Treatment Of Cardiovascular Disease Risk Factors Research Articles

The impact of the COVID-19 pandemic on cardiovascular disease prevention and management.

How the Coronavirus Disease 2019 (COVID-19) pandemic has affected prevention and management of cardiovascular disease (CVD) is not fully understood. In this study, we used medication data as a proxy for CVD management using routinely collected, de-identified, individual-level data comprising 1.32 billion records of community-dispensed CVD medications from England, Scotland and Wales between April 2018 and July 2021. Here we describe monthly counts of prevalent and incident medications dispensed, as well as percentage changes compared to the previous year, for several CVD-related indications, focusing on hypertension, hypercholesterolemia and diabetes. We observed a decline in the dispensing of antihypertensive medications between March 2020 and July 2021, with 491,306 fewer individuals initiating treatment than expected. This decline was predicted to result in 13,662 additional CVD events, including 2,281 cases of myocardial infarction and 3,474 cases of stroke, should individuals remain untreated over their lifecourse. Incident use of lipid-lowering medications decreased by 16,744 patients per month during the first half of 2021 as compared to 2019. By contrast, incident use of medications to treat type 2 diabetes mellitus, other than insulin, increased by approximately 623 patients per month for the same time period. In light of these results, methods to identify and treat individuals who have missed treatment for CVD risk factors and remain undiagnosed are urgently required to avoid large numbers of excess future CVD events, an indirect impact of the COVID-19 pandemic.

How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology.

A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.

Novel Nutritional and Dietary Approaches to Weight Loss for the Prevention of Cardiovascular Disease: Ketogenic Diet, Intermittent Fasting, and Bariatric Surgery.

Cardiovascular disease (CVD) is highly associated with obesity and cardiometabolic dysfunction. This review will focus on three novel therapies that have been identified for potential treatment of obesity and its associated CVD risk factors. Intermittent fasting (IF) studies in animal models have shown improvements in cardiometabolic factors, including improved glucose metabolism, reduced inflammation, and reduced blood pressure. However, there is still a lack of prospective human trials to support results from animal-based studies and observational data. Studies of ketogenic diets in humans have produced mixed effects in CVD risk factors. It has been shown that the ketogenic diet (KD) increases low-density lipoprotein cholesterol (LDL-C) but decreases triglycerides. Additionally, implementation of KD in rodent studies have demonstrated increased insulin resistance and glucose intolerance. Bariatric surgery is a useful tool to help patients with obesity lose significant amounts of weight while alleviating CVD risk factors such as hypertension, LDL-C levels, triglyceride levels, and diabetes. The type of procedure influences degree of improvement in weight and CVD risk factors, yet complications remain possible. IF and bariatric surgery offer potential for weight loss and treatment of CVD risk factors. Negative cardiovascular effects of KD have been noted and should be considered before recommending this diet to patients, particularly those with established cardiovascular disease.

Triggers of Cardiovascular Diseases in Rheumatoid Arthritis.

The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is higher than that in patients without RA, and it is even higher than that in patients with diabetes. Autoimmune-mediated inflammation is observed in patients with RA, resulting in endothelial dysfunction, oxidative stress and activation, and vascular migration of white blood cells. Traditionally, RA-associated CVD was assumed to be mediated by disease-related inflammation, resulting in atherosclerosis (AS). However, this concept has been challenged because treatment with anti-rheumatic drugs, such as methotrexate or proinflammatory cytokine antagonists, such as tumor necrosis factor-alpha (TNF-α) inhibitors, did not reduce the risk of CVD in patients with RA. Current cardiovascular guidelines recommend screening and treatment of CVD risk factors in patients with RA but without clear biomarkers and treatment goals. There is no scientific basis for establishing therapeutic targets for cardiovascular risk factors in RA. Numerous studies have shown that the mechanism of early cardiac dysfunction in patients with RA may occur prior to AS. Therefore, it is crucial to explore the related mechanisms to prevent early cardiac dysfunction in patients with RA.

