1 / 43

Dead on Arrival: Heart Disease in Women

Dead on Arrival: Heart Disease in Women. Adity Bhattacharyya, MD, FAAFP RWJMS Family Medicine Residency At Capital Health. Dead on Arrival: Heart Disease in Women. Cardiovascular disease is the leading cause of death in women. CVD kills more than all cancers put together.

malo
Download Presentation

Dead on Arrival: Heart Disease in Women

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. Dead on Arrival: Heart Disease in Women Adity Bhattacharyya, MD, FAAFP RWJMS Family Medicine Residency At Capital Health

  2. Dead on Arrival: Heart Disease in Women • Cardiovascular disease is the leading cause of death in women. • CVD kills more than all cancers put together. • Public awareness has increased from 30% in 1997 to 54% in 2009. • 1 death per minute in women in the US is from CVD. • CVD deaths in women 30-54 is increasing, possibly from the obesity epidemic. • Death from heart disease is significantly higher in black women.

  3. Huge economic burden on the Health care and the country. • Many large institutions are actively looking into this problem like the AHA and NIH are funding public health campaigns to increase awareness of this issue.

  4. Dead on Arrival: Heart Disease in WomenAHA video

  5. Dead on Arrival: Heart Disease in Women • Why women fare poorly with CHD: • They have atypical symptoms like • Abdominal pain and back pain. • Pain at rest. • Jaw and shoulder pain, especially right shoulder. • Nausea. • Shortness of breath. • Fatigue. • Sweating. • Indigestion.

  6. Dead on Arrival: Heart Disease in Women • 95% of women have prodromal symptoms, sometimes for a month prior to a cardiac event. • The commonest symptom that women complain of is • Sleep disturbances • Shortness of breath • Indigestion • Fatigue • Anxiety

  7. Dead on Arrival: Heart Disease in Women • Why women fare poorly with CHD: • 95% of women have prodromal symptoms, sometimes for a month prior to a cardiac event. • Fatigue 71% • Sleep disturbances 49% • Shortness or breath 42% • Indigestion 40% • Anxiety 36%

  8. Dead on Arrival: Heart Disease in Women • Why women fare poorly with CHD: • Delay in getting treatment at multiple levels. • EMS comes later. • They get CHD treatment later in the Emergency rooms. • ASA works poorly compared to male counterparts. • Increased arrhythmias with drugs that block potassium channels: Amiodarone, Sotalol, Sulfonylureas. • Women with Atrial fibrillation have more strokes and poorer outcomes.

  9. Dead on Arrival: Heart Disease in Women • Why women fare poorly with CHD: • Women are smoking more. • Myths about heart disease and estrogen. • Myths about lipids as risk factors in women. • Women ignore symptoms till late. • Most women still think CHD is a man’s disease

  10. Dead on Arrival: Heart Disease in Women • Estrogen and Heart disease: • Multiple trials like HERS, WHI, and PEPI showed that estrogens do not prevent CVD, in fact most showed harm. • WHI also demonstrated that HT was less risky in younger women between 50 and 59 years compared to women older than 60. • Using HT is safe for menopausal symptoms in younger women for a short time.

  11. Dead on Arrival: Heart Disease in Women • Which of the following is false: • Post WHI follow up showed: • CVD risk disappears after 10 years. • Fracture benefit disappears immediately. • Total cancer mortality increases, mostly from colon cancer. • All cause mortality increases- mostly from cancer deaths. • Strokes increases slightly.

  12. Dead on Arrival: Heart Disease in Women • Estrogen and CVD: • Post WHI follow up showed: • CVD risk disappears after 2 years. • Fracture benefit disappears immediately. • Total cancer mortality increases, mostly from colon cancer. • All cause mortality increases- mostly from cancer deaths. • Strokes increases slightly- age is a powerful risk factor for atherosclerosis.

  13. Dead on Arrival: Heart Disease in Women • The commonest risk factor for CVD in women is • Increased blood glucose • Smoking • Hypertension • Salt • Hyperlipidemia

  14. Dead on Arrival: Heart Disease in Women • Gender differences in risk factors for CVD. • WomenMen • Hypertension smoking • Smoking Hypertension • Inactivity Obesity • Increased BG Increased BG • Salt Salt • Increased TG LDL/ Transfats

  15. Dead on Arrival: Heart Disease in Women • Role of Diabetes in Women: • DM is a major risk factor of CVD. The risk is highest in Black and Hispanic women . • Even Pre-diabetes is a bigger risk factor in women. • Metabolic syndrome is a significant risk factor in Black women.

