Risk factor treatment in veteran women at risk for cardiovascular disease

Debra L Canter, Marvin D Atkins, Catherine J McNeal, Ruth L Bush
Journal of Surgical Research 2009, 157 (2): 175-80

OBJECTIVES: Cardiovascular disease (CVD) is the leading cause of death in women. Aggressive management of atherosclerotic risk factors can prevent or delay the onset of CVD. Treatment of modifiable risk factors provides an important opportunity to reduce the burden of CVD in women and decrease future adverse event rates. The aims of this study were to assess current treatment of atherosclerotic risk factors in women found to be at moderate or high-risk for CVD and to examine levels of CVD knowledge and awareness among women found to be at moderate or high-risk for CVD METHODS: In a cross-sectional study, we screened ambulatory female veterans aged 40 to 85 y for the prevalence of peripheral vascular disease (PVD) and associated atherosclerotic risk factors, and administered a survey to assess the participants' knowledge and awareness of CVD, risk factors, and consequences. Medical records, pharmacy data, and clinician encounter notes were reviewed for documented evidence of CVD risk factors, comorbidities, and corresponding treatment. From a total cohort of 162 women, 108 (66.7%) were categorized as having an increased risk of cardiovascular disease based on a modification of the Framingham cardiovascular risk score, which took into account the presence of carotid intimal-medial thickness (cIMT) > 1.0 mm or ankle-brachial index <or= 0.9, as determined by a voluntary, one time, noninvasive screening.

RESULTS: In no category of CVD risk factor were 100% of the women receiving adequate medical or behavioral management. Especially surprising to us were the low levels of treatment for women with heart disease, smoking, and previous history of peripheral artery disease (PAD). Over half of the women who were postmenopausal or who have had hysterectomy at the time of this study continued to use hormone replacement therapy (HRT) despite warnings about its role in coronary artery disease (CAD), stroke, and PAD. One-third of moderate- to high-risk women had evidence of increased cIMT, which is a known surrogate marker of subclinical heart disease. Knowledge and awareness scores were low, regardless of risk factor level and respectable levels of education.

CONCLUSIONS: Our findings show a high prevalence of CVD risk factors and low knowledge levels among ambulatory veteran women. There is a need for improvement in recognition and aggressive management of CVD risk factors, including the use of noninvasive studies as surrogate markers for early diagnosis. Continued efforts to educate women and providers about CVD risk factors, heart-healthy behaviors, screening, and treatment are vital to improve the current state of women's health and decrease future adverse cardiac event rates.

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