Increased knowledge makes a difference! – general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial

Objectives To explore how pictorial information on subclinical atherosclerosis affects GPs’ perception of patient cardiovascular disease (CVD) risk, their communication with patients, and GPs’ attitude to the treatment of CVD risk factors. Design, setting and subjects Fifteen individual interviews were conducted between March 2014 and December 2016, with GPs who had received pictorial information regarding their patients’ subclinical atherosclerosis. The pictorial information was also received by the patients together with written information regarding atherosclerosis and CVD risk prior to the appointment with their GP. The interviews were recorded, transcribed and analyzed using qualitative content analysis. Results Three categories were identified in the analysis. Increased knowledge makes a difference: When patients had more in-depth knowledge regarding atherosclerosis, the consultation became more patient-centered and moved towards shared decision making. This is real, not just a number: GPs described their risk assessment and the patient’s risk perception as more accurate with pictorial information about subclinical atherosclerosis. How to deal with the result – A passive to active approach: Some GPs acted promptly on the pictorial information while others took no action. Conclusion and implications Pictorial information regarding patients’ subclinical atherosclerosis affected GPs’ assessment of CVD risk. The communication shifted towards shared decision-making although the GPs’ attitude to the result and treatment of CVD risk factors varied. Informing patients about examination results, both in writing and pictures, prior to a consultation can facilitate shared decision making and enhance preventive measures. Trial registration https://clinicaltrials.gov/ct2/show/NCT01849575. KEY POINTS Providing pictorial information about carotid ultrasound results and information regarding atherosclerosis to GPs and patients affects primary prevention: •Informing patients about examination results prior to a consultation can be useful in clinical practice to enhance preventive measures •GPs experienced that increased patient knowledge resulted in a more patient-centered consultation and improved shared decision-making •GPs described their risk assessment and patients’ risk perception as more accurate with pictorial information about subclinical atherosclerosis

Nonalcoholic Fatty Liver Disease and Cardiovascular Disease.

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B-33 Highlighted Symposium - Exercise and Medications in the Treatment of CVD Risk Factors Wednesday, May 27, 2020, 3: 15 PM - 5: 15 PM Room: CC-3012 Medications are widely used to manage cardiovascular disease (CVD) risk factors in conjunction with lifestyle recommendations. However, the clinical relevance of combining medications with exercise on the prevention and treatment of CVD risk factors is largely untested. This symposium will highlight potential interactions of exercise and common med

Exercise and Metformin: Effect on Adaptations Related to Aging and Type 2 Diabetes

B-33 Highlighted Symposium - Exercise and Medications in the Treatment of CVD Risk Factors Wednesday, May 27, 2020, 3: 15 PM - 5: 15 PM Room: CC-3012 Medications are widely used to manage cardiovascular disease (CVD) risk factors in conjunction with lifestyle recommendations. However, the clinical relevance of combining medications with exercise on the prevention and treatment of CVD risk factors is largely untested. This symposium will highlight potential interactions of exercise and common med

Exercise and Antihypertensive Medications: Are their Blood Pressure Effects Equal to the Sum of their Parts?

B-33 Highlighted Symposium - Exercise and Medications in the Treatment of CVD Risk Factors Wednesday, May 27, 2020, 3: 15 PM - 5: 15 PM Room: CC-3012 Medications are widely used to manage cardiovascular disease (CVD) risk factors in conjunction with lifestyle recommendations. However, the clinical relevance of combining medications with exercise on the prevention and treatment of CVD risk factors is largely untested. This symposium will highlight potential interactions of exercise and common med

Abstract P471: Citizenship Status and the Prevalence, Treatment, and Control of Cardiovascular Disease Risk Factors Among Immigrants in United States, 2011-2016

