Identification of risk factors for prevention and early diagnosis of a-symptomatic post-menopausal women

At present, healthcare for post-menopausal a-symptomatic women offers a great opportunity to identify risk factors (RFs) for prevention of diseases which cause high mortality or disability. It is always necessary to promote a healthy lifestyle and identify RFs in order to stratify people according their risk of suffering cardiovascular disease (CVD), cancer (especially of the lung, breast and colon) and osteoporosis. Cardiovascular disease is the leading cause of death. The main independent factors are: age, smoking, high blood pressure, elevated LDL, low HDL cholesterol, and diabetes. Several global risk scores, such as the Framingham score, allow us to assess the risk of suffering a fatal or severe accident in the next 10 years. According to such scores, patients are classified as high, intermediate or low-risk and several intervention strategies may be proposed. There are several genetic and reproductive factors related to breast cancer. Global risk can be assessed by means of the Gail index, which predicts both individual lifetime and 5-year risk. This allows us to recommend breast cancer chemoprevention in high-risk patients. Age, family history, previous fragility fractures, low body mass index, smoking and the administration of oral glucocorticoids are the main osteoporosis RFs. Their assessment allows the indication of bone mineral density (BMD) testing and, according to the T-score, whether to start anti-resorptive therapy. The common problem with RFs is their variability among different populations and fact that the extrapolation of data for an individual is difficult. (c) 2005 Elsevier Ireland Ltd. All rights reserved.