Women and Heart Disease Across the Lifespan

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What is Coronary Heart Disease?

Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease; Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD

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Facts about Heart Disease

Number one cause of death for women over the age of 25.

Kills 1 out of every 3 women. In 2005, 22,150 women died of heart

disease. Kills 1 in 4 women in Florida.

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Prevalence of Heart Disease

8,000,000 American women are living with heart disease.

6,000,000 have a history of heart attack or angina or both.

435,000 American women have heart attacks each year. (74 – avg. age)

4,000,000 suffer from angina. 47,000 were hospitalized in 1999.

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Mortality

Leading cause of death of American women and the major cause of disability.

43% of deaths in American women, or nearly 500,000, are caused by cardiovascular disease each year.

Kills 267,000 women a year. Six times as many women as breast cancer.

31,837 women die each year of congestive heart failure. Women comprise 62.6% of all heart failure deaths.

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Racial and Ethnic Groups

Leading cause of death for African Americans, Latinos, Asian Americans, Pacific Islanders, and American Indians.

African American women are at highest risk for death among all racial, ethnic and gender groups.

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What is Atherosclerosis?

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What is Atherosclerosis Buildup of plaque on artery walls

restricts blood flow. Plaques can burst causing a blood clot

leading to heart attack or stroke. Develops gradually over time. No symptoms until an artery is so

clogged that the organs and tissues are not receiving adequate blood supply.

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Causes of Atherosclerosis:

Starts with damage or injury to inner layer of the artery.

Platelets clump at injury site leading to inflammation.

Plaque may begin as early as childhood.

Accumulates at the injury site causing hardening and narrowing the arteries.

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Blockage Occurs in Various Arteries

Coronary arteries: similar to heart attack, i.e. angina

Arteries leading to brain: stroke symptoms

Peripheral arteries: leg pain when walking or intermittent claudication

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Complications

Angina or heart attack Transient ischemic attack

(TIA) or stroke Peripheral artery disease Aneurysms

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How do I Know if I am at Risk?

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Who is at Risk for Heart Disease?

African American Women: Have 72% higher rate of heart

disease than white women. Aged 55-64 are twice as likely as

white women to have a heart attack.

Are 35% more likely to suffer from coronary artery disease.

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Who else? Women who smoke. Women with diabetes. Women using contraceptives that

contain hormones. Women who are sedentary and get no

leisure time physical activity. Women with a history of pre-

eclampsia or eclampsia during pregnancy.

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Uncontrollable Risk Factors

Increasing Age Gender Heredity Previous Cardiovascular Event

• Heart Attack• Stroke • TIA• Eclampsia

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Modifiable Risk Factors

Modifiable risk factors• Smoking• High blood cholesterol• High blood pressure• Physical inactivity• Obesity and overweight• Diabetes

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Smoking

Smoking –increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot.

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Cholesterol – Good and Bad

Used to form cell membranes, some hormones, and is needed for other functions.

Hypercholesterolemia is a major risk factor for coronary heart disease.

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LDL Cholesterol

Transports cholesterol and triglycerides from the liver to peripheral tissues.

Can build up in the walls of the arteries and form plaque.

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HDL Cholesterol

Carries cholesterol away from the arteries and back to the liver, where it's passed from the body.

May remove excess cholesterol from plaque formations.

Low HDL level (less than 40 mg/dL in men; less than 50 mg/dL in women) indicates a greater risk.

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Triglycerides

Major source of energy and the most common type of fat in your body

The chemical form in which most fat exists in food as well as in the body

Present in blood plasma and, in association with cholesterol, form the plasma lipids 

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High Blood Pressure

Directly increases the risk of coronary heart disease.

Can occur in children or adults. Particularly prevalent in

• African Americans • Middle-aged and elderly people • Obese people• Heavy drinkers

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Physical Inactivity Exercise improves your mood and helps to

relieve stress. Regular exercise can help you prevent — or

manage — high blood pressure. Regular exercise lowers LDL and raises HDL. Regular exercise helps you manage your

weight. Regular exercise strengthens your heart and

lungs. Regular exercise promotes better sleep.

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Obesity and overweight

Obesity is a major risk factor for coronary heart disease. Raises blood cholesterol and

triglyceride levels. Lowers HDL. Raises blood pressure levels . Can induce diabetes.

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Diabetes

2 out of 3 people with diabetes die from heart disease or stroke.

Up to 60% of adults with diabetes have high blood pressure and nearly all have one or more lipid abnormalities.

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Metabolic Syndrome

Characteristics: Abdominal obesity Atherogenic

dyslipidemia Hypertension Insulin resistance

or glucose intolerance

Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood)

Proinflammatory state (e.g., elevated C-reactive protein in the blood)

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Other Risk Factors

Excessive alcohol intake can lead to:

Elevated triglycerides Hypertension Heart failure Increased calorie intake and obesity

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Stress

May lead to hypertension and elevated lipid levels.