Introduction: Immigrants without US citizenship, i.e., noncitizens, encounter barriers in accessing care which may contribute to disparities in cardiovascular disease (CVD), the leading cause of death among immigrants in the US. Despite this, little is known about whether the prevalence, treatment, and control of CVD risk factors differ by citizenship status This study estimates the prevalence, treatment, and control of CVD risk factors (hypercholesterolemia, hypertension, and diabetes) among US immigrants by citizenship status. Methods: We used nationally representative, cross-sectional data from the National Health and Nutrition Examination Survey (2011/12 to 2015/16), restricted to 5,306 immigrant adults (≥20 years). Citizenship status (exposure) was categorized as either citizen or noncitizen. CVD risk factor prevalence (age-standardized), treatment, and control were defined per national guidelines and determined using examinations and prescription-medication inventories. Treatment was estimated among persons with relevant conditions and control was estimated among persons who were receiving treatment. Associations were evaluated using Poisson regressions (prevalence ratios, PR). Results: Hypercholesterolemia (42.0%), hypertension (29.0%), and diabetes (15.7%) were common among immigrants and marginal differences were observed between citizens and noncitizens. However, noncitizens were less likely to be treated for hypercholesterolemia (16.4% vs. 43.3%, PR 0.38 [CI 0.31-0.46], P <0.001), hypertension (60.3% vs. 79.6%, PR 0.76 [CI 0.70-0.84], P <0.001), and diabetes (51.2% vs. 66.6%, PR 0.77 [CI 0.66-0.90], P <0.001) than citizens. Because noncitizens disproportionally lack a usual source of care (30.2% vs. 16.6%, P <0.001) and health insurance (48.8% vs. 19.1%, P <0.001), adjusting for access to care largely explained differences in the treatment of CVD risk factors. Among those treated for CVD risk factors, citizens and noncitizens achieved similar control of hypercholesterolemia (36.2%) and hypertension (67.5%), but disparities in diabetes control were observed (35.3% vs. 46.9% , P =0.04). Conclusions: While CVD risk factors were common in citizens and noncitizens, treatment rates were significantly lower among noncitizens due to poor access to care. Efforts to prevent CVD morbidity and mortality among immigrants should address the undertreatment of risk factors by ensuring access to care among immigrants, regardless of citizenship status.

Outreach to Promote Management of Cardiovascular Risk in Primary Care Among Patients With Rheumatoid Arthritis Seen in Rheumatology Practice.

ObjectiveRheumatoid arthritis (RA) confers a 1.5‐ to 2.0‐fold increased risk of cardiovascular disease (CVD). A prior multifaceted quality improvement approach to improving CVD preventive care increased CVD risk factor assessments, but there was no significant effect on the management of risk factors. We tested the impact of adding a proactive outreach strategy promoting primary care treatment of CVD risk factors among patients with RA through their rheumatology practice.MethodsThrough electronic health record searches, we identified patients with RA who were potential candidates for hypertension treatment initiation or intensification, statin therapy, or a smoking‐cessation intervention. A nonclinician care manager contacted patients by phone and mail on behalf of the rheumatologists, provided information about the identified risk factor(s), recommend follow‐up with primary care physicians (PCPs), sent correspondence to PCPs, and followed up with patients to see what actions had been taken. We measured preventive cardiology quality indicators and compared preintervention and intervention time periods using interrupted time series methods.ResultsDuring the 6‐month intervention period, the proportion of patients prescribed at least moderate‐intensity statin treatment for primary prevention rose from 18.4% to 23.8%. The rate of increase was 1.06% greater per month than during the preceding period (P < 0.001). Rates of increase in hypertension diagnosis and control improved more rapidly during this phase (P < 0.001 for each) and reversed preceding negative trends.ConclusionImplementing proactive nonclinician outreach to encourage primary care–based treatment of CVD risk factors was associated with increases in statin prescribing and in hypertension diagnosis and control. Smoking was not affected.

Cardiaovascular Disease Risk Factors in Thai Natural Menopause with First-Time Diagnosis of Low Bone Mass Density

Objective: To evaluate the prevalence of initial cardiovascular disease (CVD) risk factors in naturally postmenopausal Thai women with first-time diagnosis of low bone mass density (BMD), and compare with those reported among general Thai women of the same age range during the same studied time. Methods: A retrospective cross-sectional study of initial CVD risk factors of 473 naturally postmenopausal Thai women (45-60 years) with the first-time diagnosis of osteopenia or osteoporosis without previous treatment for CVD risk factors, except for hypertension(HT) and diabetes mellitus(DM), was performed. Only subjects with all available initial CVD risk factors were recruited. Data included age, weight, height, waist circumference(WC), and underlying diseases. Extracted initial CVD risk factors were: HT, DM, body mass index(BMI), cholesterol level, triglyceride, high density lipoprotein, and family history of CVD. The main outcome was prevalence of initial CVD risk factors with 95%CI. Results were compared with data of previous Thai reports in women of the same age during the same time period. Results: All subjects (86.3% osteopenic, 13.7% osteoporotic) had on average 3.6 years since menopause. Prevalence of women with initial CVD risk factors was 73.8%. The three most common risk factors were high BMI (48.6%), high WC (37.8%) and high cholesterol (22.2%). Only high BMI was more prevalent than previously reported. In contrast, the other factors were lower than previously published data. Conclusion: With the exception of high BMI, initial CVD risk factors in this study were comparable to or lower than those reported in general Thai women of the same age during the same time period.

