1. Better Health. No Hassles. Megan McCarren and Valerie Hacker Pacific Lutheran University November 2007 Women and Heart Disease

2. Better Health. No Hassles. What is a Heart Attack?

3. Better Health. No Hassles. Source: AHA Heart and Stroke Statistical Update, 2003  Since 1984, the number of deaths for women has exceeded those for males. Heart Disease Is Not Just A Man’s Disease

4. Better Health. No Hassles.  More women in every age group die from heart disease than breast cancer  One in two women will die of heart disease (breast cancer is one in ten)  Two-thirds of women who die from a heart attack, have no previous symptoms of the disease  Women die twice as often after a heart attack as compared to men More Facts

5. Better Health. No Hassles.  Most of the research on heart disease has been done on men.  Physiological differences between men and women leading up to a heart attack  Symptoms are different between men and women  Problem of awareness and perception Why do Gender Differences Exist?

6. Better Health. No Hassles.  Anatomy: Smaller heart arteries  Physiology: Estrogen has a protective effect in women  Pathology: Less likely to have total blockage of heart arteries How are Women Different?

7. Better Health. No Hassles.  Cholesterol Level- High cholesterol more common in older women than men  Blood Pressure– Pregnancy and some BCPs can increase risk of high blood pressure  Diabetes- Increases heart disease risk in women up to 7 times (men up to 3 times)  Smoking- Combination of smoking and BCPs increases risk  Age- women experience symptoms 10 years later  Physical inactivity- osteoporosis and other age-related conditions may limit ability to exercise Are there Differences in Risk Factors?

8. Better Health. No Hassles.  Women may have “typical” or “atypical” symptoms typical: crushing chest pain traveling down the left arm, nausea atypical: shortness of breath, abdominal pain indigestion, fatigue  Atypical symptoms lead to delays in treatment because the symptoms are vague and associated with other medical conditions  Delayed treatment often means poorer outcomes How are Women’s Symptoms Different?

9. Better Health. No Hassles.  Women will show up one hour later to the Emergency Room, as compared to men  Women are less likely to complain of “heart attack” symptoms  Women will continue activities when feeling ill  The bottom line: women are less likely to seek rapid and appropriate care when their symptoms start. This causes significant delays in treatment. Denial is Part of the Problem

10. Better Health. No Hassles.  Compared to men, women are: -7% less likely to receive clot dissolving drugs during the first hour of heart attack treatment -6% less likely to receive aspirin within the first 24 hours of hospital care -More likely to receive a “do not resuscitate” order  Some diagnostic tests and procedures, including the exercise stress tests, are less accurate in women. Are There Gender Differences in Care?

11. Better Health. No Hassles.  Need more gender-specific research and development of clinical guidelines  Women need to demand that there be more gender specific care  Need more gender-specific diagnostic testing (example: 80 lead EKG) What is Needed to Bridge the Gender Gap?