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Women and Heart Disease by Debra Kelly

Women and Heart Disease by Debra Kelly. History Anatomy Physiology Risk Factors Symptoms Treatments HRT Prevention. History. Heart Disease is the #1 Killer of women. 50,000 more women die each year than men. In 1995 there were 500,000 deaths related to CVD. 2x that of cancer.

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Women and Heart Disease by Debra Kelly

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  1. Women and Heart Diseaseby Debra Kelly • History • Anatomy • Physiology • Risk Factors • Symptoms • Treatments • HRT • Prevention

  2. History • Heart Disease is the #1 Killer of women. • 50,000 more women die each year than men. • In 1995 there were 500,000 deaths related to CVD. 2x that of cancer. • African American women have a 70% increase in deaths when compared to White women. • Women not treated as aggressively as men. www.heartgroup.com/heartandsoul.html

  3. Anatomy of Circulation • Right Coronary Artery Supplies the right ventricle and right atria. • Right Posterior Descending Artery Supplies the posterior portion of heart(AV node, IV Septum and posterior papillary muscle). • Left Coronary Artery Branches into the anterior descending and circumflex ,they supply Left Ventricle,anterior papillary muscle and anterior IV septum and left atria. • Women's arteries are 0.5 to 1.0 mm smaller in diameter than those of men. www.heartpoint.com/coronarteries.html

  4. Physiology of Thrombus • Hyperlipedemia contributes to plaque formation. • Arteries most effected are proximal left anterior descending, proximal right coronary artery and the distal right coronary artery • Injury theory, plaque rupture and thrombosis formation cause blockage. www.yoursurgery.com/proceduredetails.cfm

  5. Risk Factors Risk Factors That Risk Factors That Can be Treated Or Cannot Be Changed Changed Heredity Smoking Diabetes Gender /Race High Blood Pressure Obesity Increasing Age Sedentary Life Hyperlipidemia

  6. Unchangeable Risk Factors • Heredity: The risk increases 2 to 3 fold in patients with a family history of MI and rose with the number of relatives with a history of MI. • Gender: Mortality rate higher in women. 50,000 die annually. 1st heart attacks often fatal. Within 1 year of MI 42% of women die/24% of men. 6 years after 1st MI 33% of women will suffer 2nd MI as opposed to 21% of men. Fewer studies are done with women . • Race: African American Women have an increased mortality rate as opposed to white women, they are more likely to be overweight and also have diabetes and hypertension, independent risk factors.

  7. Treatable Risk Factors • Smoking: Decreases estrogen and increases lipids. As few as 4 cigarettes/day can have twice the risk of CAD than non-smokers • High Blood Pressure: Approximately 50% of women have HTN by age 45 and 79% of African American Women respectively. > than 140/90 is determined as HTN. • Sedentary Life: Moderate exercise program can decrease BP and increase HDL and decrease VLDL levels.

  8. Treatable Risk Factors • Diabetes: Type II diabetes increases 3 to 7 fold the risk of CAD as opposed to men which is 2 to 3 fold. It also contributes to HTN and hyperlipidemia. More prevalent in African American Women. Increases risk of recurrent MI and heart failure. • Obesity: Maintenance of ideal body weight decreases risk of MI 35%-60%. Increased weight causes increases in lipids, blood pressure and diabetes. • Hyperlipidemia: postmenopausal HDL levels decline and LDL levels rise.

  9. Common Symptoms Chest Pain, heaviness,tightness Pain in arms Shortness of Breath Uncommon Symptoms Nausea, vomiting, heartburn Fainting, confusion, sweating Jaw pain, neck pain, back pain Fatigue, palpations Symptoms

  10. Angioplasty Thrombolytics ASA Beta-Blockers ACE Inhibitors Gp IIb/IIIa Inhibitors CABG It’s What’s inside that counts Acute Myocardial Infarction Treatments

  11. Angioplasty • PTCA: 1st line of treatment if within 1 hour of infarct. • Stents: currently have a 30% restenosis rate caused from the injury cascade to the vessel wall. • Sirolimus-Eluting Stents: new stent just out March 2003. Coated with a immunosupressive drug which prevents cell proliferation in the G1 phase . In recent studies it has shown to decrease the in-stent stenosis by 25%. • Results: 30 days after stenting women’s death rate or MI was 3.1% as compared to men at 1.8%. The 1 year outcomes were similar for men and women, 5.8% and 6.0% respectively. Women were older had more diabetes, hypertension and hypercholesterolemia.

