1. 1 Women & Heart Disease Julia C. Orri, Ph.D. Biol. 330 November 21, 2006

2. 2 Objectives  List the trends in heart disease for women  Name the risk factors for CAD  Define atherosclerosis, MI  Compare MI signs between men and women  Explain gender differences in heart disease  Describe strategies to decrease CAD risk in women

3. 3 233,886 41,566 67,894 American Heart Association, 2006 Deaths From Breast Cancer, CAD, and lung Cancer (2003)

4. 4 Women & CVD Only 13% of women in America believe that CAD and stroke are the greatest health threats to women.

5. CDC, 2006

6. 6 Women & CVD Facts  Nearly 39% of all female deaths occur from CVD  The death rate due to CVD is substantially higher in African American women than in Caucasian women

7. 38% of women compared to 25% of men will die within 1 year after a heart attack. American Heart Association, 2006

9. Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sex NHANES: 1999-2002 American Heart Association. Heart Disease and Stroke Statistics-2005 Update

10. 10 ALOHA to Heart Disease  A- Assess your risk

11. 11 Positive Risk Factors for CAD  Family history  Hypercholesterolemia  Hypertension  Cigarette smoking  Impaired fasting glucose  Obesity  Physical inactivity

12. 12 Quiz  Holly, 42 years old  MI Runner Non-smoker Non-HT Low cholesterol

13. 13 Daily Physical Activity (PA) Every U.S. adult should accumulate 30 min or more of moderate-intensity physical activity on most, preferably all, days of the week. (U.S Surgeon General, CDC, ACSM)

14. 14 ALOHA to Heart Disease  A- Assess your risk  L- Lifestyle change  O- Other interventions  H- Highest risk women: highest priority  A- Avoid… Mosca. Circulation, 2004; 109: 158-160

15. 15 LDL DIABETES MELLITUS HT SMOKING

16. 16 Coronary Artery Disease (CAD)

17. Normal?

18. Coronary Artery Disease (CAD) AtherosclerosisNormal

19. 19 CAD (con’t)

20. 20 CAD (con’t)  Atherosclerosis Plaque narrows coronary arteries Results in ischemia Leads to myocardial infarction (MI)

21. 21 Thrombosis of Coronary Artery

22. CAD (con’t) Myocardial Infarction

23. Myocardial Infarction (MI)

24. 24 MI Signs  Severe chest pain/pressure  Sweating, nausea, vomiting   cardiac enzymes  ECG changes

25. 25 The Female Heart

26. 26 What’s your diagnosis?  Stella, aged 68  Symptoms Sleep disturbance Unexplained fatigue SOB Indigestion/nausea Pain in back and high chest

27. 27 The Female Heart  38.2 million women have CVD  Silent MI more common  Atypical chest pain  Delayed diagnosis  Underutilized prevention & research

28. 28 Female Heart (con’t)  45 million women older than 50 yr  Smoking cessation rates declining slower than among men  Abdominal obesity  3-7x  in CAD risk if diabetic

29. More visceral abdominal fat (light) = greater health risk

30. 30 Female Heart (con’t)  Worse prognosis for women with CAD than men  Women had 2x in-hospital mortality rate  Age, size of coronary arteries, severity of sickness at presentation Fatality rate

31. 31 Take-Home Message  Women have worse prognosis and die more often than men after MI or bypass  CAD is largely preventable  Major emphasis on lifestyle modifications: smoking cessation, regular PA, maintenance of healthy weight, lipid lowering therapy

32. 32 Thank you! Any questions?  jorri@usfca.edu