HEART DISEASE AND YOU

1. HEART DISEASE AND YOU All Women

2. WHAT IS HEART DISEASE? 2

3. Arrhythmias What is Heart Disease? • Heart disease is a broad term used to describe a range of diseases that affect your heart Coronary Artery Disease(heart attack & stroke) Conditions & Infections

4. Coronary Artery Disease(heart attack & stroke) Coronary Artery Disease • Your heart is a pump thatcirculates blood, oxygen and nutrients throughout your body • Coronary artery disease isa disease of the heart, andcan lead to: • Chest pain • Shortness of breath • Heart failure • Heart attack • Stroke

5. Heart Arrhythmias • Electrical impulses cause your heart to beat • When your heart beats too fast, too slow or irregularly, you have an arrhythmia • Most are harmless. However, some heart arrhythmias may cause bothersome — sometimes even life-threatening — signs and symptoms Arrhythmias

6. Heart disease is the leading cause of death for women and men, regardless of race and ethnicity 44.8% African American Males 47.3% • African American Females2 50.0% 60.0% 0.0% 10.0% 20.0% 30.0% 40.0% The Heart of the Matter 82.6 Million American Adults Have Heart Disease1 37.4% White Males 33.8% White Females3 30.9% Hispanic/Latino Females4 Hispanic/Latino Males 30.7% American Heart Association. Heart Disease and Stroke Statistics-2012 Update American Heart Association. African Americans and CVD – 2012 Statistical Fact Sheet American Heart Association. Whites and CVD – 2012 Statistical Fact Sheet American Heart Association. Hispanics/Latinos and CVD – 2012 Statistical Fact Sheet

7. Heart Disease: The Leading Cause of Death AMERICAN WOMEN Experts estimate that 1-in-2 women will die of heart disease or stroke, compared with 1-in-25 women who will die of breast cancer U.S. Department Health and Human Services, Agency for Healthcare Research and Quality American Heart Association. Hispanics/Latinos and CVD – 2012 Statistical Fact Sheet

8. The Heart of the Matter • Heart disease, being overweight or obese, and having high blood pressure are prevalent among American women, particularly as they age • Some women have simply accepted this is a way of life • This doesn’t have to be true for you • Heart disease and most risk factors can be prevented or treated Take responsibility for your heart’s health

9. WHAT YOU NEED TO KNOW ABOUT HEALTH CARE DISPARITIES 9

10. Over 65 Ethnic Groups Non-English Women RacialGroups Disparities in Health Care Racial or ethnic differences in the quality of health care that are not due to access-related factors, clinical needs, preferences,or appropriateness of intervention Smedley BD, Stith AY, Nelson AR. Institute of Medicine. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Policy, Institute of Medicine. Washington, DC: National Academy Press; 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Accessed: http://www.nap.edu/openbook.php?record_id=12875&page=R1

11. Reasons Are Complex Insurance Culture Refusal Time Stereotypes Language Bias Geography Behavior Language Uncertainty Preference Health System Provider Patient Henry J. Kaiser Family Foundation. Why the Difference Power Point Presentation, slide # 26. Unequal Treatment Confronting Racial and Ethnic Disparities in Healthcare: March 2000. 11

12. WHAT CAN I DO? 12

13. Talk to Your Doctor Know Your Risk Factors Take Charge of Your Heart Health

14. Know Your Risk Factors

15. Risk Factors Lead to Heart Disease • Risk Factors You Can NOT Control • Increasing Age • Family History • Risk Factors You CAN Control • Diabetes • High Blood Pressure • High Cholesterol • Physical Inactivity • Overweight/Obesity • Smoking • Stress • Alcohol National Heart Lung and Blood Institute. “Your Guide to a Healthy Heart.” 2005. NIH Publication No. 06-5269

16. Age and Family History • Increasing Age • For men, are you over 45? • For women, are you over 55? • Family History • Does anyone in your immediate family have a history of heart disease or diabetes? National Heart Lung and Blood Institute. “Your Guide to a Healthy Heart.” 2005. NIH Publication No. 06-5269

