Preventative Health Lecture Follow-up: Talking with Patients and Vaccinations

After Dr. Nunez’s informative and entertaining lecture on Women’s Health and Prevention Issues this afternoon, a few additional thoughts came to mind.  As she pointed out, sometimes there’s a little bit of a disconnect (or at least order of priorities) between what the patient is seeking help for and what the physician considers most urgent.  In the case presented, the patient was concerned about joint pain (osteoarthritis), but the physician would also be concerned about cardiovascular risk (hypertension, obesity, hyperlipidemia in a post-menopausal woman).  One way of trying to tie the two together to unite common goals might be to explain to the patient that weight loss (which would benefit her lipids and blood pressure control) would also likely ease the stress on her joints (knees) and decrease some of the pain she is experiencing.

On a different note, physicians often forget about vaccinations as an effective preventive care measure.  This patient should have been receiving annual flu vaccinations (as we all should) and should also be asked about the last time she received a tetanus vaccine.  If she is due for a tetanus shot (which many adults neglect/forget since it is received ~ every 10 years), she should receive Tdap.  This tetanus toxoid combined with pertussis vaccine is now recommended for all adults who have not already received it and is especially important for those who may have small children (e.g. grandchildren) in their household, since pertussis is most serious, even potentially fatal, in infants.  When she turns 60, she will be eligible for the shingles vaccine (ZOSTAVAX) and at age 65 for two pneumococcal vaccines (PREVNAR 13 and PNEUMOVAX 23, which are recommended to be given sequentially).  If she were part of a high risk group such as individuals with diabetes, heart disease, chronic liver or lung disease, pneumococcal vaccination would be administered at a younger age.  Guidelines are currently in flux with the availability of two vaccines now for adults, so stay tuned for the CDC to issue new guidelines soon!

Resources:

http://www.cdc.gov/vaccines/schedules/hcp/adult.html

Risk Factors For Heart Disease: Worse for Women & African Americans

A recent study reported in Health Day.com demonstrates the disparity felt by women and African Americans when it comes to risk factors for heart disease. In particular, diabetes and high blood pressure were found to be major contributors to this sex and race gap by increasing the chance for heart disease to develop significantly in these groups when compared to men in general.

When looking at combined risk from 5 factors (High cholesterol, smoking, high blood pressure, obesity and diabetes) blacks had an increased risk of 67% to develop heart disease as compared to 48% in whites. Women had a combined risk of 58% compared to 48% in men. These risks ultimately make these groups more likely to experience poor health outcomes, or even die from complications of heart disease and stroke.

 But why is this happening? From a clinical perspective, the article suggested that " this difference in risk could be due to the fact that heart disease has typically been considered a disease of white men, and doctors have not tackled contributing factors as much when they crop up in women and blacks." If this is the case, this image of the "typical" heart disease patient can be putting lives at risk. It is later suggested that doctors take risk factors more seriously in these populations since their chance for later development is higher.

Patients can also have an important role in bridging this gap. It is important to know your family history, be aware of the things you are at high risk for and  try your best to manage any risk factors you do have. If you don't feel like your doctor is taking your risk factors seriously, seek a second opinion. Remember, your family history does not have to be your biography. Ask your doctor what you can do to reduce your risk factors for heart disease. In some cases, small life changes can make a big difference.

Resources:

Original Article: Women, African Americans Hit Harder by Heart Disease Risk Factors, Heath Day.com

Article Referenced: Philly.com 

Article: How to Prevent and Control Coronary Heart Disease Risk Factors , NIH

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