Heart Disease in Women

1
Heart Disease in Women
Susan P. DAnna ARNP Clinical Instructor in
Medicine Section of Cardiology - DHMC
2
1 Cardiovascular Disease Is the Number 1 Cause
of Death in American Women

• Myth
• Heart disease is a mans disease
• Fact
• Each year heart disease kills more women than men
• 38 of women die within one year of suffering a
  heart attack (compared to 25 of men)

CDC National Vital Statistics Report, Vol.49,
No., 11 2001 Adapted from the American Heart
Association website, 2002
3
Heart Disease Affects Women in Every Age Group
AHA 2003 Heart and Stroke Statistical Update
20028.
4
Women Do Not Perceive Heart Disease as Their
Major Health Threat
Female Perception of Their Greatest Health Risk
61
Women still fear cancer most
1997
7
62
2000
8
51
2003
13
Awareness of Leading Cause of Death for Women
50
But, awareness is improving
1997
30
40
2000
34
35
2003
46
Source Tracking Womens Awareness of Heart
Disease AHA National Study Circulation
2004109573-579.
5
Cardiovascular Disease 41
Cancer 22
Source National Vital Statistics Report, Vol.
50, No. 15, September 16, 2002
6
(No Transcript)
7
2 Risk Factors Help Predict Who Is at Risk to
Develop Coronary Artery Disease

• Age As women grow older, the chance of
  developing heart disease increases (especially
  after the onset of menopause) The risk of CAD
  increases 2 to 3 times after menopause
• Race African-American women have a higher risk
  of death from heart disease than white women

women.americanheart.org
8

• Cholesterol Low blood levels of good
  cholesterol (HDL) and high triglycerides are
  stronger predictors of heart
  disease death in women than in men

9

• Blood Pressure More than half of all women
  over 55 have high blood pressure, which
  increases their risk of heart disease, stroke
  and other serious conditions
• Diabetes Increases the risk of heart disease
  3-7 fold
• A more powerful risk for heart disease in
  women than in men

Jneid and Thacker, Cleveland Clinic J of Med.
2001 441-448 women.americanheart.org
10
Why Women Dont Take Action Against Heart Disease

• They dont put their health as a top priority
• They think theyre not old enough to be at risk
• They feel too busy to make changes in their lives
• Theyre already feeling stressed
• They dont have the familial and social support

11
3 Womens Experience of Heart Disease Is
Different Than Mens

• Women are more likely to die within one year
  after a heart attack
• Women are less likely to survive coronary artery
  bypass surgery
• Women are more likely to experience complications
  after angioplasty
• Women are more likely to have life threatening
  arrhythmias (irregular heart beats)

These differences may be partially due to
hormones, a womans smaller heart size and
advanced age at diagnosis
Wenger, N.K., J. Am. Med. Womens Assoc.
199449181 Wenger, N.K., Int. J. Fertile Womens
Med. 1998 4384
12
Traditional Heart Attack Warning Signs

• Pressure, burning, squeezing in the center of the
  chest
• Discomfort in one or both arms, shoulders, neck,
  jaw, stomach, or back
• Shortness of breath
• Fatigue, cold sweat, nausea, weakness

Adapted from the Harvard Medical School website
www.harvard.health.edu
13
Symptoms of Coronary Heart Disease Can Differ in
Women

• Pain in upper back, jaw or neck
• Shortness of breath
• Flu-like symptoms nausea or vomiting, cold
  sweats
• Fatigue or weakness
• Feelings of anxiety, loss of appetite, discomfort

Adapted from the Harvard Medical School website
www.harvard.health.edu
14
Severity of Heart Disease Men and Women
Men Women
AHA 2003 Heart and Stroke Statistical update
200212, 14, 17
15
61 million Americans with CVD
48 are men
52 are women
1
1
Yet, more men are being treated than women
2
3
3
4
4
1. The AHA 2001 Heart and Stroke Statistical
Update 3. PTCI J Am Coll Card 2002 Apr 3
39(7)1096-103 2. CABG Ann Thorac Surg 2001 Feb
71(2)512-20 4. Estimated from internal
Guidant records
16
Heart Disease Gender Bias or Sex Difference?

• Data used for the care of women derived from
  studies conducted in middle-aged men
• Initial efforts for prevention focused more on
  men than women
• Women and doctors often attribute chest pain in
  women to noncardiac causes

Exploring the Biological Contributions to Human
Health-Does Sex Matter Institute of Medicine 2001
17
Heart Disease Gender Bias or Sex Difference?

