Transcript Women & Heart Disease: How are We Different & How Can You Take Care of Yourself.

Women &
Heart Disease:
How are We Different
& How Can You Take
Care of Yourself
Did You Know?
• Heart disease doesn’t discriminate
• It is the leading killer of men and women
• However, there is a gender gap in
diagnosis and treatment
• Women with an acute heart attack are
more likely to die than men
Facts (AHA)
• Cardiovascular Disease (CVD) ranks first
among all disease categories in hospital
discharges for women
• 51.8% of all female deaths in the US occur
from CVD
• More than 1 in 3 female adults in the US has
some form of cardiovascular disease
• Since 1984, the number of CVD deaths for
females has exceeded those of males
Facts
Top 5 Causes of Death for American Women
•
•
•
•
•
Heart Disease
315, 000
Stroke
82, 000
Lung Cancer
71, 000
Chronic Obstructive
Lung Disease
65, 000
Breast Cancer
41, 000
Source: 2006 CDC & American Cancer Society
Cardiovascular Disease Mortality
Trends for Males & Females
United States: 1979-2001
Racial & Ethnic Groups
• Cardiovascular disease is the leading cause
of death for African Americans, Latinos,
Asian Americans, Pacific Islanders, and
American Indians
• African American women are at the
highest risk for death from heart disease
among all racial, ethnic, and gender
groups
Risk Factors for Heart Disease
• Smoking
• Family History
• Hypertension
• Elevated Cholesterol
• LDL bad cholesterol | HDL good cholesterol
• Sedentary Lifestyle / Obesity
• Diabetes
• Metabolic Syndrome / Obesity
• Waist to hip ratio / elevated blood sugar (insulin resistance)
Risk Stratification
• CHD equivalent
– Diabetes mellitus
– Established atherosclerotic disease
– Includes many patients with chronic kidney disease,
especially ESRD
• Major Risk Factors:
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–
–
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Age > 55 years
Smoking
Hypertension, whether or not treated with medication
HDL cholesterol < 40mg/dL
(HDL cholesterol ≥ 60mg/dL is a negative risk factor)
– Family history of premature CVD
Source: Mosca 2004, ATP III 2002
Risk Stratification
• Diabetes
– Automatically places a patient in a “High Risk”
category
• Family History
– Defined as CVD in a female first degree relative
< 55 years old, or a first degree male relative <
45 years old
Source: Mosca 2004
LDL / HDL Cholesterol
• Elevated Cholesterol
– LDL bad cholesterol
• LDL normal < 130
• If you have diabetes < 70
• Coronary heart disease < 70
– HDL good cholesterol
• > 40 (the higher the better)
• Walking or exercise is the best way the raise
HDL
Obesity / Metabolic Syndrome
• Apple versus Pear Shape
– Waist to hip ratio is calculated by dividing your
waist measurement by your hip measurement.
(Hips are the widest part of your bottom/butt).
• Best Waist-Hip Ratio for Men and Women
– Ideally, women should have a waist-to-hip ratio
of 0.8 or less.
– Ideally, men should have a waist-to-hip ratio of
0.95 or less.
Definition of Metabolic Syndrome in Women
• Abdominal obesity - waist circumference >
35 in.
