Hispanic Women and Heart Disease Sallie Alvarez March 12,2013

Demographics  Hispanics constitute one of the fastest- growing racial/ethnic groups in the United States  By 2050, Hispanics are expected to number 97 million and account for nearly one- quarter of the U.S. population. (Morales, Lara, Kington, Valdez & Escarce, 2007)

Heart Disease  About 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths.  Heart disease is the leading cause of death for both men and women.  Coronary heart disease is the most common type of heart disease, killing more than 385,000 people annually.  Every year about 935,000 Americans have a heart attack. Of these, 610,000 are a first heart attack. 325,000 happen in people who have already had a heart attack.  Coronary heart disease alone costs the United States $108.9 billion each year. This total includes the cost of health care services, medications, and lost productivity. ("Heart disease facts," 2012)

Heart Disease and Women  Heart disease causes 1 in 3 women’s deaths each year, killing approximately one woman every minute.  90 percent of women have one or more risk factors for developing heart disease.  Since 1984, more women than men have died each year from heart disease and the gap between men and women’s survival continues to widen.  While 1 in 31 American women dies from breast cancer each year, 1 in 3 dies of heart disease. (Go red for Women, 2012)

Heart Disease and Hispanic Women  Hispanic women are likely to develop heart disease 10 years earlier than Caucasian women.  Only 1 in 3 Hispanic women are aware that heart disease is their No. 1 killer.  Only 3 in 10 Hispanic women say they have been informed that they are at a higher risk.  Only 1 in 4 Hispanic women is aware of treatment options.  Hispanic women are more likely to take preventive actions for their family when it comes to heart health. (Go Red for Women, 2012)

Anatomical Differences  Women are smaller in stature and have smaller coronary arteries  Women deposit plaque differently causing impairment in vasodilator response  Women’s resting heart rate is higher  Lower blood volume and lower oxygen capacity  Greater percentage of fat in women (Netce, 2011)

Risk Factors  Age  Family history  High blood pressure  High cholesterol  Smoking  Overweight  Diabetes  Metabolic Syndrome  Lack of Physical Activity  Less than 5 servings of fruit and vegetable a day (Hintz, 2010)

Gender Specific Risks  Employment Role Conflict- higher stress at the job increases risk comparable to men  Oral Contraceptives increases MI risk  Menopause causes lowered estrogen levels which increases LDL levels (Netce, 2011)

Prevalence of Risk Factors for Hispanic Women in the U.S.  Hypertension= 23.5%  Hyperlipidemia= 36.9%  Obesity= 42.6%  Diabetes= 17.2%  Smoking= 15.2% (Daviglus, 2012)

Healthy People 2020 Goal Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events. (CDC, 2012)

Social Factors  Language barriers leads to poor outcomes  Low education/cognition  Lack knowledge to seek out resources to get help  Geographic location makes it difficult to get to health care resources where women sometimes do not drive. (Morales, Lara, Kington, Valdez & Escarce, 2007 )

Political Factors  High levels of immigration from Latin America have created a large foreign- born and Spanish-speaking Hispanic population in the United States.  Some illegal residents afraid to seek medical care, fearing deportation.  As many as 98 percent report speaking primarily Spanish at home, while only 24 percent report speaking English very well. (Morales, Lara, Kington, Valdez & Escarce, 2007)

Political Factors Organizations making strides against health disparities and promoting Hispanic health awareness and interventions.  The National Alliance for Hispanic Health  National Council of La Raza  The Hispanic Health Council  The National Hispanic Health Foundation  The Office of Minority Health (Gillette, 2012)

Economic Factors  A 2009 Gallup poll found that 41.7 percent of Hispanics lacked health insurance (Gillette, 2012)  While the median family income for all Americans was $42,299, the median income for Hispanic families was $26,178 (Morales, Lara, Kington, Valdez & Escarce, 2007)  No primary care physician- studies have shown that Hispanics seek out less medical care  Limited or no money for preventive care

Cultural Factors  Woman takes care of family and husband but puts herself last  Unhealthy cooking ingredients i.e. pork and lard  Communication barriers exist with health- care workers since Spanish is primary language  Exercise is not seen as necessary to improve health

Preventing Heart Disease  Stop smoking  Monitor Blood pressure  Exercise regularly  Control Blood sugar  Eat diet low in fat/salt/cholesterol  Know your risk factors  Debunk myths

Primary Prevention  During office visits, check all risk factors and educate patient on all parameters.  Health Fair in churches, neighborhoods to target Hispanic women and nurses will check blood pressures, blood sugars, weight, and risk factors  Nurses will educate on diet choices to help chose meals that help modify cultural favorite foods into healthy meals.  Nurses will provide different alternatives to incorporate exercises into participant’s lifestyle.

Secondary Prevention  Early detection and knowledge of symptoms.  Review medication compliance if applicable  Knowing when to call physician/911. Early intervention increases damage to heart and or may help prevent death.  Encourage follow up EKGs, stress test, blood work to monitor any changes

Tertiary Prevention  Cardiac rehabilitation  Home health care to reinforce need to stay on necessary medications  Educate patient on need for regular physician nurse follow-up

Outcomes  Education critical for knowledge of preventative measures  Better awareness of risk factors  Better awareness of symptoms and need for early intervention

Resources  American Heart Association  Centers of Disease Control  Health Department  Blood Pressure Screenings at pharmacies  Primary Care Physician

References American Heart Association (2012). Heart disease statistics at a glance. Retrieved from disease/facts_about_heart_disease_in_women-sub-category/statistics-at-a-glance/ Centers for Disease Control and Prevention, Division For Heart Disease and Stroke Prevention. (2012). Heart disease facts. Retrieved from Daviglus, M. L., Talavera, G. A., Avilés-Santa, M. L., Allison, M., Cai, J., Criqui, M. H., Stamler, J. (2012). Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the united states. JAMA: The Journal of the American Medical Association, 308(17), doi: /jama

References Gillette, H. (2012, July 5). Top 5 hispanic organizations in the u.s.. Retrieved from Gillette, H. (2012, August 2). What are the main issues affecting hispanics in the U.S.?. Retrieved from Go Red for Women (2012). Causes and prevention of heart disease. Retrieved from disease/facts_about_heart_disease_in_women-sub-category/causes-prevention/ Healthy People 2020 (2012). Heart disease and stroke. Retrieved from =21#seven Hintz, K. (2010, April 27). Ways to lower your blood pressure without medication. Retrieved from

References Morales, L. S., Lara, M., Kington, R. S., Valdez, R. O., & Escarce, J. J. (2007). Socioeconomic, cultural, and behavioral factors affecting hispanic health outcomes. National Institute of Health, 13(4), doi: / Netce Continuing Education for Healthcare Professionals (2011). Women and heart disease. Retrieved from Sherrod, M., McIntire. (2011). Hispanic women's symptoms of coronary heart disease: Are they different? Hispanic Health Care International, 9(1), doi: