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Heart Disease in Women How to Protect Yourself


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

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

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?

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

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Comparison of deaths from CV disease and breast
cancer, by age
Heart Disease
Breast Cancer
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

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

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

  • 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

  • High blood pressure is more common in women
    taking oral contraceptives, especially in obese
  • 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

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

Normal Coronary Anatomy
Current Path in Cardiac Muscle
Microscopic Pathology of Atherosclerosis
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?
During a Heart Attack
Myocardial Infarction
Detecting Coronary heart disease
  • EKG
  • Stress testing
  • Echocardiogram
  • Cardiac Catheterization/Coronary angiogram
  • CAT scan- calcium score
  • MRI of the heart

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

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

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

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

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

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

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

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

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

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

Benefits of Cholesterol Reduction
Effect of Aspirin on Survival
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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

  • 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

  • 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

  • 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

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

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

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

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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

Heart Disease in Women
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