17. Diabetes • What is it? • A lifelong disease in which there are high levels of sugar (glucose) in the blood • Why a major risk factor? • Heart disease and stroke account for about 65% of deaths in peoplewith diabetes1 • How many women affected2? • Nearly 8% of women havediagnoseddiabetes • A little over 2% of women have undiagnoseddiabetes • Nearly 30% of women havepre-diabetes Good diabetes management can help reduce your riskMany people are not even aware that they have diabetes American Heart Association. Cardiovascular Disease and Diabetes. Accessed: http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp American Heart Association. Women and CVD – 2012 Statistical Fact Sheet

18. High Blood Pressure (Hypertension) • What is it? • Blood pressure (the force of blood against thewalls of arteries) that stays high and damagesthe heart over time • Why a major risk factor? • About 69% of people who have a first heartattack, 77%who have a first stroke, and 74%who have congestive heart failure have highblood pressure, i.e. higher than 140/90 mm Hg.1 • How many women affected? • More men than women have HBP until age 451 • From 45-64, men and women have similar HBP (50%)1 • From 65-74, 69% of women have HBP compared to 64% of men1 • From 75+, 79% of women have HBP compared to 67% of men1 American Heart Association. High Blood Pressure– 2012 Statistical Fact Sheet

19. High Blood Cholesterol • What is it? • The body needs cholesterol — a waxy, fat-like substance in your blood — but too much bad (LDL) cholesterol can lead to plaque build up in arteries and veins • Your LDL cholesterol level is a better gauge of risk than total blood cholesterol1 • Why a major risk factor? • When levels of bad (LDL) cholesterol are 130 mg/dl or higher there is a higher risk of developing coronary heart disease1 How many women affected?2 • 32% of Latinas and White women have highbad cholesterol • 28% of Black women have high bad cholesterol American Heart Association. What Your Cholesterol Levels Mean. Accessed: http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/What-Your-Cholesterol-Levels-Mean_UCM_305562_Article.jsp American Heart Association. High Blood Cholesterol– 2012 Statistical Fact Sheet

20. Physical Inactivity • What is it? • Lack of regular moderate physical activity • Why a major risk factor? • Exercise helps to prevent or reduce high blood pressure, diabetes and being overweightor obese • How many women affected? • Inactivity in women (35%) is higher among than men (30%), starts early and increases with age1 • Black women (55%) and Latino women (60%) do no spare-time physical activity2 • Women (54.1%) were more likely than men (43.9%) to not meet the 2008 Federal Physical Activity Guidelines1 • Key Guidelines Snapshot3 • Adults (aged 18–64) • Moderate-intensity aerobic exercise; 2 hours and30 minutes /week; • Muscle-strengthening; 2+days per week • Older Adults (aged 65+) • Follow adult guidelines(as abilities allow) • Inactivity should be avoided American Heart Association . Physical Inactivity– 2012 Statistical Fact Sheet National Heart, Lung and Blood Institute’s “The Heart Truth for African American Women: An Action Plan.” NIH Pub. No. 07-5066; National Heart, Lung and Blood Institute’s “The Heart Truth for Latinas: An Action Plan.” NIH Pub. No. 07-5065 U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. http://www.health.gov/paguidelines/factsheetprof.aspx

21. Overweight & Obesity • What is it? • When your weight exceeds what is generally considered healthy for your height • A waist measurement greater than 35 inches for women or a BMI of 25.0 and higher • Why a major risk factor? • Leads to many diseases and conditions, including high blood pressure and Type 2 diabetes which can cause heart disease • How many women affected?1 • 59% of White women are overweight/obese • 75% of Latinas are overweight/obese • 78% of Black women are overweight/obese American Heart Association. Overweight & Obesity– 2012 Statistical Fact Sheet

22. Cigarette and Tobacco Smoke • What is it? • Inhalation of the smoke of burning tobacco encased in cigarettes, pipes, and cigars • Why a major risk factor? • Cigarette smoking and secondhand smoke further raises risk of heart disease when combined with high cholesterol, high blood pressure, and being overweight or obese • How many women affected?1 • 18% of women smoke • 21% are White women • 17% are Black women • 9% are Latinas American Heart Association . Women & CVD– 2012 Statistical Fact Sheet