  16. Dead on Arrival: Heart Disease in Women • Role of obesity in women: • Android obesity pattern (male pattern) has a much higher risk of CVD compared to gynecoid pattern. • These women have increased visceral fat . This predisposed them to premature CVD and DM. • This kind of fat deposition is genetic.

  17. Dead on Arrival: Heart Disease in Women

  18. Dead on Arrival: Heart Disease in Women

  19. Dead on Arrival: Heart Disease in Women • Role of physical activity: • Physical activity is independently associated with the risk of CVD, HDL cholesterol, Triglycerides, Glucose and Blood pressure. • AHA recommends 150 min/ week of moderate intensity exercise or 75 min/ week of vigorous exercise. • Aerobic exercises of at least 10 minutes per day or regular brisk walking daily for 30 minutes is also recommended. • Fat and fit is better than fat and unfit

  20. Dead on Arrival: Heart Disease in Women • Population diversity and heart disease: • Highest CV deaths are in Blacks. Hispanics have more risk factors but lower death rates. • Life expectancy in the US: • Hispanics 80 yrs • Non Hispanic Whites 77.5yrs • Non Hispanic Blacks 72.3yrs • Hispanic women 83 yrs • Non Hispanic White women 80.4 yrs • Non Hispanic Black women 76.2 yrs

  21. Dead on Arrival: Heart Disease in WomenScottsdale video

  22. Dead on Arrival: Heart Disease in Women • Cardiovascular Risk Assessment: based on Framingham risk scoring • HIGH RISK: 10 year predicted risk of CHD >20% • AT RISK: 10 year predicted risk of CHD 10 to 20% • LOW RISK: 10 year predicted risk of CHD <10% • OPTIMAL RISK: Ideal CV profile

  23. Dead on Arrival: Heart Disease in Women • Limitations of Framingham scoring: • Lack of Medical history • Lack of Lifestyle history • Lack of Family history of CVD. • Lack of Markers of Preclinical disease.

  24. Dead on Arrival: Heart Disease in Women • New Risk stratification includes: • A focus on 10 year risk for CVD and not only CHD. • No clear identification of risks associated with HSCRP or advanced lipid testing or Calcium scoring. • Atypical risk factors have been identified: • Preeclampsia. • Gestational diabetes. • Preterm birth • IUGR babies. • Autoimmune diseases.

  25. Dead on Arrival: Heart Disease in Women • Which of the following is not included in the AHA criteria for ideal cardiovascular health in women? • TC< 200 • BP < 120/80 • Fasting blood sugar <100- untreated • Triglycerides<150 • Physical activity at goal for adults :- > 150 min/wk moderate intensity or 75 min/ wk vigorous intensity or combination.

  26. Dead on Arrival: Heart Disease in Women • Classification of cardiovascular risk in women: • HIGH RISK: • Clinically manifest CHD • Clinically manifest cerebrovascular disease. • Clinically manifest peripheral vascular disease. • Abdominal aortic aneurysm • End-stage CKD • Diabetes Mellitus. • 10 yr predicted CVD risk >10%

  27. Dead on Arrival: Heart Disease in Women • Classification of cardiovascular risk in women: • AT RISK: • Cigarette smoking • SBP>120, DBP>80 or treated hypertension • TC>200, HDL<50 or treated Dyslipidemia • Central adiposity • Physical inactivity • FH of premature CVD • Metabolic syndrome • Evidence of advanced subclinical atherosclerosis • Poor exercise capacity on treadmill. • Systemic autoimmune collagen vascular disease. • History of preeclampsia, gestational diabetes, PIH

  28. Dead on Arrival: Heart Disease in Women • Ideal cardiovascular health: • TC< 200 • BP < 120/80 • Fasting blood sugar <100- untreated • BMI <25 • Physical activity at goal for adults :- > 150 min/wk moderate intensity or 75 min/ wk vigorous intensity or combination. • Healthy ( DASH ) like diet. • Non smoker.

