Cardiovascular disease in women: challenge of the middle years.

Although heart disease remains the primary cause of death among women of all races and ethnic groups in the United States, many women are still unaware of these facts. Health care providers may also not be aware. Lack of awareness among providers may limit or delay the education and intervention to prevent future cardiovascular disease for women in their middle years. In addition, the metabolic syndrome may develop in these years of a woman's life because of today's lifestyle issues and the reported increases in obesity. The appearance of the metabolic syndrome already places a woman in a precarious position for the development of risk factors such as frank hypertension and diabetes. The metabolic syndrome presents an opportunity for providers to enhance surveillance and to educate their patients in the prevention of future events. Complications of pregnancy may also foreshadow the development of hypertension as well as type 2 diabetes mellitus later in life. Some investigators consider pregnancy as an excursion into the metabolic syndrome and as a failed "stress test," if complications such as gestational diabetes or preeclampsia develop. The emergence of those complications may give a more recognized prediction of future cardiovascular events. All primary care providers, including obstetricians and gynecologists, need to be alert as to the follow-up of these women, and incorporate continued vigilance within the standard office visit including waist measurement, annual lipid measurement, glucose monitoring, blood pressure assessment, and intense education and referrals when needed.