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Heart Disease in Women How to Protect Yourself

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What are the risk factors for heart disease? What is the role of ... Cardiac Catheterization/Coronary angiogram. CAT scan- calcium score. MRI of the heart ... – PowerPoint PPT presentation

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Title: Heart Disease in Women How to Protect Yourself


1
Heart Disease in Women How to Protect Yourself
  • Banu Mahalingam MD, FACC, RCS.
  • Cardiology Associates Of Princeton

2
Heart disease in women
  • Facts about heart disease in women
  • How does the heart work?
  • How to diagnose heart disease?
  • What are the risk factors for heart disease?
  • What is the role of hormone replacement therapy?
  • What are the latest updates?
  • What to expect in the future?

3
Coronary Heart Disease
  • Prevalent and preventable
  • 600,000 deaths of which coronary heart disease is
    the direct cause of 460,000
  • 1.1 million myocardial infarction/heart attacks
    of which 650,000 are first infarctions
  • An economic burden of 101 billion
  • From 1988 to 1998, death rate from CAD has
    declined

4
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5
Comparison of deaths from CV disease and breast
cancer, by age
Heart Disease
Breast Cancer
6
Heart disease in women
  • More women present with atypical symptoms
  • More frequent silent MI
  • Mortality rate of MI and bypass surgery are 50
    higher in women
  • Cholesterol lowering has shown similar efficacy
  • Cardioprotective agents have similar efficacy
  • Treatment rates tend to be lower
  • Diabetes is a particularly serious risk factor

7
Compared with Men
  • 38 of women and 25 of men will die within one
    year of a first recognized heart attack
  • 35 of women and 18 of men heart attack
    survivors will have another heart attack within
    six years
  • 46 of women and 22 of men heart attack
    survivors will be disabled with heart failure
    within six years

8
Compared with Men
  • Women are almost twice as likely as men to die
    after bypass surgery
  • Women are less likely than men to receive
    beta-blockers, ACE inhibitors or even aspirin
    after a heart attack
  • Women constituted less than 25 of the research
    patient population

9
At-Risk
  • The age-adjusted rate of heart disease for
    African American women is 72 higher than for
    white women
  • Women who smoke risk having a heart attack 19
    years earlier than non-smoking women
  • Women with diabetes are two to three times more
    likely to have heart attacks

10
At-Risk
  • High blood pressure is more common in women
    taking oral contraceptives, especially in obese
    women
  • 39 of white women, 57 of black women, 57 of
    Hispanic women, and 49 Asian/Pacific Islander
    women are sedentary and get no leisure time
    physical activity
  • 23 of white women, 38 of black women, and 36
    Mexican American women are obese

11
Compared with Men
  • More women than men die of heart disease each
    year, yet women receive only
  • 33 of angioplasties, stents and bypass surgeries
  • 28 of implantable defibrillators and
  • 36 of open-heart surgeries
  • Women comprise only 25 of participants in all
    heart-related research studies

12
Normal Coronary Anatomy
13
Current Path in Cardiac Muscle
14
Microscopic Pathology of Atherosclerosis
15
What is a Heart Attack?
  • A heart attack occurs when the blood supply to
    part of the heart muscle itself - the myocardium
    - is severely reduced or stopped. The medical
    term for heart attack is myocardial infarction
  • This is usually caused by the buildup of
    cholesterol plaque.

What causes a Heart Attack?
16
During a Heart Attack
17
Myocardial Infarction
18
Detecting Coronary heart disease
  • EKG
  • Stress testing
  • Echocardiogram
  • Cardiac Catheterization/Coronary angiogram
  • CAT scan- calcium score
  • MRI of the heart

19
Normal Thallium Stress Test
20
Abnormal Stress Test
21
Cardiac Catheterization
  • Catheters are also used to inject dye into the
    coronary arteries. This is called coronary
    angiography
  • It's also used to get information about the
    pumping ability of the heart muscle.