Cardiovascular risk factors among ART-experienced people with HIV in South Africa.

IntroductionPeople with HIV (PWH) are at increased risk for atherosclerotic cardiovascular disease (CVD). Screening for CVD risk factors is recommended but not routine in South African HIV clinics. We sought to describe the prevalence of CVD risk factors among antiretroviral treatment (ART)‐experienced patients in South Africa.MethodsWe performed a prospective, observational cross‐sectional study of PWH (>21 years, excluding pregnant women) on ART in South Africa. We interviewed patients regarding CVD risk factors, and obtained two blood pressure (BP) measurements and random/fasting glucose via a point‐of‐care glucometer. Standardized chart reviews provided individuals' HIV‐specific data. We defined hypertension as: self‐reported use of antihypertensives or mean systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg (Stage 1) or SBP ≥160 mmHg or DBP ≥100 mmHg (Stage 2). We defined diabetes as self‐reported use of insulin/oral hypoglycaemics or fasting (random) glucose ≥7.0 (≥11.1) mmol. We obtained risk ratios (RR) for hypertension from a multivariable log‐binomial regression model, adjusting for age, sex and diabetes.ResultsFrom March 2015 to February 2016, 458 participants enrolled with median age 38 years (interquartile range (IQR) 33 to 44 years) and median CD4 466/μL (IQR 317 to 638/μL); 78% were women. Participants were on ART for a median of four years, with 33% on ART ≥6 years. Almost a quarter (106/458) met the study definition for hypertension, of whom 45/106 (42%) were previously diagnosed, 23/45 (51%) were on medication and 4/23 (17%) were controlled. Eight participants had asymptomatic hypertensive urgency (BP≥180/110 mmHg). Of the 458 participants, 26 (6%) met the study definition for diabetes, half of whom (13/26) were already diagnosed; 11/13 (85%) were on treatment, of whom 4/11 (36%) had normal glucose. Age was the only significant predictor of hypertension (RR, 1.04; 95% CI, 1.03 to 1.06, p < 0.0001) in the multivariable model.ConclusionsHypertension and diabetes were prevalent among PWH prescribed ART in South Africa with less than half diagnosed, and still fewer treated and controlled. Hypertension was independently associated with age but not with HIV‐specific factors. Screening for and treatment of CVD risk factors could decrease future morbidity and mortality, especially as this population ages.

Cardiovascular Protection in People With Diabetes.

Cardiovascular Protection in People With Diabetes.

Heart Score Estimation by Specialized Nurses in a Greek Urban Population.

Specialized nurses estimated the HeartScore in an urban Greek population by recognizing cardiovascular disease (CVD) risk factors in the setting of the Onassis Cardiovascular Prevention Program (OCPP). They also provided nursing consultation and assessed the clinical and biochemical characteristics of the studied population. Individuals were recruited through TV announcements and via the website of the Onassis Cardiac Surgery Centre. All participants visited the Onassis Cardiac Centre from 20 September to 30 October 2011. Overall, 2,145 individuals were included in the study. CVD risk was calculated by the HeartScore and serum total cholesterol was measured (mean: 193±43 mg/dl). Although 33% of the participants reported dyslipidaemia, only 17% were on hypolipidaemic treatment. Hypertension and dyslipidaemia frequency increased with age. In the present study, specialized nurses estimated the HeartScore in a Greek urban population. The majority of the studied population was undiagnosed and untreated. These results highlight the necessity for both primary and secondary prevention programs that can be carried out by specialized nurses. Such programs may improve the diagnosis and treatment of CVD risk factors; early initiation and optimization of therapy as well as management of drug intolerance (e.g. statins) can contribute to CVD risk reduction.