  12. Pre and Post Stenting www.areo.ufl.edu/~uhk/ANGIOPLASTY.jpg

  13. Medications • Thrombolytics: Within in 1 hour of symptoms can reduce mortality by 3.5%. There has been a 17% reduction in the 30 day mortality form 1975-1995. • ASA: The increased use has been the greatest contributor to decreased mortality. In 1975 only 5% usage, 1995 75% usage. • Beta-blockers: Reduces sudden death and reinfarction rate. • ACE Inhibitors: Reduces morbity and mortality in MI survivors and womenwith LV dysfunction. • GIIb/IIIa Inhibitors: Aggrastat, Integrilin and plavix these are platelet aggragates which improve outcomes equally in women and men with stent placement.

  14. 32% of all surgeries are female. Higher complications early. Per/post op period. More risk factors at time of surgery (HTN, PVD, CHF and Diabetes) Older at time of surgery Smaller body size and artery size difficult anastomoses. Less relief from Angina symptoms. Less use of Internal Mammary Artery, which has better outcomes. 5 years out no difference in death rate of both sexes. www.sas.upenn.edu/~lsnyder2/Facts.html Coronary Artery Bypass Grafting

  15. Hormone Replacement Therapy THE GOOD THE BAD and THE UGLY Prevents Increases Alarming • Osteoporosis Invasive breast ca less use of proven • < colon cancer risk of stroke CAD prevention • Hot flashes risk of PE therapies. • Mood swings risk of CAD such as ASA, • Beneficial in the 1st year of HERS ACE inhibitors Presence of study showed a 22% Beta-blockers & Vascular injury increase in CVD lipid lowering Rx In CABG

  16. Prevention is the Key • Healthy Diet • Weight Loss • Exercise • Smoking Cessation • Monitor Blood Pressure • Monitor Lipids • Diabetes Control

  17. Conclusions • Increase usage of CV drugs known for heart disease • Increase knowledge of heart disease by women and theirdoctors • Early diagnosis of heart disease symptoms • Monitoring for Diabetes, weight management • Monitoring for HTN and lipid profile • Increase usage of Cardiac Rehab programs • Inclusion of Women in more cardiac studies • “Knowledge, coupled with action, is POWER” (2)

  18. Works Cited • 1. Aflalo-Caldercon, B. (2002) HRT, Women and Heart Disease: What We Need toKnow about Prevention. Heart Bytes. Retrieved Feb. 18, 2003 from MedScape http://www.medscape.com • 2. Facts About Women and Cardiovascular Disease. (1998) American HeartAssociation, Inc. • 3. Grady, D. “et.al.” (July 3, 2002) Cardiovascular Disease Outcomes During 6.8Years of Hormone Therapy. Jama. (Vol. 288 No. 1). • 4. Heindenreich, P.A., McClellan, M. (Feb. 2001) “Trends in Treatment andOutcomes for Acute Myocardial Infarction: 1975-1995.” The American Heart Journal of Medicine. (Vol. 110 (3) pp 165-174. • 5. Herrington, D.M. (Jan 7-14, 2003) Hormone Replacement Therapy andHeart Disease: Replacing Dogma with Data. Circulation Vol. 107 (1) p. 2-4.

