1 / 59

Ischemic Heart Disease: Minority and Gender Issues

Ischemic Heart Disease: Minority and Gender Issues. Charles K. Francis, M.D., FACP President American College of Physicians. Cardiovascular Disease Mortality Trends for Males and Females United States: 1979-2002. Source: CDC/NCHS.

cian
Download Presentation

Ischemic Heart Disease: Minority and Gender Issues

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ischemic Heart Disease:Minority and Gender Issues Charles K. Francis, M.D., FACP President American College of Physicians

  2. Cardiovascular Disease Mortality Trends for Males and Females United States: 1979-2002 Source: CDC/NCHS.

  3. Age-Adjusted Death Rates for Coronary Heart Disease, Stroke, and Lung and Breast Cancer for White and Black Females United States: 2002 Source: CDC/NCHS.

  4. Deaths From Diseases of the Heart* United States: 1900–2002 Total CVD data are not available for much of the period covered by this chart. Source: CDC/NCHS.

  5. Hospital Discharges* for Cardiovascular Diseases as First Listed Diagnosis United States: 1970-2002 Note: Hospital discharges include people both living and dead. Source: CDC/NCHS.

  6. Percentage Breakdown of Deaths From Cardiovascular Diseases United States:2002 Preliminary Source: CDC/NCHS.

  7. Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sex NHANES: 1999-2002 Source: CDC/NCHS and NHLBI. These data include coronary heart disease, congestive heart failure, stroke and hypertension.

  8. Leading Causes of Death for All Males and Females United States: 2002 Deaths in Thousands A Total CVD (Preliminary) B Cancer C Accidents D Chronic Lower Respiratory Diseases E Diabetes Mellitus F Alzheimer’s Disease Source: CDC/NCHS

  9. Leading Causes of Death for White Males and Females United States: 2002 Percent of Total Deaths A Total CVD (Preliminary) B Cancer C Accidents D Chronic Lower Respiratory Diseases E Diabetes Mellitus F Alzheimer’s Disease G Influenza and Pneumonia Source: CDC/NCHS

  10. Leading Causes of Death for Black or African-American Males and Females United States: 2002 Percent of Total Deaths A Total CVD (Preliminary) B Cancer C Accidents D Assault (Homicide) E HIV(AIDS) F Diabetes Mellitus G Nephritis, Nephrotic Syndrome and Nephrosis Source: CDC/NCHS

  11. Leading Causes of Death for Hispanic or Latino Males and Females United States: 2002 Percent of Total Deaths A Diseases of the Heart, and Stroke B Cancer C Accidents D Diabetes Mellitus E Assault (Homicide) F Chronic Lower Respiratory Disease Source: CDC/NCHS

  12. Leading Causes of Death for Asian or Pacific Islander Males and Females United States: 2002 Percent of Total Deaths A Diseases of the Heart, and Stroke B Cancer C Accidents D Chronic Lower Respiratory Diseases E Diabetes Mellitus F Influenza and Pneumonia Source: CDC/NCHS

  13. Leading Causes of Death for American Indian or Alaska Native Males and Females United States: 2002 Percent of Total Deaths A Diseases of the Heart, and Stroke B Cancer C Accidents D Diabetes Mellitus E Chronic Liver Disease and Cirrhosis F Chronic Lower Respiratory Diseases Source: CDC/NCHS

  14. Coronary Heart Disease in the U.S. • CHD largest killer of U.S. men and women • From 1992-2002 death rate from CHD declined 26.5% but # of deaths fell only 9.9% • 83% of people who die are age 65 or older • 2002 overall CHD death rate 170.8/100,000. • 2002 death rates/100,000: WM 220.5; BM 250.6; WF 131.2; BF 169.7; 1999 Hisp. 138.4; American Indian/Alaskan Native 123.9 Asian Pacific Islanders 115.7 Heart and Stroke Facts, American Heart Association 2002

  15. Coronary Heart Disease in the U.S. Prevalence of CHD: Race, ethnicity and gender Adults >age 20 CHD MI White males 6.9% 5.2% White females 5.4% 2.0% Black males 7.1% 4.3% Black females 9.0% 3.3% Mex.Am.Males 7.2% 4.1% Mex.Am.Females 6.8% 1.9% Heart and Stroke Facts. American Heart Association 2000

  16. Tracking Women’s Awareness of Heart Disease (Circ 2004:109:573-579) Prior research has shown a lack of awareness of the risk of CHD among women. Telephone survey of 1024 women >25 yrs; 68% Wht; 12% Blk;12% Hisp; 8% other. CVD leading killer: 30% in 1997; 34% in 2000 and 46% in 2003. Fewer women reported that cancer was leading killer Black, Hispanic and younger women (<45 yrs) were less aware of heart disease as main killer 38% reported that doctors had discussed CVD

