Heart Disease in Women

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Heart Disease in Women 10 Things Every Woman Should Know About Heart Disease usan P. D’Anna ARNP linical Instructor in Medicine ection of Cardiology - DHMC

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10 Things. Every Woman Should Know About Heart Disease. Heart Disease in Women. Susan P. D’Anna ARNP Clinical Instructor in Medicine Section of Cardiology - DHMC. #1 Cardiovascular Disease Is the Number 1 Cause of Death in American Women . Myth: Heart disease is a man’s disease Fact: - PowerPoint PPT Presentation

Transcript of Heart Disease in Women

Page 1: Heart Disease in Women

Heart Disease in Women

10 Things

Every Woman Should Know About Heart Disease

Susan P. D’Anna ARNPClinical Instructor in MedicineSection of Cardiology - DHMC

Page 2: Heart Disease in Women

#1 Cardiovascular Disease Is the Number 1 Cause of Death in American Women

Myth:♥ Heart disease is a man’s

diseaseFact: Each year heart disease kills

more women than men 38% of women die within one

year of suffering a heart attack (compared to 25% of men)

CDC National Vital Statistics Report, Vol.49, No., 11 2001Adapted from the American Heart Association website, 2002

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Heart Disease Affects Women in Every Age Group

AHA 2003 Heart and Stroke Statistical Update; 2002:8.

U.S.: 1988 - 1994Estimated Prevalence of CVD by Age and Gender

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Source: Tracking Women’s Awareness of Heart Disease – AHA National Study; Circulation 2004;109:573-579.

Women Do Not Perceive Heart Disease as Their Major Health Threat

But, awareness is improving

46%

34%

30%

13%

8%

7%

35%

40%

50%

51%

62%

61%

2003

2000

1997

2003

2000

1997

Cancer (net)Heart Disease

Awareness of Leading Cause of Death for Women

Female Perception of Their Greatest Health Risk

Women still fear cancer most

Cancer (net)Heart Disease

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All CVD 40.9%

All Cancers 21.8%

Lung Cancer 5.3%

Chronic lower respiratory diseases 5.1%

Breast Cancer 3.4%

Diabetes 3.1%

Influenza and pneumonia

Alzheimers 2.9%

Accidents 2.8%

Colon Cancer 2.4%

Nephritis 1.6%

Septicema 1.4%

Chronic liver disease and cirrhosis 0.8%

Pneumonitis due to solids and liquid 0.7%

Parkinson's .06%

Intentional Self harm 0.5%

Assault 0.3%

HIV 0.3%

Source: National Vital Statistics Report, Vol. 50, No. 15, September 16, 2002

Car

diov

ascu

lar D

isea

se 4

1%

Cancer 22%

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Age: As women grow older, the chance of developing heart disease increases (especially after the onset of menopause) – The risk of CAD increases 2 to 3 times after menopause

Race: African-American women have a higher risk of death from heart disease than white women

women.americanheart.org

#2 Risk Factors Help Predict Who Is at Risk to Develop Coronary Artery Disease

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Cholesterol: Low blood levels of “good” cholesterol (HDL) and high triglycerides are stronger

predictors of heart disease death in women than in men

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Blood Pressure: More than half of all women over 55 have high blood pressure, which increases

their risk of heart disease, stroke and other serious conditions

Diabetes: Increases the risk of heart disease 3-7 fold

A more powerful risk for heart disease in women than in

men

Jneid and Thacker, Cleveland Clinic J of Med. 2001: 441-448women.americanheart.org

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Why Women Don’t Take Action Against Heart Disease They don’t put their health as a top priority They think they’re not old enough to be at risk They feel too busy to make changes in their

lives They’re already feeling stressed They don’t have the familial and social

support

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#3 Women’s Experience of Heart Disease Is Different Than Men’s

Women are more likely to die within one year after a heart attack

Women are less likely to survive coronary artery bypass surgery

Women are more likely to experience complications after angioplasty

Women are more likely to have life threatening arrhythmias (irregular heart beats)

These differences may be partially due to hormones, a woman’s smaller heart size and

advanced age at diagnosisWenger, N.K., J. Am. Med. Women’s Assoc. 1994:49:181 Wenger, N.K., Int. J. Fertile Women’s Med. 1998; 43:84

