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The Little Red Dress: Understanding Gender Differences Concerning Cardiovascular Disease in Women

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Title: The Little Red Dress: Understanding Gender Differences Concerning Cardiovascular Disease in Women


1
The Little Red Dress Understanding Gender
Differences Concerning Cardiovascular Disease in
Women
  • By Jama C. Barker
  • Eileen Van Dyke Advisor
  • April 6, 2006

2
Objectives
  • Understand the differences in perception of
    severity of symptoms of CVD
  • Review the historical lack of inclusion of women
    in cardiac research
  • Understand gender differences in
  • Presentation
  • Diagnosis
  • Treatment

3
What is Cardiovascular Disease
  • Intricate topic encompassing all vessel diseases
    of the heart including
  • arrhythmias, angina, valvular disease,
    cardiomyopathy, heart failure, stroke and
    coronary artery disease.

4
Cardiovascular Disease
  • Claims more than 500,000 women each year.
  • Cardiovascular disease is the number one killer
    of women.
  • (American Heart Association, 2005)

5
Cardiovascular Disease
  • When women enter menopause, their risk of CVD
    increases two times that of premenopausal women.
  • Decreased estrogen levels also increases LDL
    levels and decreases HDL levels, therefore,
    further increasing a womans risk for
    cardiovascular disease.

6
Perception of Cardiovascular Disease
  • It was once believed that women were immune to
    cardiovascular disease.
  • This has been proven wrong but now
  • After sustaining a MI women perceive the severity
    of their symptoms to be less severe than men do
    following a MI.

7
Perception of Cardiovascular Disease
  • A retrospective study of men and women using a
    functional scale found that both sexes reported
    the same problems with physical, mental and
    general health status post myocardial infarction,
    but women did not recognize the severity of their
    disease.
  • Women rated their severity to be less than men.

8
Historical Background
  • Prior to 1990, in general, women were excluded
    from research studies.
  • The male model was established in the medical
    world as the normal physiological state.

9
Historical Background
  • Women were excluded from cardiovascular research
    studies due to the belief that coronary artery
    disease did not affect women (Caves,1998).

10
Clinical Presentation
  • Men
  • Prolonged Chest Pain
  • Radiates down left arm
  • Shortness of breath
  • Women
  • Nausea/Vomiting
  • Abdominal Pain
  • Jaw Pain
  • Back Pain
  • Dizziness

11
Clinical Presentation of MI in Women
  • Women also experience prodromal symptoms such as
  • Fatigue
  • Discomfort around the shoulder blades
  • Chest sensations

12
Diagnosis
  • Exercise electrocardiogram (EKG) is the gold
    standard for diagnosis of cardiovascular disease
    in men.
  • Women tend to have higher ejection fractions at
    rest and approximately thirty percent of women,
    when exercising, do not increase their ejection
    fraction.

13
Diagnosis
  • To exclude cardiovascular disease in women, they
    must have a normal resting EKG and no risk
    factors for cardiovascular disease.

14
Diagnosis
  • A woman who has an abnormal resting EKG or has
    risk factors such as a family history of
    cardiovascular disease, hypertension, diabetes
    mellitus, postmenopausal status, smokes, older
    than 65 years old etc., must undergo a cardiac
    imaging study rather than an exercise EKG
    (Wenger, 2005, Medscape, 2005).
  • Exercise or dobutamine echocardiography will
    increase the diagnosis specificity.

15
Diagnosis
  • Women have higher mortality rates due to
    arrhythmias than men.
  • Women have fatal arrhythmias as the first
    indicator of cardiovascular disease more often
    than men.

16
Diagnosis
  • Women have longer rate-corrected QT intervals
    than men.
  • It has been determined that males who have long
    QT intervals have a strong correlation with
    fatality post myocardial infarction, so there is
    an indication that since women have longer QT
    intervals, they may be at an increased risk for
    sudden cardiac failure. (Malloy, 1999)

17
Treatment
  • While the primary benefit of digoxin is to
    decrease hospitalizations, women have benefited
    less than men.
  • Women who had stable heart failure and were
    taking digoxin had higher death rates than men.

18
Treatment
  • Women had no decrease in cardiovascular events
    when taking an ACE inhibitor, whereas men had a
    17 reduction in cardiovascular events when
    taking an ACE inhibitor.

19
Treatment
  • Women also experience more side effects due to an
    ACE inhibitor.
  • Women have more side effects from
    anti-hypertensive drugs than men, including
    hyponatremia and hypokalemia.

20
Treatment
  • Thrombolytics such as tissue plasminogen
    activator, have been proven beneficial in both
    men and women but there is an increased risk of
    intracerebral hemorrhage in women, possibly
    because of inappropriate dosing due to smaller
    body size in women.

21
Treatment
  • Streptokinase and t-plasminogen activator was
    found to have a three-time higher 30-day
    mortality rate for women than men.
  • Women probably receive thrombolytic therapy later
    than men due prolongation of diagnosis.

