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The annual "well-woman visit" to the primary care provider should include an assessment of heart disease risk, according to the American Heart Association (AHA) and American College of Obstetricians and Gynecologists (ACOG).

In addition to stressing the importance of healthy behaviors, clinicians need to perform enhanced screening for cardiovascular disease and associated risk factors, such as obtaining a full patient history through pre-examination questionnaires, reported Haywood L. Brown, MD, immediate past president of ACOG, and colleagues in .

The AHA/ACOG presidential advisory highlighted that the population-adjusted cardiovascular mortality risk is greater among women (20.9% versus 14.9% in men). Further, recommended screenings should focus on:

• Diabetes -- carries a greater cardiovascular risk for women (19.1% versus 10.1% in men)
• Hyperlipidemia -- counseling is recommended for women with elevated lipids
• Hypertension -- more women over 65 have hypertension than men, yet fewer of these women get adequate blood pressure management (29% versus 41%)
• Weight, physical activity -- obese women have a higher risk of coronary artery disease (64% versus 46% in men)

With changes in workforce trends, the authors noted the importance of having a variety of clinicians be aware of sex-specific risks for cardiovascular disease.

"Ob/gyns are primary care providers for many women, and the annual 'well-woman' visit provides a powerful opportunity to counsel patients about achieving and maintaining a heart-healthy lifestyle, which is a cornerstone of maintaining heart health," said John Warner, MD, president of AHA, in a statement.

In addition, sex-specific risk factors for pregnant women may be related to pregnancy, the authors noted -- with pregnancy complications such as pre-eclampsia, gestational diabetes, and gestational hypertension potentially linked to increased cardiovascular risk later in life.

The authors further suggested a "well-woman cardiovascular visit."

The American College of Cardiology (ACC)/AHA guidelines recommend that adults without cardiovascular disease be screened for risk factors, such as smoking, hypertension, diabetes mellitus, total cholesterol, and high-density lipoprotein cholesterol every 4 to 6 years from ages 20 to 79 to calculate their 10-year cardiovascular risk.

Recommended screenings at these well-woman visits can include:

• The U.S. Preventive Services Task Force (USPSTF) recommendation to screen for abnormal blood glucose in adults ages 40 to 70 who are overweight or obese
• The American Diabetes Association recommendation to screen those with family history of diabetes or established cardiovascular disease
• USPSTF recommendations that adults age ≥40 and those at risk for high blood pressure be screened annually
• ACOG supporting 20 to 30 minutes of moderate-intensity exercise for "most days" of the week during pregnancy

The AHA also offers other specific recommendations for screening patients for cardiovascular risk factors, including:

• Blood pressure screened during regular healthcare visits at least once every 2 years
• ACC/AHA lifestyle guidelines concerning physical activity
• Following the as part of the AHA's 2020 Impact Goal

The authors also highlighted the new ACC/AHA 2017 blood pressure guidelines, noting that contraceptives such as low-dose estrogen, intrauterine devices or barrier methods are recommended in women with established hypertension. Notably, they said that the postpartum follow-up visit may also be considered an opportunity to focus on lifestyle choices and optimal cardiac health.

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