Persistently elevated levels of adrenaline and cortisol lead to high blood pressure and increased abdominal fat.

Linked to changes in the way blood clots.

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Periodontal Disease

Oral bacteria may attach to fatty plaques in the coronary arteries and contribute to clot formation.

Inflammation caused by periodontal disease may increase plaque build up.

People with periodontal disease almost twice as likely to suffer from coronary artery disease.

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How Can I Protect Myself and My Family?

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Prevention Begins in Childhood

"Thirty to 60 percent of children in the United States exhibit at least one risk factor for cardiovascular disease by the age of twelve." Philip R. Nader, M.D., UCSD Professor of Pediatrics, Emeritus, Child and Adolescent Trial for Cardiovascular Health .

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Prevention Begins in Childhood

Overweight children as young as four are exhibiting hypertension, diabetes and hyperlipidemia.

Habits are generally created in childhood. Children learn both good and bad habits from their parents.

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Women of Childbearing Age

“Women 35-to-44 have always been thought of as being very low-risk, by the traditional standards. And we know that this isn't always true”.

Dr. Suzanne Steinbaum, head of the Women's Heart Program at New York's Lenox Hill Hospital

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Women of Childbearing Age

Know your family history. Be aware of your blood pressure and

blood sugar readings. Reduce your stress levels whenever

possible. Get regular exercise.

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Women of Childbearing Age

Get the recommended amount of B-Vitamins and Folic Acid.

Don’t smoke, especially if you use any form of hormonal contraceptives.

Tell your doctor if you experienced pre-eclampsia or eclampsia during pregnancy.

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Prevention Across the Lifespan

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Lower Your Risk for Heart Disease – GO RED for Women Wearing red in February is the first step to awareness, but don’t stop there. Take a few more steps for wellness, and lower your risk for heart disease

Find out:  your risk for a heart attack. You may

be surprised.  how to lower your risk for heart

disease. It’s simpler than you think.

  what your body mass index (BMI) is.  how easy it is to get 30 minutes of

physical activity most days. what the signs and symptoms of a

heart attack are. what questions to ask your health

care provider. where you can learn more.

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BMI 19 20 21 22 23 24 25 26 27 28 29 30 35 40

Height (IN.) Weight (lb.)

58 91 96 100 105 110 115 119 124 129 134 138 143 167 191

59 94 99 104 109 114 119 124 128 133 138 143 148 173 198

60 97 102 107 112 118 123 128 133 138 143 148 153 179 204

61 100 106 111 116 122 127 132 137 143 148 153 158 185 211

62 104 109 115 120 126 131 136 142 147 153 158 164 191 218

63 107 113 118 124 130 135 141 146 152 158 163 169 197 225

64 110 116 122 128 134 140 145 151 157 163 169 174 204 232

65 114 120 126 132 138 144 150 156 162 168 174 180 210 240

66 118 124 130 136 142 148 155 161 167 173 179 186 216 247

67 121 127 134 140 146 153 159 166 172 178 185 191 223 255

68 125 131 138 144 151 158 164 171 177 184 190 197 230 262

69 128 135 142 149 155 162 169 176 182 189 196 203 236 270

70 132 139 146 153 160 167 174 181 188 195 202 207 243 278

71 136 143 150 157 165 172 179 186 193 200 208 215 250 286

72 140 147 154 162 169 177 184 191 199 206 213 221 258 294

73 144 151 159 166 174 182 189 197 204 212 219 227 265 302

74 148 155 163 171 179 186 194 202 210 218 225 233 272 311

75 152 160 168 176 184 192 200 208 216 224 232 240 279 319

76 156 164 172 180 189 197 205 213 221 230 238 246 287 328

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Risk of Associated Disease According to BMI and Waist Size

BMI

 Waist equal to40 in. (men) or35 in. (women)

Waist >40 in. (men) or35 in. (women)

18.5 or less Underweight -- N/A

18.5 - 24.9 Normal -- N/A

25.0 - 29.9 Overweight Increased High

30.0 - 34.9 Obese High Very High

35.0 - 39.9 Obese Very High Very High

40 or greater Extremely Obese Extremely High Extremely High

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What’s Your Risk?QUESTION            Yes No

Do you smoke?    

Is your blood pressure 140/90 or higher, OR have you been told by your doctor that your blood pressure is too high?

   

Has your doctor told you that your total cholesterol level is 200 mg/dL or higher OR that your HDL (good cholesterol) is less than 40 mg/dL?

   

Has your father or brother had a heart attack before age 55, OR has your mother or sister had one before age 65?

   

Do you have diabetes OR a fasting blood sugar of 126 mg/dL or higher, OR do you need medicine to control your blood sugar?

   

Are you over 55 years old?    

Do you have a body mass index (BMI) score of 25 or more?    

Do you get less than a total of 30 minutes of physical activity on most days?

   

Has a doctor told you that you have angina (chest pains), OR have you had a heart attack?

