Over 10 years ago, publication of Women's Health Initiative (WHI) studies affected both public perceptions and our clinical prescribing of hormone replacement therapy (HRT). Front-page reports of higher risks of heart attacks, stroke and breast cancer led to around a million women in the UK stopping HRT, many without medical advice or clinical assessment. Since then, new evidence has emerged, much of which does not support the earlier alarming headlines.
PCCJ Editor-in-Chief Mike Kirby reviews a recent large observational study in the BMJ which concludes that women with atrial fibrillation are at a higher risk of cardiovascular disease and death than men.
Claire Bellone, clinical nurse specialist at the Chelsea & Westminster Hospital NHS Trust, gives her personal view on how primary healthcare professionals can work with women with menopausal symptoms and implement the recommendations of the NICE guideline on the diagnosis and management of menopause.
Unplanned pregnancy with poor glycaemic control at conception is associated with major maternal and perinatal complications. However, contraception is used haphazardly by women with diabetes and is often not discussed by diabetes professionals. Practice nurses need to be able to give appropriate advice about contraception to the increasing numbers of women of childbearing age who have type 1 or type 2 diabetes.
The impact of female hormones on cardiovascular risk is a hot issue. Many nurses working in the NHS, including in general practice, are aged 50 or older. This means that there is a strong possibility that some of us may be experiencing menopausal symptoms, along with our patients. In this article, we look at the use of hormonal therapies at the time of the menopause, with particular reference to cardiovascular risk. We will also touch on the use of oral contraception and associated cardiovascular factors.
Results from the ADVANCE trial support the need for intensive efforts to promote smoking cessation in people with diabetes. As well as increased risks to cardiovascular health in all diabetic patients who smoke, women with diabetes who smoke appear to be at a greater risk of coronary events than men.
Women with diabetes appear to be at a higher risk of developing vascular dementia than men, according to the results of a major systematic review including >2 million people published in Diabetes Care.
In the UK, the last 30 years have seen a significant decline in deaths from coronary heart disease (CHD) in men, but the fall has been less significant in women. This may be because women need a different, more gender-specific approach if they are to benefit fully from recent advances in treatment.