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Traditional Heart Attack Warning Signs

Pressure, burning, squeezing in the center of the chest

Discomfort in one or both arms, shoulders, neck, jaw, stomach, or back

Shortness of breath Fatigue, cold sweat, nausea, weakness

Adapted from the Harvard Medical School website – www.harvard.health.edu

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Symptoms of Coronary Heart Disease Can Differ in Women

Pain in upper back, jaw or neck Shortness of breath Flu-like symptoms: nausea or vomiting, cold

sweats Fatigue or weakness Feelings of anxiety, loss of appetite, discomfort

Adapted from the Harvard Medical School website – www.harvard.health.edu

Women’s signs are non-specific and more easily overlooked.

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Severity of Heart Disease: Men and Women

Deaths within one year of 1st MI 25% 38%Sudden deaths with no previous symptoms 50% 63%Within six years of recognized MI, percent who will: have another MI have a stroke experience SCD be disabled with heart failure

18%8%7%

22%

35%11%6%

46%

Men Women

AHA 2003 Heart and Stroke Statistical update; 2002:12, 14, 17

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65%

65%

65%

53%

77%

80%

35%

35%

35%

47%

23%

20%

PTCI

CABG

PTA

Brady

Tachy

Heart Failure

MenWomen

61 million Americans with CVD

Yet, more men are being treated than women

1. The AHA 2001 Heart and Stroke Statistical Update 3. PTCI: J Am Coll Card 2002 Apr 3; 39(7):1096-1032. CABG: Ann Thorac Surg 2001 Feb; 71(2):512-20 4. Estimated from internal Guidant records

2

3

4

3

4

48% are men48% are men 1 52% are women52% are women 1

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Heart Disease Gender Bias or Sex Difference?

Data used for the care of women derived from studies conducted in middle-aged men

Initial efforts for prevention focused more on men than women

Women and doctors often attribute chest pain in women to noncardiac causes

Exploring the Biological Contributions to Human Health-Does Sex Matter: Institute of Medicine 2001

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Heart Disease Gender Bias or Sex Difference?

Women tend to have heart attacks later in life than men

Women present more often than men with atypical symptoms

Some diagnostic tests and procedures may not be as accurate in women

Heart disease may be different in women and men

Exploring the Biological Contributions to Human Health-Does Sex Matter: Institute of Medicine 2001

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#4 Heart Attacks Are Caused by Coronary Artery Disease (CAD)

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Obstructed coronary artery

Diffuse narrowing in coronary artery

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#5 Know Which Tests are More Effective in WomenTest Other

NamesDescription

Fasting Lipid Profile Measures total, “good” (HDL) and “bad” (LDL), levels of cholesterol

Electrocardiogram ECG or EKG Measures electrical impulses of heart

Stress Test Tests function of heart during strenuous physical exercise

Echocardiogram Echo Uses ultrasound waves to evaluate heart structure and function

Nuclear Imaging Thallium, Sestamibi,MUGA scan

Uses radioactive isotope injected into blood stream to evaluate heart function

Cardiac Catheterization

Angiogram“cath”

Used to diagnose coronary artery disease(CAD). An invasive procedure in which tubes are inserted through blood vessels, dye is injected and x-rays of the heart are taken

Shaw et al. Card. In Review, 2000: 65-74

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#6 Estrogen and Menopause May Be Related to Heart Disease

Estrogen increases production of “good” cholesterol (HDL) As estrogen decreases, women experience lower levels of

“good” cholesterol (HDL) and the flexibility in arteries decreases.

Women will live one third of their lives after menopause Hormone Replacement Therapy (HRT) should not be used

for the purpose of reducing the risk of cardiovascular disease in women

Jneid and Thacker, Cleveland Clinic J of Med. 2001: 441-448

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Source: JAMA 2002; 288:321-333

National Institutes of Health * mdash study shows a trend toward increase in risk

WHI Had Unexpected Results

Increased Risk

Heart attack 29%

Breast cancer 26%

Blood clots 2X Strokes 41% Dementia Ovarian Cancer

Strokes Probable dementia or

memory loss*

Decreased Risk

Hip fractures 34% Colorectal cancer 37% Cancer of uterine lining

Hip fractures

No Effect

Quality of life Number of deaths

Breast cancer Heart disease

Estrogen plus progestin - July 2002

Estrogen alone – March 2004

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CONCLUSIONS of WHI

After a 5.2 year follow up: Health risks exceeded benefits of

combined estrogen plus progestin All-cause mortality was not affected This regimen should not be initiated

or continued for primary prevention of CHD.