   

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What to Ask You Health Care Provider

What are my numbers and what do they mean? Blood Pressure Cholesterol HDL and LDL Triglycerides BMI

Am I at risk for heart attack or stroke? What do you recommend to reduce my

risk?

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Healthy Lifestyle: A Family Affair

Eat a Heart Healthy Diet

Include a variety of fruits, vegetables, whole grains, dairy products, fish, legumes, poultry and lean meat.

Limit high fat foods after the age of 2. Limit salt intake to less than 6g a day. Limit the intake of sugar.

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Healthy Lifestyle: A Family Affair

Physical activity has the strongest protective effect against heart disease.

22% of adult Americans get the recommended amount of physical activity.

2 hours and 30 minutes (150 minutes) of moderate intensity aerobic activity every week.

Muscle strengthening activities on 2 or more days a week.

*CDC 2008 Physical Activity Guidelines for Americans

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Healthy Lifestyle: A Family Affair

Children should be physically active each day.

Include at least 60 minutes of moderate to vigorous fun physical activities.

Limit sedentary time watching TV, playing video games, talking on the phone, etc. to less than 2 hours a day.

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Healthy Lifestyle: A Family Affair

Don't smoke or use tobacco products.

Maintain a Healthy Weight. Manage stress in constructive ways. Know your family history.

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Gender Discrepancies in Care

Women receive fewer interventions to prevent and treat heart disease including:• Fewer cholesterol screenings• Fewer lipid-lowering therapies • Less use of heparin, beta blockers, and

aspirin during heart attack• Fewer referrals to cardiac rehabilitation

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Gender Discrepancies in Care

More women than men die of heart disease each year, yet women receive: 33% of angioplasties, stents and bypass

surgeries 28% of implantable defibrillators. 36% of open-heart surgeries Women comprise only 25% of participants

in all heart-related research studies.

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Managing Heart Disease

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Physical Evidence of Heart Disease

Signs of narrowed, enlarged, or hardened arteries

Weak/absent pulse below narrowed area of artery

Decreased BP in affected limb Bruits over arteries Aneurysm in abdomen or behind knee Evidence of poor wound healing in areas

where blood flow restricted

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Diagnostic Tests

Blood tests: cholesterol and blood sugar

Doppler ultrasound

Ankle-brachial index electrocardiogram (ECG)

Angiogram Ultrasound CT scan MRA

(magnetic resonance angiogram)

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Treatment and Medications

Cholesterol lowering medications, including statins and fibrates.

Anti-platelet medications, such as aspirin.

Anticoagulants, such as heparin or warfarin to reduce clots from forming by thinning blood.

Blood pressure medications, such as beta blockers, ACE inhibitors, and calcium channel blockers.

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Other Treatments

Angioplasty  Endarterectomy Thrombolytic therapy Bypass surgery

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Compared with Men.....

38% of women experiencing a heart attack will die within one year compared to 25% of men.

35% of women heart attack survivors will have another heart attack compared to 18% of men.

Women are almost twice as likely as men to die after bypass surgery.

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Heart Attack Warning Signs Chest discomfort:

Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest. It may last a few minutes or it may go away and come back.

Upper body pain: Pain or discomfort in one or both arms, the back, neck, jaw, or stomach.

Shortness of breath: Can occur before or along with chest discomfort.

Other symptoms: Cold sweatNauseaLightheadedness

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Women may be Different

Research by the National Institutes of Health (NIH) indicates that women often experience new or different physical symptoms as long as a month or more before experiencing heart attacks.

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Gender Differences in Myocardial Infarctions

NIH Study 95-percent said they knew their symptoms

were new or different a month or more before experiencing their heart attack.

Fewer than 30% reported having chest pain or discomfort prior to their heart attacks.

43% reported having no chest pain during any phase of the attack.

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Acute Symptoms Vomiting Nausea Pain in the right back, shoulder, arm,

throat, or neck Heavy sweating Shortness of breath Fatigue Indigestion or stomach pain

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Call 911

"Part of the reason women fare so badly immediately after a heart attack may be because they delay treatment and have more heart damage.“

Dr. Nieca GoldbergSpokeswoman for the American Heart Association

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Your Heart – Your Health Your Responsibility

1. Make a date and keep it2. Tone up as you tune in3. Grab H2O on the go

4. Out of sight, out of mouth5. Eat to live

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6. Shake the habit7. Kick butts8. Be a good loser9. Don’t let a slip keep you down10.Celebrate

Your Heart – Your Health Your Responsibility

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Resources Heart Disease and Stroke Prevention

Program• (850)254-4369• Susan_Allen@doh.state.fl.us• Carol_vickers@doh.state.fl.us

Websites:• http://www.doh.state.fl.us/Family/Heart• http://www.doh.state.fl.us/Family/heart/PDF/

cvd_surv_summ_2007.pdf• http://www.womenheart.org• http://www.americanheart.org• womentowomen.com