23. Stress and Heart Disease • What is it? • Stress affects each of us in different ways — youmay have physical signs, emotional signs or both • Why a major risk factor? • Stress sets off a chain of events • Stressful situation • Breathing and heart rate speed up; blood pressure rises • Body experiences “fight or flight” response • When it lasts days/weeks = chronic stress • Chronic stress increases heart rate and blood pressure • How many Americans affected? • 22% of Americans reported extreme stress in 2011 • Top reasons: money, work, economy, relationships, family responsibilities American Psychological Association. Stress in America report. http://www.apa.org/news/press/releases/2012/01/chronic-disease.aspx

24. Alcohol Beverages and Heart Disease • What is it? • Women’s bodies react differently to alcohol than men’s bodies • Women face particular health risks from alcohol e.g. liver damage, heart disease, breast cancer and pregnancy, when they drink beyond moderate levels, i.e., more than 3 drinks/day or more than 7 drinks/week1 • How many women are affected? • In 2010, 47% of women aged 12 and older were current drinkers; current male drinkers were estimated at 57%2 4 oz. National Institute on Alcohol Abuse and Alcoholism. Webpage “Women.” http://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/women Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.

25. Risk Factors Don’t Add Their Potential Danger Like 1 + 1 = 2  They Multiply It1 The Multiplier Effect Woman over 55Overweight+High Blood Cholesterol 3 = 10more likely to develop heart disease National Heart Lung and Blood Institute “The Heart Truth” speaker’s guide. 2010. Publication No. 10-520B, p. 17 National Heart, Lung, and Blood Institute (2006), HEART DISEASE RISK FACTOR "MULTIPLIER EFFECT“ IN MIDLIFE WOMEN infographic

26. Talk to Your Doctor

27. Talk to Your Doctor • Being honest will get you the most realistic assessment • Help your doctor develop a plan to lower your overall risk • Visit your doctor regularly and bring 2–3 questions

28. Talk to Your Doctor • Do I have heart disease? What tests should I have? • What do my test results mean? • Are my blood pressure numbers within a normal range? Cholesterol numbers? • Can you help me plan a safe weight loss and exercise program? • What are the possible side effects of the medications I’ve been prescribed? Your doctor is your partner — working together you can live a longer, healthier and happier life

29. Take Charge of Your Heart Health

30. Enjoy Regular Physical Activity • Recommendation • Pick a physical activity that you like(brisk walking, dancing, swimming) • Make the time! • Do it for 30+ minutes 5X per week • Why? • 70% of Americans do not get thephysical activity they need1 • Daily physical activity will guarantee you a healthier and more satisfying life while lowering your risks for heart disease, stroke and diabetes1 • Studies show that for every hour of walking, life expectancy may increase by 2 hours2 American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=8&CultureCode=en-US American Heart Association: Get Moving. Where Do I Start http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/StartWalking/Get-moving-Where-do-I-start_UCM_307978_Article.jsp

31. Eat a Heart-Healthy Diet • Recommendation: • Stock up on healthy foods • Eat a lot of vegetables and fruits • Eat unrefined fiber-rich whole-grain foods • Eat fish at least twice a week • Choose skinless lean meats and poultry • Select fat-free, 1% fat, and low-fatdairy products • Cut back on saturated/trans fats,cholesterol, salt and added sugars • Remember candy, cakes, cookies, ice cream, etc. are occasional special treats! • Why? • One of your best weapons for fighting heart disease • Over 90% of us fail to eat a heart-healthy diet • Poor eating can lead to heart disease, stroke, diabetes and obesity American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=10&CultureCode=en-US

32. Maintain a Healthy Weight • Recommendation • Know your Body Mass Index or BMI • Understand your caloric needs • Track your calories • Only eat at restaurants/fast food1-2 times per week • Why? • When you shed extra fat and unnecessary pounds, you reduce the burden on your heart, lungs, blood vessels and skeleton American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=11&CultureCode=en-US

33. Body Mass Index (BMI) Chart Weight-control Information Network: an information service of the National Institute of Diabetes and Digestive and Kidney Diseases: Web page, “Understanding Adult Obesity.” Accessed http://win.niddk.nih.gov/publications/understanding.htm#bodymass

34. Stop Smoking (please!) • Recommendation • Do whatever it takes to quit! • Talk with your health-care provider or look for a quit-smoking program • Why? • Cigarette smokers have a higher risk of developing cardiovascular disease1 • Smoking is one of our nation’s top causes of early death1 • Smoking will only add to your stress by taking away your good health and shortening your life1 • On average, smokers die 13–14 years earlier than nonsmokers2 American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=14&CultureCode=en-US Centers for Disease Control and Prevention. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/.

