heart disease risk factor profile than those who do not, which translates into a potential reduction of approximately 30% in coronary heart disease risk.

Congenital and acquired thrombotic risk factors in women using oral contraceptives: clinical aspects.

We describe the thrombophilic and clinical characteristics of a group of patients who suffered venous thrombosis (VT) (n = 36) and ischemic stroke (n = 8) while taking oral contraceptives (OC). Our purpose is to ascertain whether there are differences between users of second and third generation progestogen and to investigate the influence of concurrent congenital and acquired risk factors (other than OC) on the onset of the thrombosis. The group of patients included 36 women with VT and eight with ischemic stroke. The patients' recognized predisposing factors were recorded. We also considered age, length of time on OC, types of OC, rethrombosis, family history of VT, and the presence of thrombophilic genetic defects. In the group of patients with VT, 54% were treated with second generation OC (n = 23), and 30% (n = 11) were treated with third generation OC. We found no significant statistical differences with respect to age and length of time on OC between the two types of OC. The prevalence of genetic defects in these patients--factor V (FV) Leiden, prothrombin G20210A mutation and protein S deficiency--was 19% (n = 7), 17% (n = 6), and 8% (n = 3) respectively. We observed the shortest time lapse between initiating OC and the first thrombotic event in carriers of FV Leiden and in patients with combined defects, but the differences were not significant. In patients with ischemic stroke, 50% were treated with second generation OC and 50% were treated with third generation OC. Prothrombin G20210A mutation was detected in two patients. In both patients,the stroke occurred earlier than in the rest of the patients, but these differences were not statistically significant. With respect to preventing thrombotic events in these patients, our data suggest that OC therapy should be avoided in patients with a previous history of thrombosis and in patients with an evident thrombotic tendency in the family. In patients in whom the family history of thrombosis is not very evident, it would be recommended to screen for FV Leiden, prothrombin G20210A mutation, and protein S, and to rule out OC if the patient does in fact have one of these risk factors. Moreover, if a patient develops a thrombotic complication while taking OC, an evaluation to search for a thrombophilic defect is warranted, and at the same time, alternative methods of contraception should be considered.

Carpal tunnel syndrome: a nested case-control study of risk factors in women.

Risk factors for the development of carpal tunnel syndrome in women were studied by means of a nested case-control analysis of a prospective cohort study of the health effects of oral contraception in British women. A total of 1,264 women who had a diagnosis of carpal tunnel syndrome reported by their general practitioner between 1968 and 1993 were compared with 1,264 age-matched control women who did not have this diagnosis. The syndrome was associated in older women with some hormonal factors, notably past use of oral contraception (adjusted odds ratio in women aged 40 years and over = 1.38, 95 percent confidence interval: 1.08, 1.76) and more generally with obesity (adjusted odds ratio = 1.68, 95 percent confidence interval: 1.29, 2.18). However, the strongest link was with a previous history of another musculoskeletal complaint for which consultation had been sought (adjusted odds ratio = 1.98, 95 percent confidence interval: 1.61, 2.42). Previous findings of a higher risk in women with diabetes and myxoedema were confirmed, but these contribute only a small proportion of all cases in women. There was no link with psychologic problems or nonmusculoskeletal pain complaints. The previously described increased incidence of carpal tunnel syndrome in women may be partly due to hormonal factors, but is also related to an underlying propensity to musculoskeletal problems and their higher overall frequency in women.

Effects of Menopause and Estrogen Replacement Therapy or Hormone Replacement Therapy in Women With Diabetes Mellitus

Given that the prevalence of non-insulin-dependent diabetes mellitus (type 2 DM) is increasing in postmenopausal women and type 2 DM substantially increases the risk for cardiovascular events in postmenopausal women, a population that is at higher risk for coronary heart disease, The North American Menopause Society (NAMS) developed a consensus opinion on appropriate management strategies for postmenopausal women who have or who are at risk for developing type 2 DM.NAMS held a closed conference of experts in the field to evaluate the published clinical data on the effects of menopause, type 2 DM, and estrogen or hormone replacement therapy (ERT/HRT) in women, especially the effects on cardiovascular risk factors, and to discuss therapeutic options. The proceedings of the conference were used to assist the NAMS Board of Trustees in developing this consensus opinion.On the basis of the current knowledge, NAMS established consensus on the following issues: (1) Controlling cardiovascular risk factors through pharmacologic and nonpharmacologic means can significantly decrease the risk for developing cardiovascular events. (2) A broad-based recommendation for ERT/HRT cannot be made; rather, the benefits and risks must be weighed in the context of each woman's risk factors. (3) When ERT/HRT is recommended, the greatest benefits may be obtained from the use of transdermal estrogen preparations, low doses of oral estrogens, progesterone instead of progestin, and/or nonandrogen preparations, although more research is needed in this area. (4) Counseling can help maximize the patient's adherence to multiple medication regimens and increase her understanding of the potential benefits and risks of ERT/HRT.Controlling an individual woman's risk factors for cardiovascular events should be the focus of any management strategy for a postmenopausal woman who has or is at risk for developing type 2 DM.