1. Hispanic Women and Heart Disease Sallie Alvarez March 12,2013

2. 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)

3. 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)

4. 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)

5. 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)

6. 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)

7. 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)

8. 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)

9. 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)

10. 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)

11. 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 )

12. 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)

13. 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)

14. 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

15. 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

16. 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

17. 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.

18. 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

19. 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

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

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

22. References American Heart Association (2012). Heart disease statistics at a glance. Retrieved from http://www.goredforwomen.org/about-heart- 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 http://www.cdc.gov/heartdisease/facts.htm 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), 1775-1784. doi: 10.1001/jama.2012.14517

23. References Gillette, H. (2012, July 5). Top 5 hispanic organizations in the u.s.. Retrieved from http://www.voxxi.com/hispanic-health-organizations/ Gillette, H. (2012, August 2). What are the main issues affecting hispanics in the U.S.?. Retrieved from http://www.voxxi.com/health-issues-hispanics/http://www.voxxi.com/health-issues-hispanics/ Go Red for Women (2012). Causes and prevention of heart disease. Retrieved from http://www.goredforwomen.org/about-heart- disease/facts_about_heart_disease_in_women-sub-category/causes-prevention/ Healthy People 2020 (2012). Heart disease and stroke. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid =21#seven Hintz, K. (2010, April 27). Ways to lower your blood pressure without medication. Retrieved from http://www.examiner.com/article/ways-to-lower-your-blood-pressure-without-medication

24. 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), 477-503. doi: 10.1177/104920802237532 Netce Continuing Education for Healthcare Professionals (2011). Women and heart disease. Retrieved from http://www.netce.com/coursecontent.php?courseid=698http://www.netce.com/coursecontent.php?courseid=698 Sherrod, M., McIntire. (2011). Hispanic women's symptoms of coronary heart disease: Are they different? Hispanic Health Care International, 9(1), 5-12. doi: http://dx.doi.org.ezproxy.lib.ucf.edu/10.1891/1540-4153.9.1.5http://dx.doi.org.ezproxy.lib.ucf.edu/10.1891/1540-4153.9.1.5