  17. Estimated 10-Year CHD Risk in 55-Year-Old Adults According to Levels of Various Risk Factors Framingham Heart Study A B C D Blood Pressure (mm Hg) 120/80 140/90 140/90 140/90 Total Cholesterol (mg/dL) 200 240 240 240 HDL Cholesterol (mg/dL) 50 50 40 40 Diabetes No No Yes Yes Cigarettes No No No Yes mm Hg = millimeters of mercury mg/dL = milligrams per deciliter of blood l Source: Wilson PWF, et al. Circulation 1998;97:1837-1847.

  18. Annual Number of Americans Having Diagnosed Heart Attack by Age and Sex ARIC: 1987-2000 Source: Extrapolated from rates in the NHLBI’s ARIC surveillance study, 1987-2000. These data don’t include silent MIs.

  19. Annual Rate of First Heart Attacks by Age, Sex and Race ARIC: 1987-2000 Source: NHLBI’s ARIC surveillance study, 1987-2000.

  20. Prevalence of Coronary Heart Diseases by Age and Sex NHANES :1999-2002 Source: CDC/NCHS and NHLBI.

  21. Hospital Discharges for Coronary Heart Disease by Sex United States: 1970-2002 Note: Hospital discharges include people both living and dead. Source: CDC/NCHS.

  22. Prevalence of High Blood Pressure in Americans by Age and Sex NHANES: 1999-2002 Source: CDC/NCHS and NHLBI.

  23. Extent of Awareness, Treatment and Control of High Blood Pressure by Age NHANES : 1999-2000 Source: JAMA 2003;290:199-206.

  24. Age-Adjusted Prevalence Trends for High Blood Pressure in Americans Age 20 -74 by Race/Ethnicity, Sex and Survey NHANES: 1976-80, 1988-94 and 1999-2002 Source: CDC/NCHS. Data based on a single measure of BP.

  25. Extent of Awareness, Treatment and Control of High Blood Pressure by Race/Ethnicity NHANES: 1999-2000 Source: JAMA 2003;290:199-206.

  26. Prevalence of Congestive Heart Failure by Age and Sex NHANES: 1999-2002 Source: CDC/NCHS and NHLBI.

  27. Hospital Discharges for Congestive Heart Failure by Sex United States: 1970-2002 Note: Hospital discharges include people living and dead. Source: CDC/NCHS.

  28. Prevalence of High School Students in Grades 9-12 Reporting Current Cigarette Smoking by Race/Ethnicity and Sex YRBS:2003 Source: MMWR, Vol. 53, (23), June 18, 2004, CDC/NCHS.

  29. Prevalence of Current Smoking for Americans Age 18 and Older by Race/Ethnicity and Sex NHIS:2002 Source: MMWR, Vol. 53, (20);427-31, May 28, 2004, CDC/NCHS.

  30. Trends in Mean Total Blood Cholesterol Among Adolescents Ages 12-17 by Sex, Race and Survey NHES III: 1966-70; NHANES I & III: 1971-74, 1988-94 Source: CDC/NCHS. Prev Med 1998;27:879-90.

  31. Prevalence of Students in Grades 9-12 Who Participated in Sufficient Vigorous or Moderate Physical Activity During the Past 7 Days by Race/Ethnicity and Sex YRBS: 2003 Note: “Vigorous activity” is defined as activity causing sweating and hard breathing for at least 20 minutes on 3 or more of the 7 days. “Moderate activity” is defined as activities such as walking or bicycling lasting for at least 30 minutes on 5 or more of the 7 days. Source: MMWR, Vol. 53, No. SS-2, May 21, 2004, CDC/NCHS.

  32. Prevalence of Moderate or Vigorous Physical Activity in Americans Age 20 and Older by Sex, Race/Ethnicity and BMI NHANES III: 1988-94 Note: BMI indicates body mass index: weight in kilograms divided by height in meters squared (kg/m2). Source: CDC/NCHS.

  33. Prevalence of Overweight among Students in Grades 9-12 by Sex and Race/Ethnicity YRBS: 2003 Source: BMI 95th percentile or higher. MMWR, Vol. 53,No. SS-2, May 21,2004, CDC/NCHS.

  34. Age-Adjusted Prevalence of Obesity in Americans Ages 20-74 by Sex and Survey NHES, 1960-62; NHANES, 1971-74, 1976-80, 1988-94 and 1999-2002 Note: Obesity is defined as a BMI of 30.0 or higher. Source: CDC/NCHS.