35. Reduce Your Blood Sugar • Recommendation • Reduce consumption of simple sugars that are found in soda, candy and sugary desserts • Get regular physical activity! • Take medications or insulin, if prescribed for you • Why? • High levels of blood sugar can damage your heart, kidneys, eyes and nerves • When you reduce excessive sugars you help protect your vital organs American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=13&CultureCode=en-US

36. Control Your Cholesterol • Recommendation • Eat healthy foods low in cholesterol, trans fats and saturated fats and lots of fiber • Schedule a cholesterol screening • Get active • Maintain a healthy weight • Take your prescribed medication • Why? • When you control your cholesterol, you are giving your arteries their best chance to remain clear of blockages that can lead to heart disease and stroke American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=9&CultureCode=en-US

37. Manage Your Blood Pressure • Recommendation: • Eat a heart-healthy diet with less sodium • Enjoy regular physical activity • Maintain a healthy weight • Take your prescribed medication • Managing stress • Limit alcohol • Avoid tobacco smoke • Why? • High blood pressure is the single most significant risk factor for heart disease • Managing it is common sense forgood health American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=12&CultureCode=en-US

38. Stress and Heart Disease • Recommendation for Stress • Exercise • Maintain a positive attitude • Do not smoke or drink toomuch coffee • Enjoy a healthy diet • Maintain a healthy weight • Talk to your doctor or other healthcare professionals • Why? • Managing stress is good for youroverall health • After a heart attack or stroke, people can feel depressed, anxious or overwhelmed by stress • American Heart Association/American Stroke Association: webpage, “Stress and Heart Health” Accessed http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Stress-and-Heart-Health_UCM_437370_Article.jsp

39. Alcohol Beverages and Heart Disease • Recommendation • Talk to your doctor about benefits and risks based on your own family history and health • If you drink alcohol, do so in moderation • 1 to 2 drinks per day for men • 1 drink per day for women • Why? • Alcohol use may be harmful for anyone with: • Personal/family history of alcoholism • Hypertriglyceridemia • Certain blood disorders • Heart failure • Uncontrolled hypertension • Taking certain medications 4oz. 4% 80 Standard Drink Equivalents American Heart Association. Alcohol Beverages and Cardiovascular Disease. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Alcoholic-Beverages-and-Cardiovascular-Disease_UCM_305864_Article.jsp

40. DISCUSSION 40

41. How Heart Healthy Are You? • Raise your hand if you…. • Have immediate family members who have heart disease/diabetes • Smoke or live with someone who does • Have been tested for type 2 diabetes in the last 2 years • Had your blood pressure checked in the last year • Know your cholesterol numbers, i.e., total, LDL and HDL • Exercise for 30 minutes a day at least 4 days a week • Know how many calories you should eat in a day

42. Know Your Numbers American Heart Association; webpage, “Numbers That Count for a Healthy Heart.” Accessed http://www.heart.org/HEARTORG/Conditions/Numbers-That-Count_UCM_305427_Article.jsp

43. Questions? 43

44. Heart Attack Signs in Women • Uncomfortable pressure, squeezing, fullness or pain in center of chest • Pain or discomfort in one or both arms, the back, neck, jaw or stomach • Shortness of breath with or without chest discomfort • Breaking out in a cold sweat, nausea or lightheadedness • Most common heart attack symptom is chest pain or discomfort • Shortness of breath, nausea/vomiting and back or jaw pain are likely If you have any of these signs, don’t wait more than five minutes before calling 9-1-1 and get to a hospital right away American Heart Association. Heart Attack Symptoms in Women. Accessed http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Heart-Attack-Symptoms-in-Women_UCM_436448_Article.jsp

45. Stroke Warning Signs • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body • Sudden confusion, trouble speaking or understanding • Sudden trouble seeing in one or both eyes • Sudden trouble walking, dizziness, loss of balance or coordination • Sudden severe headache with no known cause If one or more of these signs is present, don’t delay — call 9-1-1 American Stroke Association: home page. Accessed: http://www.strokeassociation.org/STROKEORG/WarningSigns/Warning-Signs_UCM_308528_SubHomePage.jsp