HeartScore estimation by specialized nurses in a Greek urban population

Aims Specialized nurses estimated the HeartScore in an urban Greek population by recognizing cardiovascular disease (CVD) risk factors in the setting of the Onassis Cardiovascular Prevention Program. They also provided nursing consultation and assessed the clinical and biochemical characteristics of the studied population. Methods and results Individuals were recruited through TV announcements and via the website of the Onassis Cardiac Surgery Centre. Overall, 2145 individuals were included in the study. CVD risk was calculated by the HeartScore and serum total cholesterol was measured (mean: 193 ± 43 mg/dL). Although 33% of the participants reported dyslipidaemia, only 17% were on hypolipidaemic treatment. Hypertension and dyslipidaemia frequency increased with age. Conclusions In the present study, specialized nurses estimated the HeartScore in a Greek urban population. The majority of the studied population was undiagnosed and untreated. These results highlight the necessity for both primary and secondary prevention programs that can be carried out by specialized nurses. Such programs may improve the diagnosis and treatment of CVD risk factors; early initiation and optimization of therapy as well as management of drug intolerance (e.g. statins) can contribute to CVD risk reduction.

Cardiovascular risk management after reproductive and pregnancy-related disorders: A Dutch multidisciplinary evidence-based guideline.

In the past decades evidence has accumulated that women with reproductive and pregnancy-related disorders are at increased risk of developing cardiovascular disease (CVD) in the future. Up to now there is no standardised follow-up of these women becausee guidelines on cardiovascular risk management for this group are lacking. However, early identification of high-risk populations followed by prevention and treatment of CVD risk factors has the potential to reduce CVD incidence. Therefore, the Dutch Society of Obstetrics and Gynaecology initiated a multidisciplinary working group to develop a guideline for cardiovascular risk management after reproductive and pregnancy-related disorders. The guideline addresses the cardiovascular risk consequences of gestational hypertension, preeclampsia, preterm delivery, small-for-gestational-age infant, recurrent miscarriage, polycystic ovary syndrome and premature ovarian insufficiency. The best available evidence on these topics was captured by systematic review. Recommendations for clinical practice were formulated based on the evidence and consensus of expert opinion. The Dutch societies of gynaecologists, cardiologists, vascular internists, radiologists and general practitioners reviewed the guideline to ensure support for implementation in clinical practice. For all reproductive and pregnancy-related disorders a moderate increased relative risk was found for overall CVD, except for preeclampsia (relative risk 2.15, 95% confidence interval 1.76-2.61). Based on the current available evidence, follow-up is only recommended for women with a history of preeclampsia. For all reproductive and pregnancy-related disorders optimisation of modifiable cardiovascular risk factors is recommended to reduce the risk of future CVD.

A prospective multicentre study on the treatment of cardiovascular risk factors and claudication symptoms in patients with peripheral artery disease (the IDOMENEO study).

The objective of this prospective multicenter cohort study was to characterise the use of pharmacological and non-pharmacological treatment for cardiovascular disease (CVD) risk factors and intermittent claudication (IC) symptoms in clinical practice patients with peripheral artery disease (PAD), and to determine the care gap with international guidelines and evidence-based therapy. From 2011 through 2013, participating centres enrolled consecutive patients with PAD of atherosclerotic, origin demonstrated by ultrasound, ankle brachial index (ABI) < 0.9 and symptoms of IC. A seven item grid was built for the assessment of care gap (percentage of patients eligible for a treatment who did not receive it). cerebrovascular disease or at least two CVD risk factors. Care gap was lower than 25 % for any method to stop smoking, lipid lowering agents, antiplatelet and/or anticoagulation therapy and any kind of exercise program; between 25% and 50% for ACE inhibitors/ angiotensin II antagonist therapy; between 50% and 75% for beta-blocker therapy; and higher than 75% for supervised exercise program and use of cilostazol. Patients with and without CADI cerebrovascular disease were differently treated with clopidogrel (27.3% and 4.8 %, p < 0.001), any antiplatelet/anticoagulant therapy (98.7% and 83.3 %, p <0.001) and beta-blockers (46.8% and 16.0%, p<0.001). All patients (232) presented at least one CVC risk factor, 90.2% at least two, and 91.5% had either established CAD or Many gaps with evidence-based recommendations are still present in the pattern of the use of pharmacological and non-pharmacological treatment for CVD risk factors and IC symptoms in clinical practice PAD patients.

