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 Disease315, 000 Stroke 82, 000 Lung Cancer71, 000 Chronic Obstructive Lung Disease65, 000 Breast Cancer41, 000 Source: 2006 CDC & American Cancer Society

Cardiovascular Disease Mortality Trends for Males & Females United States:

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: –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

Smoking cessation Physical activity Heart healthy diet Weight reduction/maintenance Lifestyle Interventions 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

Healthy food selections: 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) Diet Source: Mosca 2004

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 Weight Maintenance/Reduction Goals Source: Mosca 2004, ATP III 2002

Recommendation: Lifestyle and pharmacotherapy should be used to achieve near normal HbA1C (<7%) in women and men with diabetes Diabetes Source: Grundy 2004

Source: Adapted from Krolewski 1991

Benefits of ASA in Women with Established CAD Source: Adapted from Harpaz 1996

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 low- dose 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 Preventive Drug Interventions Source: NHLBI

Antioxidant supplements –No cardiovascular benefit in randomized trials of primary and secondary prevention Interventions that are not useful or effective and may be harmful for the prevention of heart disease Source: Mosca 2004

Resources

Resources

Getting the Message Out

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."

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