• High triglycerides ≥ 150mg/dL
• Low HDL cholesterol < 50mg/dL
• Elevated BP ≥ 130/85mm Hg
• Fasting glucose ≥ 100mg/dL
Misperceptions: Women & CVD
• Women lack understanding of their risks
• Women lack understanding of signs and
symptoms of CVD
• Woman’s risk of CVD increases after
menopause
• Only 30 % of women polled said that their
doctor had mentioned heart disease when
discussing general health issues
Women Receive Less Interventions to
Prevent & Treat Heart Disease
• Less cholesterol screening
• Less lipid-lowering therapies
• Less use of heparin, beta-blockers and
aspirin during myocardial infarction
• Fewer referrals to cardiac rehabilitation
Typical MI Symptoms
• Crushing chest pain radiating to the neck,
jaw or arm
• Sweating for no apparent reason
• Nausea
• Sudden, rapid heartbeat
Atypical Symptoms
• Unexplained exhaustion or fatigue
• Unexplained shortness of breath
• Chest discomfort such as tingling or
squeezing
• Discomfort in the neck, jaw, ear or teeth
with exertion
Atypical Symptoms
• Indigestion
• Discomfort in the upper shoulder blades
• Dizziness
• Discomfort in one or both arms
• Swelling of the legs or ankles
Atypical Symptoms
• Heart palpitations, cold sweat
• Chest pain at rest
Lifestyle Interventions
• Smoking cessation
• Physical activity
• Heart healthy diet
• Weight reduction/maintenance
Source: Mosca 2004
Smoking
• All women and men should be consistently
encouraged to stop smoking and avoid
environmental tobacco
– The same treatments benefit both women
and men
– Women face different barriers to quitting
• Concomitant depression
• Concerns about weight gain
Source: Fiore 2000
Physical Activity
• Consistently encourage women and men
to accumulate a minimum of 30 minutes of
moderate intensity physical activity on
most, or preferably all, days of the week
Source: Mosca 2004
Diet
• Healthy food selections:
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•
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Fruits and vegetables
Whole grains
Low-fat or nonfat dairy
Legumes
Low-fat protein
Fish
• Saturated fats < 10% of calories, < 300mg
cholesterol
• Limit trans fatty acid intake (main dietary sources are baked
goods and fried foods made with partially hydrogenated
vegetable oil)
Source: Mosca 2004
Weight Maintenance/Reduction Goals
• BMI between 18.5 and 24.9
• Waist circumference < 35 inches
• Weight loss goals
– 10% of body weight over six months or
1-2 pounds weight loss/week
– Reduce calories by 500-1,000 per day
Source: Mosca 2004, ATP III 2002
Diabetes
• Recommendation: Lifestyle and
pharmacotherapy should be used to
achieve near normal HbA1C (<7%) in
women and men with diabetes
Source: Grundy 2004
Morta lity Ra te (per 10 00 wome n)
Coronary Disease Mortality and Diabetes
in Women
60
50
40
Diabetic Women
30
Nondiabetic
Women
20
10
0
0-3
4-7
8 - 11
Source: Adapted from Krolewski 1991
12 15
16 19
Duration of follow-up (yrs)
20 23
Benefits of ASA in Women
with Established CAD
Source: Adapted from Harpaz 1996
Preventive Drug Interventions
• Aspirin – Lower risk women
– Many women, especially those age 65 and older,
may benefit from taking low-dose aspirin every
other day to prevent stroke
– Women over age 65 may benefit from taking lowdose aspirin to reduce major cardiovascular events
– The use of low dose aspirin in lower risk women
should be balanced against the risk of increased
internal bleeding
Source: NHLBI
Interventions that are not useful or
effective and may be harmful for the
prevention of heart disease
• Antioxidant supplements
– No cardiovascular benefit in randomized
trials of primary and secondary prevention
Source: Mosca 2004
Resources
• www.americanheart.org
Resources
• www.hearttruth.gov
Getting the Message Out
Stories from the Heart
CLAUDETTE'S STORY
"I consider myself to be relatively healthy and I exercise
for about 90 minutes every morning. I started having pain
in my chest and face during my exercising, and finally
went to the cardiologist. I never thought that the pain in
my face could be related to my heart, so I was shocked
when the tests showed that I had had a heart attack. I
thought I was too young, but my father died of a heart
attack when he was only 38, so I had family history as a
risk factor. After my second heart attack, I knew that I
needed to help get the message out. Women need to
know that heart disease is their biggest health threat."
Stories from the Heart
STEPHANIE'S STORY
"It's only been a few weeks since I had a heart attack and
it really hasn't sunk in. I just keep thinking, 'I'm too young
for this.' If I didn't work at a hospital, I wouldn't have even
known what was going on. I just thought it was
indigestion. I know I need to make changes, but it's easier
said than done. Quitting smoking has been much harder
than I expected. Between work, taking classes and four
children, there really isn't a lot of time to think about
caring for myself. But I have started paying attention to
what's going on with me, just like I would do for one of
the kids."
Questions? Call SOMC
Heart & Vascular Services
740-356-8305
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