Table 1B.

Continued

Lifestyle Factors (continued)Goal(s)ScreeningRecommendations
Psychosocial factors1. Positive adaptation to stressful situations. 2. Improved quality of life. 3. Maintain or establish social connections.1. Assess presence of stressful situations and response to stress as part of a routine evaluation. 2. Evaluate for depression, especially in women with recent cardiovascular events. 3. Assess social support system and evaluate for social isolation.1. Encourage positive coping mechanisms for stress (eg, substitute physical activity for overeating or excessive smoking in response to stress). 2. Encourage adequate rest and relief for women who are caretakers of others. 3. Consider treatment of depression and anxiety when appropriate. 4. Encourage participation in social activities or volunteer work for socially isolated women.
Risk FactorsGoalsScreeningRecommendations
Blood pressure1. Achieve and maintain blood pressure <140/90 mm Hg and lower if tolerated (optimal <120/80). 2. In pregnant women with hypertension, the goal of treatment is to minimize short-term risk of elevated blood pressure in the mother while avoiding therapy that may compromise the well-being of the fetus.1. Measure blood pressure as part of a routine evaluation. 2. Follow-up is based on initial measurement as follows: SBP, DBP, mm Hg mm Hg Follow-up <130 <85 Recheck in 2 y 130–139 85–89 Recheck in 1 y 140–159 90–99 Confirm in 2 mo 160–179 100–109 Evaluate in 1 mo ≥180 ≥110 Evaluate in 1 wk (Follow-up screening may be modified on the basis of prior history, symptoms, presence of other risk factors, and end organ damage.) 3. In pregnant women with hypertension, evaluate for preeclampsia.1. Promote the lifestyle behaviors described above (weight control, physical activity, moderation in alcohol intake) and moderate sodium restriction. 2. If blood pressure remains ≥140/90 mm Hg after 3 months of lifestyle modification or if initial level is >160 mm Hg systolic or 100 mm Hg diastolic, then initiate and individualize pharmacotherapy based on the patient’s characteristics. 3. In pregnant women with hypertension, reduction of diastolic blood pressure to 90–100 mm Hg is recommended.
Lipids, lipoproteinsPrimary goal: Women without CVD Lower risk (<2 risk factors) LDL goal <160 mg/dL (optimal <130 mg/dL) Higher risk (≥2 risk factors) LDL goal <130 mg/dL Women with CVD LDL ≤100 mg/dL Secondary goals: HDL >35 mg/dL Triglycerides <200 mg/dL Note: In women, the optimal level of triglycerides may be lower (≤150 mg/dL) and the HDL higher (≥45 mg/dL).Women without CVD† Measure nonfasting total and HDL cholesterol and assess nonlipid risk factors. Follow-up is based on the following initial measurements: TC <200, HDL ≥45, follow-up in 5 years; TC <200, HDL <45, follow-up with fasting lipoprotein analysis. TC 200–239, HDL ≥45, and <2 risk factors, follow-up in 1–2 years. TC 200–239, HDL <45 or ≥2 risk factors, follow-up with fasting lipoprotein analysis. TC ≥240, follow-up with fasting lipoprotein analysis. (All cholesterol values in mg/dL.) Women with CVD Fasting lipoprotein analysis (may take 4–6 wk to stabilize after cardiovascular event or bypass surgery).1. Promote lifestyle approach in all women (diet, weight management, smoking avoidance, and exercise as described above). Rule out other secondary causes of dyslipidemia. 2. Suggested drug therapy for high LDL levels (defined as [a] ≥220 mg/dL in low-risk, premenopausal women, [b] ≥190 mg/dL in postmenopausal women with <2 risk factors, and [c] ≥160 mg/dL with ≥2 risk factors) is based on triglyceride level as follows: TG <200 mg/dL Statin, Resin, Niacin Note: ERT is an option for postmenopausal women, but treatment should be individualized and considered with other health risks. TG 200–400 mg/dL Statin, Niacin TG >400 mg/dL Consider monotherapy with statin, niacin, fibrate, or a combination of the above.
DiabetesFor patients with diabetes: 1. Maintain blood glucose: preprandial=80–120 mg/dL bedtime=100–140 mg/dL. 2. Maintain Hb A1c <7%. 3. LDL <130 mg/dL (<100 mg/dL if established CVD). Note: Many authorities believe that LDL should be <100 mg/dL in all patients with diabetes. 4. Triglycerides <150 mg/dL. 5. Control blood pressure.1. Monitor glucose and hemoglobin A1c as part of a routine periodic evaluation in women with diabetes. 2. Screen for diabetes (fasting glucose >125 mg/dL or >200 mg/dL 2 h after 75 g glucose) as part of a periodic examination in women with risk factors for diabetes, such as obesity.1. Encourage adoption of American Diabetes Association Diet (<30% fat, <10% saturated fat, 6–8% polyunsatured fat, cholesterol <300 mg/d). 2. A low-calorie diet may be recommended for weight loss. 3. Encourage regular physical activity. 4. Pharmacotherapy with oral agents or insulin should be used when indicated.