Post on 16-Dec-2015
transcript
Heart Disease in Women
10 Things
Every Woman Should Know About Heart Disease
Susan P. D’Anna ARNPClinical Instructor in MedicineSection 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: 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
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
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
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
di o
v as c
ula
r D
isea
s e 4
1%
Cancer 22%
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
Cholesterol: Low blood levels of “good” cholesterol (HDL) and high triglycerides are stronger
predictors of heart disease death in women than in men
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
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
#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
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
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.
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
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
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
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
#4 Heart Attacks Are Caused by Coronary Artery Disease (CAD)
Obstructed coronary artery
Diffuse narrowing in coronary artery
#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
#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
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 clots2X 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
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
#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
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
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.
#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
#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
#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
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
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/
You Can Make a Difference
Be a leader in your community for women’s cardiovascular disease
through . . .
Research
Advocacy
Awareness