  35. Age-Adjusted Prevalence of Physician-Diagnosed Diabetes in Americans Age 20 and Older by Sex and Race/Ethnicity NHANES: 1999-2002 Source: CDC/NCHS and NHLBI.

  36. Prevalence of Non-Insulin-Dependent (Type 2) Diabetes in Women* Ages 25-64 by Race/Ethnicity and Education NHANES III: 1988-94 * Findings for men are similar but of lower magnitude. See Pathways by which SES and ethnicity influence CVD risk factors. Annals NY Academy of Science. 1999;896:191-209 Source: JAMA. 1998;280:356-62.

  37. Trends in Heart Transplants UNOS: 1968-2003 Source: United Network for OrganSharing (UNOS), scientific registry data.

  38. Trends in Cardiovascular Operations and Procedures United States: 1979-2002 Source: CDC/NCHS.

  39. Total Mortality Rates in U.S. Adults, Age 30-75, with Metabolic Syndrome (MetS), With and Without Diabetes Mellitus and Pre-Existing CVD NHANES II: 1976-80 Follow-up Study** ** Average of 13 years of follow-up. Source: Circulation 2004;110:1245-50.

  40. Estimated Direct and Indirect Costs of Cardiovascular Diseases and Stroke United States: 2005 Source: Heart Disease and Stroke Statistics – 2005 Update.

  41. Angina Pectoris in the U.S. • About 400,000 new cases occur each year • 27% of men and 14% of women will develop angina within 6 years of a heart attack • Prevalence of angina age 40-70 higher in women. • Increased prevalence for Mex-Am men and women and for African American women (NS) • Annual rates (per 1000 population) of new and recurrent angina : Ages 65-74: NBM 44.3; NBW 18.8; BM 26.1; BW 29.4: Ages 75-84: NBM 56.4; NBW 30.8; BM 52.2; BW 37.7; Ages 85 < : NBM 42.6; NBW 19.8; BM 43.5; BW 15.2 • Black women at greatest risk • Heart and Stroke Facts. American Heart Association 2005

  42. Angina-like Chest Pain With “Normal” Coronary Arteriography • Clinical Features: • 10-20% of pts cath’d for angina pectoris • More common in women, premenopausal • Usually have atypical chest pain • Physical findings are usually normal • May have positive exercise test in 20% • May have abnormal coronary reserve • Long term survival is excellent • Nitrates or beta blockers are rarely effective

  43. Angina-like Chest Pain With “Normal” Coronary Arteriography • Often referred to a “Syndrome X” (should be distinguished from the endocrine syndrome • May be due to a number of conditions: 1. Abnormal pain perception of sensitivity 2. Microvascular dysfunction a. Abnormal coronary reserve b. Increased sympathetic or RAAS function c. Endothelial dysfunction d. Hypertension/left ventricular hypertrophy

  44. Angina-like Chest Pain With “Normal” Coronary Arteriography • Clinical Features: • 10-20% of pts cath’d for angina pectoris • More common in women, premenopausal • Usually have atypical chest pain • Physical findings are usually normal • May have positive exercise test in 20% • May have abnormal coronary reserve • Long term survival is excellent • Nitrates or beta blockers are rarely effective

  45. Angina-like Chest Pain With “Normal” Coronary Arteriography • Often referred to a “Syndrome X” (should be distinguished from the endocrine syndrome • May be due to a number of conditions: 1. Abnormal pain perception of sensitivity 2. Microvascular dysfunction a. Abnormal coronary reserve b. Increased sympathetic or RAAS function c. Endothelial dysfunction d. Hypertension/left ventricular hypertrophy

  46. Antihypertensive/anti-ischemic Pharmacologic Therapy • Specific antihypertensive agents -- Beta Blockers -- Nitrates -- Calcium Antagonists -- ACE inhibitors (AII blockers?) -- Drug combinations

  47. Management of the hypertensive patient with ischemic heart disease • Initial Evaluation: -- extent of target organ damage (cardiac disease, cerebrovascular disease, peripheral vascular disease, renal disease, retinopathy) -- overall cardiovascular risk (age, sex, race, menopausal status, cholesterol status, glucose tolerance, cigarette smoking, alcohol intake) -- extent and severity of coronary disease

  48. Management of the hypertensive patient with ischemic heart disease • It is more complex than simply lowering BP -- Reduce absolute cardiovascular disease risk -- Control symptoms of myocardial ischemia -- Retard cardiac and vascular disease progress -- Correct aggravating conditions (e.g. thyro-toxicosis, anemia, psychological stress) -- Improve quality of life (exercise, diet, Viagra)

More Related