46. CVD Risk and Black American Women • Heart disease is more prevalent among Black women than White women1 • As are some of the risk factors, high blood pressure (46%), obesity (51%), and diagnosed/undiagnosed diabetes (19%) 2 • Women can lower their heart disease risk by as much as 82% just by leading a healthy lifestyle1 • However, in a 2006 study of women3: • Only 57% knew heart disease is leading cause of deathamong women • Awareness was lower among Black (31%) and Latina women (29%) compared with White women (68%) • Majority (≥ 50%) reported confusion related to heartdisease prevention • More outreach and education clearly is warranted National Heart, Lung and Blood Institute’s “The Heart Truth for African American Women: An Action Plan.” NIH Pub. No. 07-5066 American Heart Association. African Americans & CVD– 2012 Statistical Fact Sheet Christian, A. et al. Nine-Year Trends and Racial and Ethnic Disparities in Women’s Awareness of Heart Disease and Stroke: An American Heart Association Study. Journal of Women’s Health. Volume 16, Number 1. 2007. Abstract accessed: http://online.liebertpub.com/doi/abs/10.1089/jwh.2006.M072?journalCode=jwh

47. CVD Risk and Women • More women die of CVD than all forms of cancer combined1 • Women experience some of the highest risk factors for CVD: • Black (71%), Latina (75%) and White (59%) women are overweight/obese 2 • Black (27%), Latina (34%) and White (28%) women are pre-diabetic 2 • Black (46%), Latina (29%) and White (31%) women have HBP3 • Women can lower their heart disease risk by as much as 80% just by leading a healthy lifestyle1 • However, in a 2006 study of women3: • Only 57% knew heart disease is leading cause of death among women • Awareness was lower among Black (31%) and Latina women (29%) compared with White women (68%) • Majority (≥ 50%) reported confusion related to heart disease prevention • More outreach and education clearly is warranted American Heart Association/Go Red for Women. “Women and Heart Disease: Myths vs. Realities” PDF 2012 American Heart Association . Women & CVD– 2012 Statistical Fact Sheet Christian, A. et al. Nine-Year Trends and Racial and Ethnic Disparities in Women’s Awareness of Heart Disease and Stroke: An American Heart Association Study. Journal of Women’s Health. Volume 16, Number 1. 2007

48. CVD Risk and Latinas • Latinas have high rates of: diabetes(13%)1, overweight and obesity (75%)1 and physical inactivity (60%)2 • However, in a 2006 study of women3: • Only 57% knew heart disease is leading cause of death among women • Awareness was lower among Black (31%) and Latina women (29%) compared with White women (68%) • Majority (≥ 50%) reported confusion related to heart disease prevention • More Latina outreach and education clearly is warranted American Heart Association. Women & CVD– 2012 Statistical Fact Sheet National Heart, Lung and Blood Institute’s “The Heart Truth for Latinas: An Action Plan.” NIH Pub. No. 07-5065 Christian, A. et al. Nine-Year Trends and Racial and Ethnic Disparities in Women’s Awareness of Heart Disease and Stroke: An American Heart Association Study. Journal of Women’s Health. Volume 16, Number 1. 2007

49. Diabetes, Heart Disease and Stroke • High blood glucose levels can lead to increased deposits of fatty materials inside blood vessels, affecting blood flow and increasing the chanceof clogging and hardening of blood vessels • If you have diabetes: • You are 2X more likely to have heart disease or a stroke than someone who does not • And are a woman, you have an even greater risk of heart disease • And have already had one heart attack, you run an even greater risk of having a second one • Your heart attack may be more serious and more likely to result in death than someone without diabetes National Diabetes Information Clearinghouse. Diabetes, Heart Disease and Stroke. Accessed: http://diabetes.niddk.nih.gov/dm/pubs/stroke/#connection

50. Women and Heart Disease • The facts are clear.More women die of heart diseasethan all forms of cancer combined.Unfortunately, the killer isn’t easy to see. Heart disease is often silent,hidden and misunderstood. American Heart Association Go Red for Women American Heart Association/Go Red for Women. “Women and Heart Disease: Myths vs. Realities” PDF 2012