22
Treatment
  • It has been found that women have smaller hearts
    than men and, therefore, smaller coronary
    arteries, which contributes to the more extensive
    complications that women have when they undergo
    invasive procedures such as angiography and CABG.
    (McCormick and Bunting, 2002, Caves 1998)

23
Treatment
  • A retrospective study of 345,000 outcomes
    concering coronary bypass surgery, since 1994
    showed that women had a significantly higher
    operative mortality rate than equally matched
    men. (Malloy, 1999)

24
Treatment
  • Lipid lowering drugs have shown to be more of a
    benefit in women than men. (Malloy, 1999)
  • The effects of pravastatin in women resulted in a
    43 reduction in risk of sudden cardiac death and
    nonfatal myocardial infarction and a 55
    reduction in stroke compared to placebo.

25
Treatments on the Horizon
  • Selective estrogen receptor modulators (SERMS)
  • Tamoxifen and Raloxifene have shown the
    capability of reducing LDL levels of cholesterol
    in postmenopausal women without affecting high
    density lipoproteins or triglycerides.

26
Conclusion
  • When women go to their medical providers seeking
    attention for their symptoms, they are often not
    treated as a medical emergency.
  • Clinicians need to be able to recognize
    cardiovascular disease in women just as rapidly
    as they do in men.

27
Conclusion
  • Since coronary artery disease occurs in women
    approximately 10 years later than men due to the
    protective benefits that estrogen provides prior
    to menopause, women have more time to incorporate
    prevention into their lifestyles.

28
Conclusion
  • Women need to be aware of risk factors for
    cardiovascular disease in order to protect
    themselves, especially when they have a positive
    family history. Such risk factors as sedentary
    lifestyle, smoking, obesity, diabetes,
    hyperlipidemia and hypertension can be changed
    over time with education.

29
Conclusion
  • Cardiovascular disease is an equal opportunity
    killer, meaning there is no immunity from the
    disease based on sex.

30
References
  • American Heart Association. Women and Coronary
    Heart Disease. http//www.americanheart.org/prese
    nter.jhtml?identifier2859. Accessed on 06
    November 2005.
  • Blake, Mary B. et al. Inclusion of Women in
    Cardiac Research Current Trends and Need for
    Reassessment. Gender Medicine. 2005. Vol. 2.
    No. 2.
  • Caves, Whynne. Women and Heart Disease Same
    Disease, Different Issues. Canadian Journal of
    Cardiovascual Nursing. 1998. 9(2)29-33.
  • Clearfield, Michael. The Role of Statin Therapy
    and Hormone Replacement Therapy. Medscape.
    http//www.medscape.com/viewarticle/484038_1.
    2004. Accessed on 11 November 2005.
  • Endoy, Mara P. CVD in Women Risk Factors and
    Clinical Presentation. The American Journal for
    Nurse Practitioners. Vol. 8. Issue 2. 2004.
  • Grimes, William. Myocardial Infarction.
    University of Kentucky. 12 October 2005.
  • Hirao-Try, Yumiko. Hypertension and Women
    Gender Specific Differences. Clinical Excellence
    for Nurse Practitioners. 2003. Vol. 7. No. 1-2.

31
References
  • Kip, Kevin E. et al. Global inflammation
    predicts cardiovascular risk in women A report
    from the Womens Ischemia Syndrome Evaluation
    (WISE) study. American Heart Journal. 2005.
    Vol. 150. No. 5.
  • Malloy, Kevin J. and Anthony Bahinski.
    Cardiovascular Disease and Arrhythmias Unique
    Risks in Women. 1999. J Gend Specif Med.
    Jan-Feb. 2(1) 37-44.
  • McCormick, Kim M. and Sheila M. Bunting.
    Application of Feminist Theory in Nursing
    Research The Case of Women and Cardiovascular
    Disease. Health-Care-for-Women-International.
    Vol. 23. Issue 8. Page 820-34. December 2002.
  • Medscape. Cardiovascular Disease May Be
    Overlooked in Women. http//www.medscape.com/vie
    warticle/416554_2. 2005. Accessed on 06
    September 2005.
  • Medscape. Risk Factors for CVD in Women.
    http//www.medscape.com/viewarticle/416554_3.
    Accessed on 06 September 2005.
  • Mosca, Lori. Cardiovascular Disease New
    Recommendations for Minimizing the Threat. The
    Female Patient. March 2002.
  • Nau, David P. et al. Gender and perceived
    severity of cardiac disease Evidence that women
    are tougher. The American Journal of Medicine.
    2005. Volume 118. Number 11.

32
References
  • Steffen, Kristen A. et al. Changing Protocols in
    the Care of Women. Emergency Medicine. March
    2004.
  • Wenger, Nanette K. Noninvasive Testing to
    Evaluate Coronary Heart Disease in Women.
    Womens Health in Primary Care. 2005. Vol.8. No.
    5.
  • Zaman, Amin M. and Suzanne Oparil. Identifying
    Hypertension in Postmenopausal Women
    Understanding the effects of Age and Sex.
    Womens Health in Primary Care. Volume 5 Number
    9. September 2002. P 571-578.
  • Zuzelo, Patti Rager. Gender and Acute Myocardial
    Infarction Symptoms. Medsurg Nursing. 2002. Vol.
    11. No.3.
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