• Women tend to have heart attacks later in life
  than men
• Women present more often than men with atypical
  symptoms
• Some diagnostic tests and procedures may not be
  as accurate in women
• Heart disease may be different in women and men

Exploring the Biological Contributions to Human
Health-Does Sex Matter Institute of Medicine
2001
18
4 Heart Attacks Are Caused by Coronary Artery
Disease (CAD)
19
Obstructed coronary artery
Diffuse narrowing in coronary artery
20
5 Know Which Tests are More Effective in Women
Shaw et al. Card. In Review, 2000 65-74
21
6 Estrogen and Menopause May Be Related to Heart
Disease

• Estrogen increases production of good
  cholesterol (HDL)
• As estrogen decreases, women experience lower
  levels of good cholesterol (HDL) and the
  flexibility in arteries decreases.
• Women will live one third of their lives after
  menopause
• Hormone Replacement Therapy (HRT) should not be
  used for the purpose of reducing the risk of
  cardiovascular disease in women

Jneid and Thacker, Cleveland Clinic J of Med.
2001 441-448
22

• Increased Risk
• Heart attack 29
• Breast cancer 26
• Blood clots 2X
• Strokes 41
• Dementia
• Ovarian Cancer
• Strokes
• Probable dementia or memory loss

• Decreased Risk
• Hip fractures 34
• Colorectal cancer 37
• Cancer of uterine lining
• Hip fractures

• No Effect
• Quality of life
• Number of deaths
• Breast cancer
• Heart disease

Estrogen plus progestin - July 2002
Estrogen alone March 2004
WHI Had Unexpected Results
Source JAMA 2002 288321-333 National
Institutes of Health mdash study shows a
trend toward increase in risk
23
CONCLUSIONS of WHI

• After a 5.2 year follow up
• Health risks exceeded benefits of combined
  estrogen plus progestin
• All-cause mortality was not affected
• This regimen should not be initiated or continued
  for primary prevention of CHD.

JAMA 2002 288321-333
24
7 More Research on Women and Heart Disease Is
Needed

• Historically, women have been under-represented
  in clinical trials related to heart disease
• There is little knowledge regarding the effects
  of commonly used cardiovascular drugs in women
• Practice patterns are based on research in
  middle-aged men that may not apply to older women
• There is limited information regarding therapies
  used to treat heart disease in the very elderly

Evelyn et al. Women's Participation in Clinical
Trials and Gender-Related Labeling FDA special
report http//www.fda.gov/cder/reports/womens_heal
th/women_clin_trials.htm
25
Enrollment of Women in CVD Trials

• 1993 NIH mandated inclusion of women in
  federally funded clinical research
• Enrollment increasing for women, but with
  single-sex trials excluded, enrollment rate was
  38, unchanged over time
• No change in gender composition of cohorts in
  majority of studies
• Federal efforts have been only moderately
  successful, mainly due to small number of large
  single-sex trials
• Even when women are included in trials, rarely
  are the results broken-out

NEJM 2000343-475
26
Representation of Women in Studies of CAD Testing
Adapted from Shaw LJ et al. Coronary Artery
Disease In Women What All Physicians Need to
Know. 1999372.
27
8 There Are a Variety of Options Available to
Treat Heart Disease

• Medications including Aspirin
• Balloon angioplasty and stenting
• Heart bypass surgery
• Pacemakers for slow heart rhythms and
  defibrillators for rapid heart rhythms

28
9 Women Can Take Action to Lower the Risk of
Heart Disease

• Know your risk factors
• Stop smoking
• Maintain a healthy body weight
• Eat a nutritious balanced diet low in saturated
  fats
• Monitor and manage blood pressure and diabetes
• Exercise regularly
• Limit alcohol intake
• Learn stress management skills
• Maintain social relationships
• Know the warning signs for heart attack and
  stroke

29
10 Women Can Save Lives

• If you or someone you know has risk factors for
  heart disease, adopt a heart healthy lifestyle
  and discuss a plan of care with your physician
• If you experience symptoms of heart attack or
  stroke, call 911 immediately
• LEARN CPR

30
Why Focus on Womens Cardiovascular Health?

• Cardiovascular disease is the largest killer of
  American women and CVD mortality in women is
  rising at a disproportionate rate compared to men
• The majority of American women are
  unknowledgeable about their personal risk for CV
  disease
• Changing a womans CV risk from higher risk to
  lower risk with present medical knowledge and
  tools reduces her chance of coronary events
• Women are often decision makers for the family

Adapted from American Heart Association and the
Nurses Health Study
31

• The following organizations can provide
  information on heart disease
• American Heart Association
• 800-242-8721
• http//www.americanheart.org
• AHA's mission is to reduce disability and death
  from cardiovascular diseases and cardiovascular
  diseases and stroke. Several consumer
  publications are available through AHA, including
  the AHA Guide to Heart Attack Treatment, Recovery
  and Prevention.
• Health and Human Services
• Office of Women's Health
• 1-800-994-WOMAN (96626)
• http//www.4women.gov
• OWH investigates a broad spectrum of women's
  health activities across governmental offices and
  agencies. It also sponsors the National
  Information Center, which links the general
  public to a wide variety of health-care resources
  and publications, including those related to
  heart disease.
• National Heart, Lung, and Blood Institute
• 301-592-8573
• http//www.4women.gov, www.hearttruth.gov
• The NHLBI publishes the Healthy Heart Handbook
  for Women (http//www.nhlbi.nih.gov/health/public/
  heart/other/hhw/index.htm), which features the
  latest information on preventing cardiovascular
  diseases. The publication also helps women
  develop a personal action plan for reducing the
  major risk factors. In addition, The Heart Truth
  website contains helpful information.

32
You Can Make a Difference

• Be a leader in your community for womens
  cardiovascular disease through . . .

Research Advocacy Awareness
33
(No Transcript)