Physician Counseling for Cardiovascular Disease

The U.S. Preventive Services Task Force and the American Heart Association recommend that all primary care physicians offer their patients counseling to promote physical activity, a healthy diet and smoking cessation as part of the preventive health examination. The Centers for Disease Control and Prevention (CDC) analyzed data from the National Ambulatory Medical Care Survey to see if physicians were providing this type of counseling for the prevention of cardiovascular disease. The report was published in the February 13, 1998, issue of Morbidity and Mortality Weekly Report.

The data indicate that a high percentage of office visits in 1995 did not include counseling for the prevention of cardiovascular disease. Physicians reported offering counseling about physical activity during 19.1 percent of office visits, diet during 22.8 percent and weight reduction during 10.4 percent. Counseling was reported more often for persons 50 to 64 years of age, for men more often than for women and for non-Hispanic whites more often and Hispanics than for non-Hispanic blacks. The prevalence of counseling was lowest in the South and highest in the Midwest. Cardiologists and family or general physicians were more likely than other specialists to provide counseling about physical activity, diet and weight reduction. Among all respondents, 64 percent reported that their office visits included an assessment of smoking status, and 41 percent of office visits included smoking cessation counseling for smokers.

To promote counseling for the prevention of cardiovascular disease by all physicians, the CDC recommends training programs to increase the emphasis on preventive counseling. Such training, according to the report, should be provided in medical schools, in residency, in other postgraduate programs, in continuing medical education courses and by professional organizations.

Update on Folic Acid Intake Among Women

Less than one third (32.2 percent) of women of childbearing age consume a daily supplement containing folic acid, according to a survey reported in the February 27, 1998, issue of Morbidity and Mortality Weekly Report. In 1997, the March of Dimes contracted the Gallup Organization to conduct the telephone survey of women 18 to 45 years of age to collect information about folic acid intake and use of vitamin supplements.

Overall, 64.4 percent of the women reported taking some form of vitamin supplement: 44.3 percent used a folic acid-containing supplement (32.2 percent daily and 12.1 percent less than daily), and 20.1 percent used a supplement that did not contain folic acid (12.5 percent daily and 7.6 percent less than daily). Daily use of a folic acid–containing supplement was 22.8 percent in women under 25 years of age, 19.6 percent in those with less than a high school education, 22.5 percent in those with household incomes under $25,000, 26.1 percent in those who were not married, 28.8 percent in those who had not heard of the recommendation for the use of folic acid, and 24.3 percent in those who were of races other than white. Forgetting to take a vitamin was the main reason for less-than-daily use (49.0 percent).

Among the 67.8 percent of women who did not take a folic-acid containing supplement daily, about one half (32.2 percent) used a supplement but either did not take one daily or took a supplement that did not contain folic acid. The report suggests that these women may be easily persuaded to use a folic acid–containing supplement.

Overall, 57.8 percent of the women who did not take a supplement daily felt that they needed more information on vitamin and mineral supplements, and 59.8 reported that cost may be a reason for not taking vitamin supplements.

Device to Treat Excessive Menstrual Bleeding

A new type of device for the treatment of benign menorrhagia in premenopausal women for whom childbearing is complete has been approved by the U.S. Food and Drug Administration. The device (ThermaChoice) is a uterine balloon catheter thermal system and may provide an alternative to hysterectomy or hysteroscopic surgical ablation in women whose abnormal uterine bleeding cannot be adequately controlled with medication.

The balloon catheter is inserted into the vagina (through the cervix and into the uterus), inflated with fluid and heated to 87° C (188° F) to destroy much of the lining of the uterus. Pressure, temperature and time are controlled by a computer. After eight minutes of treatment, the balloon catheter is removed.

In multicenter clinical trials, 125 women who were 30 to 50 years of age received treatment with the thermal ablation device and were compared with a similar number of women who were treated with hysteroscopic roller-ball ablation. All of the women in both groups had excessive menstrual bleeding and had not tolerated or responded to drug therapy aimed at controlling the bleeding. In both groups, ablation treatments were shown to be safe and were able to control excessive bleeding in over 80 percent of the women at 12-month follow-up evaluation. Effectiveness of the thermal ablation device has not been demonstrated for women with uterine fibroids or other structural uterine abnormalities, or for post-menopausal women. Ongoing studies will determine if the thermal ablation procedure permanently reduces excessive menstrual bleeding or if women will need to receive treatment periodically.