JAMA 2002; 288:321-333

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#7 More Research on Women and Heart Disease Is Needed

Historically, women have been under-represented in clinical trials related to heart disease

There is little knowledge regarding the effects of commonly used cardiovascular drugs in women

Practice patterns are based on research in middle-aged men that may not apply to older women

There is limited information regarding therapies used to treat heart disease in the very elderly

Evelyn et al. “ Women's Participation in Clinical Trials and Gender-Related Labeling” FDA special report http://www.fda.gov/cder/reports/womens_health/women_clin_trials.htm

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Enrollment of Women in CVD Trials 1993 – NIH mandated inclusion of women in

federally funded clinical research Enrollment increasing for women, but with single-

sex trials excluded, enrollment rate was 38%, unchanged over time

No change in gender composition of cohorts in majority of studies

Federal efforts have been only moderately successful, mainly due to small number of large single-sex trials

Even when women are included in trials, rarely are the results broken-out

NEJM 2000;343-475

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Representation of Women in Studies of CAD Testing

91

79

72

9

21

28

ECG

ECHO

MPI

% of Patients

Men WomenAdapted from Shaw LJ et al. Coronary Artery Disease In Women: What All Physicians Need to Know. 1999;372.

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#8 There Are a Variety of Options Available to Treat Heart Disease

Medications – including Aspirin Balloon angioplasty and stenting Heart bypass surgery Pacemakers for slow heart rhythms and

defibrillators for rapid heart rhythms

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#9 Women Can Take Action to Lower the Risk of Heart Disease

1. Know your risk factors 2. Stop smoking3. Maintain a healthy body weight4. Eat a nutritious balanced diet low in saturated fats5. Monitor and manage blood pressure and diabetes6. Exercise regularly7. Limit alcohol intake8. Learn stress management skills9. Maintain social relationships10. Know the warning signs for heart attack and stroke

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#10 Women Can Save Lives

If you or someone you know has risk factors for heart disease, adopt a heart healthy lifestyle and discuss a plan of care with your physician

If you experience symptoms of heart attack or stroke, call 911 immediately

LEARN CPR

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Why Focus on Women’s Cardiovascular Health?

Cardiovascular disease is the largest killer of American women and CVD mortality in women is rising at a disproportionate rate compared to men

The majority of American women are unknowledgeable about their personal risk for CV disease

Changing a woman’s CV risk from higher risk to lower risk with present medical knowledge and tools reduces her chance of coronary events

Women are often decision makers for the family

Adapted from American Heart Association and the Nurse’s Health Study

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The following organizations can provide information on heart disease:

* American Heart Association800-242-8721http://www.americanheart.orgAHA's mission is to reduce disability and death from cardiovascular diseases and cardiovascular diseases and stroke. Several

consumer publications are available through AHA, including the AHA Guide to Heart Attack Treatment, Recovery and Prevention.

* Health and Human ServicesOffice of Women's Health1-800-994-WOMAN (96626)http://www.4women.govOWH investigates a broad spectrum of women's health activities across governmental offices and agencies. It also sponsors

the National Information Center, which links the general public to a wide variety of health-care resources and publications, including those related to heart disease.

* National Heart, Lung, and Blood Institute301-592-8573http://www.4women.gov, www.hearttruth.govThe NHLBI publishes the Healthy Heart Handbook for Women (http://

www.nhlbi.nih.gov/health/public/heart/other/hhw/index.htm), which features the latest information on preventing cardiovascular diseases. The publication also helps women develop a personal action plan for reducing the major risk factors. In addition, The Heart Truth website contains helpful information.

* American Medical Women's Associationhttp://www.amwa-doc.org/

Mayo Clinic Health Oasis http://www.mayohealth.org/

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You Can Make a DifferenceBe a leader in your

community for women’s cardiovascular disease

through . . .

Research Advocacy

Awareness

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