22
Coronary Blockage
23
Risk Factors for Heart Disease
  • High Blood Pressure - Hypertension
  • High Blood Sugar - Diabetes Mellitus
  • High Cholesterol
  • Smoking
  • Age/Gender
  • Family History
  • Obesity

24
High Blood Pressure
  • Silent Killer
  • Uncontrolled high blood pressure can lead to
    stroke, heart attack, congestive heart failure or
    kidney failure
  • The only way to tell if you have high blood
    pressure is to have your blood pressure checked

25
High Blood Pressure
  • One in four adult Americans has high blood
    pressure, and nearly one-third of them don't know
    they have it
  • Remember, high blood pressure has no symptoms, so
    if you haven't had it checked in a while, make an
    appointment now.
  • Normal BP 120/80

26
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27
Hypertension
  • Know what your Blood Pressure is
  • Educate yourself on self measurement of BP
  • Understand the role of Diet and Exercise in
    maintaining BP

28
Diabetes Mellitus
  • Diagnosed by checking Fasting Blood Sugars
  • Can be silent/asymptomatic
  • Leading cause of complication from coronary
    artery disease
  • Completely negates the positive effect of
    estrogen in pre-menopausal women

29
Diabetic Patient
  • If you are a diabetic know your
  • Hemoglobin A1C

30
Cigarette Smoking
  • Most preventable cause of Heart Attacks
  • Responsible for 400,000 premature deaths in the
    U.S. annually
  • Nonsmokers and former smokers have significantly
    lower rates of Heart attacks than smokers
  • 7-47 reduction in mortality following smoking
    cessation

31
Dietary Management of Heart Disease
32
Diet modification
  • More complex carbohydrate
  • More fruits, vegetables and legumes
  • More fish
  • Less meat
  • Less whole milk products
  • Alpha-linolenic acid enriched canola oil
    margarine

33
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34
Lipid panel
  • Total cholesterol lt200
  • LDL cholesterol lt130
  • HDL cholesterol gt40
  • Triglycerides lt200

35
Benefits of Cholesterol Reduction
36
Effect of Aspirin on Survival
37
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38
Estrogen/Progestin Therapy also Resulted in
  • 41 increase in strokes
  • 29 increase in heart attacks
  • Doubled rates of blood clots in legs and lungs
  • 37 less colorectal cancer
  • 34 fewer hip fractures and 24 less total
    fractures

39
Recommendations
  • the therapy should not be continued or started to
    prevent heart disease
  • for osteoporosis prevention, women should consult
    their doctor and weigh the benefits against their
    personal risks
  • the therapy for relief of menopausal symptoms may
    reap more benefits than risks

40
HRT
  • Symptom relief should be the primary reason for
    taking hormone replacement therapy
  • Progestins should be added to estrogen therapy
    only to prevent endometrial cancer. If a woman
    has had a hysterectomy, there is no need for
    progestins in her hormone therapy
  • Hormone therapy should not be used to prevent
    heart disease women should take other measures
    to reduce that risk
  • Hormone therapies have been shown to help build
    stronger bones however, women should weigh the
    risks of hormone therapy before taking it to
    prevent osteoporosis

41
HRT
  • A woman should take HRT for the shortest amount
    of time possible, based on her symptoms, the
    benefits she's getting from the therapy, and her
    personal health risks
  • Doctors should consider prescribing low-dose HRT
    whenever possible
  • Doctors should consider alternate ways of giving
    HRT other than orally -- such as patches and
    creams, but should know that studies are not
    clear on the long-term risks and benefits
  • Every woman's personal health risks should be
    evaluated before any form of hormone therapy is
    prescribed. Women should be sure they understand
    the known risks

42
Top Tips for Heart Health
  • Reduce total fat, favor mono-unsaturated fats
    over saturated fats and above all, eat moderate
    portions
  • Learn how to be more stress resilient
  • Get moving today
  • Smoking cessation
  • Being a good weight for your height
  • Eating healthy and exercising regularly

43
Whats new
  • Markers for inflammation
  • C- reactive protein
  • Homocysteine
  • Lipoprotein (a)
  • Drug coated stent
  • Minimally invasive surgery
  • Off pump open heart surgery

44
What to expect in the future
  • Super HDL coronary infusion therapy
  • Non invasive visualization of coronary arteries
  • Focusing on inflammation as risk reduction in
    heart disease

45
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46
Online resources
  • www.womenheart.org
  • National coalition of women with heart disease
  • The Heart Truth Awareness campaign of the
    National Heart, Lung, and Blood Institute
  • American Heart Association Organization fighting
    heart disease and stroke

47
Heart Disease in Women
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