Adherence to cardiovascular prevention strategies in patients with rheumatoid arthritis

Objectives: Patients with rheumatoid arthritis (RA) have a high risk of cardiovascular disease (CVD). Recent national and international guidelines suggest strict treatment of CVD risk factors in RA. The aim of this study was to evaluate the self-reported adherence to CV prevention strategies in patients with RA.Method: RA patients visiting an outpatient clinic for strict CVD risk management received a validated questionnaire to evaluate adherence to CV prevention strategies. Strict treatment targets were defined and lifestyle recommendations were given following a prespecified protocol. CVD risk was assessed using the SCORE algorithm.Results: In total, 111 questionnaires were returned (response rate of 82%). A high 10-year CVD risk (≥ 20%) was present in 53%, but only 3% thought they had an increased CVD risk. A total of 53% of patients reported that they ‘follow the doctors’ suggestions exactly’ and 75% reported finding it ‘easy to follow the suggestions’. Of the 69% of patients who were prescribed lipid- and/or blood pressure-lowering drugs, 90% reported taking all prescribed tablets. The advice to follow a diet was given to 42%, of whom 68% said they followed the advised diet. Physical exercise was advised to 67%, of whom 62% said they performed specific physical exercise on at least 3 days a week. The adherence to lifestyle recommendations was not significantly different across the CVD risk groups.Conclusions: RA patients tend to underestimate their CVD risk. The self-reported adherence of RA patients to CVD risk management was high concerning pharmaceutical interventions and moderate in the case of lifestyle interventions.

O119. Cardiovascular risk management after reproductive and pregnancy related disorders: A Dutch multidisciplinary evidence-based guideline

Introduction In the past decades evidence has accumulated that women with reproductive and pregnancy related disorders are at increased risk of developing cardiovascular disease (CVD) in the future. Up to now there is no standardized follow-up of these women since guidelines on cardiovascular risk management for this group are lacking. However, early identification of high-risk populations followed by prevention and treatment of CVD risk factors has the potential to reduce CVD incidence. Objective The Dutch Society of Obstetrics and Gynaecology initiated a multidisciplinary working group (gynecologists, cardiologist, vascular internist, radiologist, general practitioner, epidemiologist and representatives of patient associations) to develop a guideline for cardiovascular risk management after reproductive and pregnancy related disorders. Methods The guideline was developed using the “Appraisal of Guidelines for Research and Evaluation” instrument. The guideline addresses the cardiovascular risk consequences of gestational hypertension, preeclampsia, preterm delivery, small-for-gestational-age infant, recurrent miscarriage, polycystic ovary syndrome and premature ovarian insufficiency. The best available evidence on these topics was gathered by systematic review and the relation between the reproductive or pregnancy related disorders and CVD risk and risk factors was assessed by meta-analysis. Recommendations for clinical practice were formulated based on the number and quality of the studies and presence or absence of a relative risk > 2 of developing CVD events and/or risk factors from the meta-analysis. The Dutch societies of gynaecologists, cardiologists, vascular internists, radiologists, and general practitioners endorsed the guideline to ensure support for implementation in clinical practice. Results For all reproductive and pregnancy related disorders only a moderate increased relative risk ( 2) was found for overall CVD, except for preeclampsia (relative risk 2.15, 95% CI 1.76–2.61). Based on the current available evidence, follow-up is only recommended for women with a history of preeclampsia. A cardiovascular risk profile should be offered at the age of 50 years. Assessment of CVD risk and treatment of cardiovascular risk factors should be performed according to the Dutch guideline for cardiovascular risk management. For all reproductive and pregnancy related disorders optimization of modifiable cardiovascular risk factors is recommended to reduce the risk of future CVD. Conclusion In this guideline we present the recommendations for cardiovascular risk management after reproductive and pregnancy related disorders. To the best of our knowledge we are the first to make such recommendations in a national guideline.