The field of women’s health encompasses more than the
reproductive health issues commonly addressed by obstetricians and
gynecologists; it evaluates diseases and conditions only seen or experienced
in women or experienced by women in ways different than men, as well
as the evidence-based prevention and treatment of risk factors and
diseases in women. Hence, all primary care providers, including
internists and family physicians, should be well versed in women’s health
issues. While this chapter refers to other disease-based chapters in the textbook, it also emphasizes the understanding of issues from the particular perspective of women.
Prevention of disease can be primary (preventing disease before
it happens as well as identifying and modifying risk factors), secondary
(identifying early disease), or tertiary (treating complications
of the disease or limiting the impact of established disease). Important
areas for primary prevention include encouraging women to exercise
regularly to reduce the risk of coronary heart disease (CHD) and breast cancer as well as counseling women to discontinue smoking to reduce the risk of cardiac and lung diseases. Cancer screening in women focuses on secondary prevention, so that disease is detected early when prompt treatment improves outcome.
Although cardiovascular disease is the leading cause of death
in women, they are often more concerned about developing breast
cancer (see below) than about developing heart disease. While some
heart disease risk factors such as age and family history are not
modifiable, as with men, other risk factors such as hypertension,
hyperlipidemia, smoking, obesity, and diabetes are potentially modifiable (see also Chapter 1: Disease Prevention & Health Promotion).
The Framingham risk calculator (http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof)
can be used to estimate a woman’s 10-year risk of CHD based
on her age, smoking status, blood pressure, and cholesterol levels.
Hypertension is a risk factor for CHD and stroke in both men
and women (see Chapter 1: Disease Prevention & Health Promotion). Approximately 70–80% of women over
age 70 have hypertension. A woman with high blood pressure is at
lower risk for CHD than a similar aged man. For many young and otherwise
healthy women, drug treatment can be deferred, since their absolute
risk of CHD in the next 10 years is likely to be low. When pharmacotherapy
is started, the choice of medication is similar to those used in
men (see Chapter 11: Systemic Hypertension).
Hyperlipidemia is a CHD risk factor in both men and women, but
low levels of high-density lipoprotein (HDL) is more predictive
of CHD risk in women. Elevated cholesterol is defined as a total cholesterol
> 240 mg/dL (> 7.2 mmol/L) or low-density lipoprotein
(LDL) cholesterol > 160 mg/dL (> 4.8 mmol/L).
Borderline cholesterol is defined as a total cholesterol between
200 mg/dL and 240 mg/dL (6 mmol/L and
7.2 mmol/L) or an LDL cholesterol of 130–159 mg/dL
(3.9–4.77 mmol/L). Ideal cholesterol is defined
as a total cholesterol < 200 mg/dL (< 6 mmol/L)
or an LDL < 130 mg/dL (< 3.9 mmol/L) and
an HDL cholesterol > 50 mg/dL (> 1.5 mmol/L).
The US Preventive Services Task Force (USPSTF) recommends screening
all women aged 45 and older for hyperlipidemia, whereas the National
Cholesterol Education Program ...