Preventing CVD in Women: Common Questions and Answers.

Cardiovascular disease (CVD) is the most common cause of mortality in the United States. Women have unique risk factors for CVD, including pregnancy, hormones, autoimmune disorders, and psychological stress. Most risk calculators underestimate the risk of CVD in women; therefore, it is essential that physicians have a heightened awareness of risk-enhancing factors. A thorough history of adverse pregnancy conditions, hormonal factors, autoimmune diseases, and psychological stress, including adverse social determinants of health, should be documented in the electronic health record. A risk assessment using the Atherosclerotic Cardiovascular Disease Risk Calculator should be routinely performed, and those with borderline (5% to less than 7.5%) and intermediate (7.5% to less than 20%) risk should undergo lifestyle modification counseling and shared decision-making regarding the initiation of a statin, aspirin, or antihypertensive therapy. Women with gestational diabetes mellitus should be screened at four to 12 weeks postpartum with a two-hour oral glucose tolerance test, and, if normal, the test should be repeated every one to three years. Women with hypertensive disorders of pregnancy should be assessed within three months of delivery, and CVD risk assessment should occur annually thereafter. Because women with a history of adverse pregnancy conditions have higher rates of traditional CVD risk factors that emerge at younger ages, earlier and more frequent monitoring should be considered. Optimizing management of mood disorders, traditional CVD risk factors, and autoimmune diseases and considering the effects of social determinants of health are essential. Lifestyle modification counseling should include guidance to adhere to a plant-based diet that is mostly vegetables, fruits, legumes, nuts, whole grains, and fish; 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise weekly; and tobacco cessation.

Characteristics of Patients With Existing Advance Directives: Evaluating Motivations Around Advance Care Planning.

INTRODUCTION: Although 80% of patients endorse an advance directive (AD), less than 35% of American adults have a documented AD. Much research has been done on barriers to creating ADs; however, there is a paucity of research addressing motivations for creating ADs. Previous research has identified 4 categories of influence for engaging in advance care planning (ACP). This study aimed to quantify the influence of these 4 motivating categories in creating an AD. METHODS: Participants included 238 adults with documented ADs. Participants completed an 11-item questionnaire addressing 1 of the 4 hypothesized categories of influence in addressing ACP: concern for self; concern for others; expectations about the impact of ACP; and anecdotes, stories, and experiences. RESULTS: Principle component analysis yielded 2 factors representing dignity and personal control (intrinsic factors) and societal and familial influence (extrinsic factors). Intrinsic factors were the primary and most influential motivating factors among participants. A regression analysis of individual motivating factors showed that prior to age 50, the desire to provide guidance about personal preferences for end-of-life care significantly predicted the creation of an AD, whereas after age 50, the urging of family members significantly predicted the creation of an AD. DISCUSSION: Results indicated that intrinsic factors were the most influential motivator among participants of all ages. Extrinsic factors appeared to be less influential in the decision to create an AD. Motivating factors were also found to vary by age. These results may help physicians be more targeted in discussions surrounding ADs, thus saving time, which physicians identify as the main barrier in engaging in such discussions, while meeting patients' wishes for their physicians to bring up the topic of ADs.