Table 1C.

Continued

Pharmacological InterventionsGoal(s)ScreeningRecommendations
Hormone replacement therapy1. Initiation or continuation of therapy in women for whom the potential benefits may exceed the potential risks of therapy. (Short-term therapy is indicated for treatment of menopausal symptoms.)1. Review menstrual status of women >40 y old. 2. If menopausal status is unclear, measure FSH level.1. Counsel all women about the potential benefits and risks of HRT, beginning at age 40 or as requested. 2. Individualize decision based on prior history and risk factors for CVD as well as risks of thromboembolic disease, gallbladder disease, osteoporosis, breast cancer, and other health risks.
2. Minimize risk of adverse side effects through careful patient selection and appropriate choice of therapy.3. Combination therapy with a progestin is usually indicated to prevent endometrial hyperplasia in a woman with an intact uterus and prescribed estrogen. The choice of agent should be made on an individual basis.
Oral contraceptives1. Minimize risk of adverse cardiovascular effects while preventing pregnancy. 2. Use the lowest effective dose of estrogen/progestin.Determine contraindications and cardiovascular risk factor status of women who are considering using oral contraceptives.1. Use of oral contraceptives is relatively contraindicated in women ≥35 y old who smoke. 2. Women with a family history of premature heart disease should have lipid analysis before taking oral contraceptives. 3. Women with significant risk factors for diabetes should have glucose testing before taking oral contraceptives. 4. If a woman develops hypertension while using oral contraceptives, she should be advised to stop taking them.
Antiplatelet agents/anticoagulantsPrevention of clinical thrombotic and embolic events in women with established CVD.1. Determine if contraindications to therapy exist at the time of the initial cardiovascular event. 2. Evaluate ongoing compliance, risk, and side effects as part of a routine follow-up evaluation.1. If no contraindications, women with atherosclerotic CVD should use aspirin 80–325 mg/d. 2. Other antiplatelet agents, such as newer thiopyridine derivatives, may be used to prevent vascular events in women who cannot take aspirin.
β-blockersTo reduce the reinfarction rate, incidence of sudden death, and overall mortality in women after MI.1. Determine if contraindications to therapy exist at the time of the initial cardiovascular event. 2. Evaluate ongoing compliance, risk, and side effects as part of a routine follow-up evaluation.Start within hours of hospitalization in women with an evolving MI without contraindications. If not started acutely, treatment should begin within a few days of the event and continue indefinitely.
ACE inhibitorsTo reduce morbidity and mortality among MI survivors and patients with LV dysfunction.1. Determine if contraindications to therapy exist at the time of the initial cardiovascular event. 2. Evaluate ongoing compliance, risk, and side effects as part of a routine follow-up evaluation.1. Start early during hospitalization for MI unless hypotension or other contraindications exist. Continue indefinitely for all with LV dysfunction (ejection fraction ≤40%) or symptoms of congestive heart failure; otherwise, ACE inhibitors may be stopped at 6 wk. 2. Discontinue ACE inhibitors if a woman becomes pregnant.
  • CVD indicates cardiovascular disease; BMI, body mass index; SBP, systolic blood prssure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglycerides; HRT, hormone replacement therapy; and FSH, follicle-stimulating hormone.

  • 1 The choice of test modality should be based on the resting ECG, physical ability to exercise, and local expertise and technologies.

  • 2 The ACC and the AHA recommend cholesterol screening guidelines as outlined by the National Cholesterol Education Panel (measure total and HDL cholesterol at least once every 5 years in all adults ≥20 y old. The consensus panel recognizes that some organizations use other guidelines, such as the US Preventive Services Task Force, which recommends that cholesterol screening in women without risk factors begin at age 45 y.