Strategies for reducing cardiovascular risk in women.

The major risk factors for coronary heart disease in women are much the same as in men. They include elevated cholesterol, hypertension, diabetes, cigarette smoking, severe obesity, a history of stroke and/or thromboembolic disease, and a family history of premature coronary heart disease. Diabetes appears to confer a greater risk and hypertension to have a lesser effect in women than in men. The obstetrician-gynecologist's role as primary care physician is important in terms of risk reduction counseling in areas that are amenable to change: diet, exercise and cigarette smoking. A fourth area, prescribing hormonal therapy, including oral contraceptives and hormone replacement, is the one risk reduction modality that is within the physician's control.