  29. Dead on Arrival: Heart Disease in Women • Guidelines for preventing CVD in Women • Lifestyle interventions. • Cigarette smoking Class I Evidence-B • Physical activity Class I Evidence-B • Cardiac rehabilitation Class I Evidence-B • Diet-DASH like Class I Evidence-B • Weight management. Class I Evidence-B • Omega 3 fatty acids. Class I Evidence –B • Psychosocial factors Class IIa Evidence -B

  30. Dead on Arrival: Heart Disease in Women • Major risk factor interventions: • Blood Pressure: Optimal levels and life style I B • Blood Pressure: Pharmacotherapy. I A • Lipid levels: Optimal and lifestyle. I B • Lipid levels and pharmacotherapy I A • LDL for HR/IR &LR • HDL for HR/IR & LR • Diabetes: Lifestyle and pharmacotherapy. IIa B

  31. Dead on Arrival: Heart Disease in Women • Preventative drug interventions: • Aspirin in high risk women. I A • Aspirin in other at-risk or health women. IIb B • Aspirin in Atrial fibrillation. I A • Warfarin in atrial fibrillation. I A • Dabigatran in atrial fibrillation. I B • Role of beta blockers. I A • Role of ACE/ARBS I A • Role of Aldosterone blockade. I B

  32. Dead on Arrival: Heart Disease in Women • Class III interventions for prevention of CVD in women: • Menopausal Therapy: HT and SERMS should not be used for primary or secondary prevention. • Antioxidants: Antioxidant vitamin supplements like Vitamin E,C and beta carotene should not be used for primary or secondary prevention in women. • Folic Acid with or without vitamin B12 should not be used for primary or secondary prevention of CVD in women. • Routine use of Aspirin for prevention of MI in women <65 years is not recommended.

  33. Dead on Arrival: Heart Disease in Women • Dietary recommendations in women: • Fruits and vegetables: over 4 cups per day • Fish : 2 times a week or more. • Fiber 30 grams /day • Whole grains: 3/day • Sugar: Less than 5/week • Nuts/ legumes/ seeds: 4/week • Saturated fates: Less than 7% of total energy used • Cholesterol: <150mg/d • Alcohol up to 1 drink/d • Sodium: < 1500mg/d

  34. Dead on Arrival: Heart Disease in Women • Exercise stress testing in women compared to men is • Is more specific and less sensitive. • Is less specific and more sensitive. • Is less specific and less sensitive. • Is more specific and more sensitive.

  35. Dead on Arrival: Heart Disease in Women • CARDIAC TESTING: Differences in women • Exercise stress testing has lower specificity but slightly higher sensitivity. • In women Stress echocardiography and nuclear perfusion scans are more specific and equally sensitive compared to EST. • Coronary artery calcium scoring: less specific but more sensitive than men.

  36. Dead on Arrival: Heart Disease in Women • CARDIAC TESTING: Differences in women • Cardiac Catheterization shows many differences, mostly anatomical. • Women have smaller coronaries. • Women have more bleeding complications compared to men. • Radial approach has much less complications than femoral approach. • Angiography difference: Women have less obstructive lesions but more diffuse atherosclerotic disease. Catheterization findings may be falsely negative. • Women have more micro vascular disease and coronary spasm

  37. Dead on Arrival: Heart Disease in Women • Newer Test being studied for women: • Intravascular ultrasounds • Coronary reactivity with acetyl choline during catheterization.

  38. Dead on Arrival: Heart Disease in Women • CVD Prevention strategies • Assess and stratify women into risk categories. • Lifestyle approaches recommended for all women and a top priority in clinical practice. • Other CVD reducing interventions should be prioritized according to the strength of recommendation and level of evidence. • Highest priority is intervention in the women at highest risk. • Avoid interventions designated as class III by AHA/ACC

  39. Dead on Arrival: Heart Disease in Women • CLASSIFICATION AND LEVEL OF EVIDENCE: • Strength of evidence: • Class I Intervention is useful and effective • Class IIa Weight of evidence/opinion is in favor or usefulness/efficacy • Class IIb Usefulness is less well established by evidence/opinion • Class III Procedure not helpful or treatment has no proven benefit. • Class IV Procedure/test without benefit or harmful to patient.

  40. Dead on Arrival: Heart Disease in Women • Level of Evidence: • A Sufficient evidence from multiple randomized studies. • B Limited evidence from single randomized trial or other non randomized studies. • C Based on expert opinion, case studies or standard of care.

  41. Dead on Arrival: Heart Disease in Women

  42. Dead on Arrival: Heart Disease in Womenlast video

  43. Dead on Arrival: Heart Disease in Women • QUESTIONS?

More Related