  19. Works Cited (Cont’d) • 6. Hippisley-Cox, J. “et.al.” (Apr 2001) “Sex Inequalities in ischaemic Heart Disease in General Practice: Cross Sectional Survey.” British Medical Journal (Vol 322(7290) pp 832-834. • 7. King, K.B., Mosca, L. (Mar 22, 2000) Prevention of Heart Disease inWomen:Recommendation for Management of Risk Factors. Progress inCardiovascular Nursing. • 8. Lee, I-Min. “et.al.” (Mar 21, 2001). Physical Activity and Coronary Heart Diseasein Women: is “No Pain, No gain” passé? JAMA (Vol 285 (11) pp. 1447-1454) • 9. Mehilli, J. “et.al.” (Oct. 11, 2000) Differences in Prognostic Factors and OutcomesBetween Women and Men Undergoing Coronary Artery Stenting. JAMA (Vol 284 No. 14) • 10. Miller, A., Oparil, S. (2003, Jan 21) Secondary Prevention of Coronary HeartDisease in Women: A call to Action, Annal of Interval Medicine, Vol 138(2).

  20. Works Cited (Cont’d) • 11. Mosca, L. “et. al” ( 1999 ) Guide to Prevention Cardiology for Women, AHA Inc. &American College of Cardiology. • 12. Mosca, L., Manson, J., Sutherland, S. (1997) Cardiovascular Disease in Women.American Heart Association. • 13. Mosca, L. The Importance of Identifying and Reducing Cardiovascular RiskFactors in Women. Retrieved March 9, 2003 from Medscape online. http://www.medscape.com/viewarticle/448971_2 • 14. Myer, J. (Jan 14, 2003) Exercise and Cardiovascular Health. Circulation. (Vol 107(1) pp e2-e5) • 15. Nabel, E.G. (Aug 24, 2000) Coronary Heart Disease in Women- An Ounce ofPrevention. New England Journal of Medicine. (Vol 343 (8) pp 572-574. • 16. Popma, J.J., Klein, K., Medicio, R. (2003) Sirolimus- Eluting Stents. Cath LabDigest. March 2003 (Vol 11 No. 3)

  21. Works Cited (Cont’d) • 17. Price, S.A., Wilson, L.M. (2003) Pathophysiology, Clinical Concepts of DiseaseProcesses. Mosby, St. Louis, Missouri, 6th Ed. • 18. Rosenthal, S.M. (2000). 50 Ways Women can Prevent Heart Disease. Los Angeles, Lowell House. • 19. Ruchisa, G. “et.al.” (Dec 25, 2002) Benefit of an Early Invasive ManagementStrategy in Women with Acute Coronary Syndromes. JAMA. Vol 288-24 pp 3124-3129. • 20. Shlipak, M.G., “et.al.” (2002) Estrogen and Progesterone, Lipoprotein(a), and theRisk of Recurrent Coronary Heart Disease Events after Menopause. JAMA, Vol 284(14) pp1845-1852. • 21. Vaccarino, V. “et.al.” (July 7, 1999) Sex-Based differences in Early Moralityafter Myocardial Infarction. The New England Journal of Medicine. (Vol 341, No. 4)

  22. Works Cited (Cont’d) • 22. Walsh, B, Moriaty, P. Preventing CVD in Women:A work in Progress. Retrieved Feb 18, 2003 from medscape online. Http://www.medscape.com/viewaricle/442233_2. • 23. Wenger, N.K. Menopause Hormone Therapy & Risk for CVD: Current Status. Retrieved from Med Scape March 9, 2003. Http://www.medscape.com/viewaricle/448971_3 • 24. Weger, N.K. The Importance of Identifying and Reducing Cardiovascular RiskFactors in Women. Retrieved from Medscape March 9, 2003. Http://www.medscape.com/viewaricle/448971_1. • 25. Wilansky, S., Willerson, J. (2002) Heart Disease in Women. Churchill Livingstone 1st Ed. USA. • 26. Yoder, M. Pharm D, BCPS. (2003) Advances in Adjunctive Pharmacotherapy forPatients Undergoing PCI. Cath Lab Digest. March 2003 (Vol 11) #3.

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