Women & Heart Disease: How are We Different & How Can You Take Care of Yourself

1. Women & Heart Disease: How are We Different & How Can You Take Care of Yourself

2. Did You Know? • Heart disease doesn’t discriminate • It is the leading killer of men and women • However, there is a gender gap in diagnosis and treatment • Women with an acute heart attack are more likely to die than men

3. Facts (AHA) • Cardiovascular Disease (CVD) ranks first among all disease categories in hospital discharges for women • 51.8% of all female deaths in the US occur from CVD • More than 1 in 3 female adults in the US has some form of cardiovascular disease • Since 1984, the number of CVD deaths for females has exceeded those of males

4. Facts Top 5 Causes of Death for American Women • Heart Disease 315, 000 • Stroke 82, 000 • Lung Cancer 71, 000 • Chronic Obstructive Lung Disease 65, 000 • Breast Cancer 41, 000 Source: 2006 CDC & American Cancer Society

5. Cardiovascular Disease Mortality Trends for Males & Females United States: 1979-2001

6. Racial & Ethnic Groups • Cardiovascular disease is the leading cause of death for African Americans, Latinos, Asian Americans, Pacific Islanders, and American Indians • African American women are at the highest risk for death from heart disease among all racial, ethnic, and gender groups

7. Risk Factors for Heart Disease • Smoking • Family History • Hypertension • Elevated Cholesterol • LDL bad cholesterol | HDL good cholesterol • Sedentary Lifestyle / Obesity • Diabetes • Metabolic Syndrome / Obesity • Waist to hip ratio / elevated blood sugar (insulin resistance)

8. Risk Stratification • CHD equivalent • Diabetes mellitus • Established atherosclerotic disease • Includes many patients with chronic kidney disease, especially ESRD • Major Risk Factors: • Age > 55 years • Smoking • Hypertension, whether or not treated with medication • HDL cholesterol < 40mg/dL (HDL cholesterol ≥ 60mg/dL is a negative risk factor) • Family history of premature CVD Source: Mosca 2004, ATP III 2002

9. Risk Stratification • Diabetes • Automatically places a patient in a “High Risk” category • Family History • Defined as CVD in a female first degree relative < 55 years old, or a first degree male relative < 45 years old Source: Mosca 2004

10. LDL / HDL Cholesterol • Elevated Cholesterol • LDL bad cholesterol • LDL normal < 130 • If you have diabetes < 70 • Coronary heart disease < 70 • HDL good cholesterol • > 40 (the higher the better) • Walking or exercise is the best way the raise HDL

11. Obesity / Metabolic Syndrome • Apple versus Pear Shape • Waist to hip ratio is calculated by dividing your waist measurement by your hip measurement. (Hips are the widest part of your bottom/butt). • Best Waist-Hip Ratio for Men and Women • Ideally, women should have a waist-to-hip ratio of 0.8 or less. • Ideally, men should have a waist-to-hip ratio of 0.95 or less.

12. Definition of Metabolic Syndrome in Women • Abdominal obesity - waist circumference > 35 in. • High triglycerides ≥ 150mg/dL • Low HDL cholesterol < 50mg/dL • Elevated BP ≥ 130/85mm Hg • Fasting glucose ≥ 100mg/dL

13. Misperceptions: Women & CVD • Women lack understanding of their risks • Women lack understanding of signs and symptoms of CVD • Woman’s risk of CVD increasesafter menopause • Only 30 % of women polled said that their doctor had mentioned heart disease when discussing general health issues

14. Women Receive Less Interventions to Prevent & Treat Heart Disease • Less cholesterol screening • Less lipid-lowering therapies • Less use of heparin, beta-blockers and aspirin during myocardial infarction • Fewer referrals to cardiac rehabilitation

15. Typical MI Symptoms • Crushing chest pain radiating to the neck, jaw or arm • Sweating for no apparent reason • Nausea • Sudden, rapid heartbeat

16. Atypical Symptoms • Unexplained exhaustion or fatigue • Unexplained shortness of breath • Chest discomfort such as tingling or squeezing • Discomfort in the neck, jaw, ear or teeth with exertion

17. Atypical Symptoms • Indigestion • Discomfort in the upper shoulder blades • Dizziness • Discomfort in one or both arms • Swelling of the legs or ankles

18. Atypical Symptoms • Heart palpitations, cold sweat • Chest pain at rest

19. Lifestyle Interventions • Smoking cessation • Physical activity • Heart healthy diet • Weight reduction/maintenance Source: Mosca 2004

20. Smoking • All women and men should be consistently encouraged to stop smoking and avoid environmental tobacco • The same treatments benefit both women and men • Women face different barriers to quitting • Concomitant depression • Concerns about weight gain Source: Fiore 2000

21. Physical Activity • Consistently encourage women and men to accumulate a minimum of 30 minutes of moderate intensity physical activity on most, or preferably all, days of the week Source: Mosca 2004

22. Diet • Healthy food selections: • Fruits and vegetables • Whole grains • Low-fat or nonfat dairy • Legumes • Low-fat protein • Fish • Saturated fats < 10% of calories, < 300mg cholesterol • Limit trans fatty acid intake (main dietary sources are baked goods and fried foods made with partially hydrogenated vegetable oil) Source: Mosca 2004

23. Weight Maintenance/Reduction Goals • BMI between 18.5 and 24.9 • Waist circumference < 35 inches • Weight loss goals • 10% of body weight over six months or 1-2 pounds weight loss/week • Reduce calories by 500-1,000 per day Source: Mosca 2004, ATP III 2002

24. Diabetes • Recommendation: Lifestyle and pharmacotherapy should be used to achieve near normal HbA1C (<7%) in women and men with diabetes Source: Grundy 2004

25. Source: Adapted from Krolewski 1991

26. Benefits of ASA in Women with Established CAD Source: Adapted from Harpaz 1996

27. Preventive Drug Interventions • Aspirin – Lower risk women • Many women, especially those age 65 and older, may benefit from taking low-dose aspirin every other day to prevent stroke • Women over age 65 may benefit from taking low-dose aspirin to reduce major cardiovascular events • The use of low dose aspirin in lower risk women should be balanced against the risk of increased internal bleeding Source: NHLBI

28. Interventions that are not useful or effective and may be harmful for the prevention of heart disease • Antioxidant supplements • No cardiovascular benefit in randomized trials of primary and secondary prevention Source: Mosca 2004

29. Resources • www.americanheart.org

30. Resources • www.hearttruth.gov

31. Getting the Message Out

32. Stories from the Heart CLAUDETTE'S STORY "I consider myself to be relatively healthy and I exercise for about 90 minutes every morning. I started having pain in my chest and face during my exercising, and finally went to the cardiologist. I never thought that the pain in my face could be related to my heart, so I was shocked when the tests showed that I had had a heart attack. I thought I was too young, but my father died of a heart attack when he was only 38, so I had family history as a risk factor. After my second heart attack, I knew that I needed to help get the message out. Women need to know that heart disease is their biggest health threat."

33. Stories from the Heart STEPHANIE'S STORY "It's only been a few weeks since I had a heart attack and it really hasn't sunk in. I just keep thinking, 'I'm too young for this.' If I didn't work at a hospital, I wouldn't have even known what was going on. I just thought it was indigestion. I know I need to make changes, but it's easier said than done. Quitting smoking has been much harder than I expected. Between work, taking classes and four children, there really isn't a lot of time to think about caring for myself. But I have started paying attention to what's going on with me, just like I would do for one of the kids."

34. Questions? Call SOMC Heart & Vascular Services 740-356-8305 SafetyQuality Service RelationshipsPerformance