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Heart Disease in Women How to Protect Yourself Banu Mahalingam MD, FACC, RCS. Cardiology Associates Of Princeton
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Heart Disease in Women
How to Protect Yourself
Banu Mahalingam MD, FACC, RCS.Cardiology Associates Of Princeton
Heart disease in women
Facts about heart disease in womenHow does the heart work?How to diagnose heart disease?What are the risk factors for heart disease?What is the role of hormone replacement therapy?What are the latest updates?What to expect in the future?
Coronary Heart Disease
Prevalent and preventable
600,000 deaths of which coronary heart disease is the direct cause of 460,000
1.1 million myocardial infarction/heart attacks of which 650,000 are first infarctions
An economic burden of $101 billion
From 1988 to 1998, death rate from CAD has declined
Comparison of deaths from CV disease and breast cancer, by age
0
100
200
300
400
35-54 55-74 >=75
Heart Disease
Breast Cancer
Heart disease in women
More women present with atypical symptoms
More frequent silent MI
Mortality rate of MI and bypass surgery are 50% higher in women
Cholesterol lowering has shown similar efficacy
Cardioprotective agents have similar efficacy
Treatment rates tend to be lower
Diabetes is a particularly serious risk factor
Compared with Men
38% of women and 25% of men will die within one year of a first recognized heart attack 35% of women and 18% of men heart attack survivors will have another heart attack within six years
46% of women and 22% of men heart attack survivors will be disabled with heart failure within six years
Compared with Men
Women are almost twice as likely as men to die after bypass surgery
Women are less likely than men to receive beta-blockers, ACE inhibitors or even aspirin after a heart attackWomen constituted less than 25% of the research patient population
At-Risk
The age-adjusted rate of heart disease for African American women is 72% higher than for white women
Women who smoke risk having a heart attack 19 years earlier than non-smoking women
Women with diabetes are two to three times more likely to have heart attacks
At-Risk
High blood pressure is more common in women taking oral contraceptives, especially in obese women
39% of white women, 57% of black women, 57% of Hispanic women, and 49% Asian/Pacific Islander women are sedentary and get no leisure time physical activity
23% of white women, 38% of black women, and 36% Mexican American women are obese
Compared with Men
More women than men die of heart disease each year, yet women receive only: 33% of angioplasties, stents and bypass
surgeries 28% of implantable defibrillators and 36% of open-heart surgeries
Women comprise only 25% of participants in all heart-related research studies
Normal Coronary Anatomy
Current Path in Cardiac Muscle
Microscopic Pathology of Atherosclerosis
What is a Heart Attack?
A heart attack occurs when the blood supply to part of the heart muscle itself - the myocardium - is severely reduced or stopped. The medical term for heart attack is myocardial infarction
This is usually caused by the buildup of cholesterol plaque.
What causes a Heart Attack?
During a Heart Attack
Myocardial Infarction
Detecting Coronary heart disease
EKG
Stress testing
Echocardiogram
Cardiac Catheterization/Coronary
angiogram
CAT scan- calcium score
MRI of the heart
Normal Thallium Stress Test
Abnormal Stress Test
Cardiac Catheterization
Catheters are also used to inject dye into
the coronary arteries. This is called
coronary angiography
It's also used to get information about the
pumping ability of the heart muscle.
Coronary Blockage
Risk Factors for Heart Disease
High Blood Pressure - Hypertension
High Blood Sugar - Diabetes Mellitus
High Cholesterol
Smoking
Age/Gender
Family History
Obesity
High Blood Pressure
Silent Killer
Uncontrolled high blood pressure can lead
to stroke, heart attack, congestive heart
failure or kidney failure
The only way to tell if you have high blood
pressure is to have your blood pressure
checked
High Blood Pressure
One in four adult Americans has high blood pressure, and nearly one-third of them don't know they have it
Remember, high blood pressure has no symptoms, so if you haven't had it checked in a while, make an appointment now.
Normal BP: 120/80
Hypertension
Know what your Blood Pressure is
Educate yourself on self measurement of
BP
Understand the role of Diet and Exercise
in maintaining BP
Diabetes Mellitus
Diagnosed by checking Fasting Blood
Sugars
Can be silent/asymptomatic
Leading cause of complication from
coronary artery disease
Completely negates the positive effect of
estrogen in pre-menopausal women
Diabetic Patient
If you are a diabetic know your
Hemoglobin A1CHemoglobin A1C
Cigarette Smoking
Most preventable cause of Heart Attacks Responsible for 400,000 premature deaths
in the U.S. annually Nonsmokers and former smokers have
significantly lower rates of Heart attacks than smokers
7%-47% reduction in mortality following smoking cessation
Dietary Management of Heart Disease
Diet modification
More complex carbohydrate
More fruits, vegetables and legumes
More fish
Less meat
Less whole milk products
Alpha-linolenic acid enriched canola oil
margarine
Lipid panel
Total cholesterol <200LDL cholesterol <130HDL cholesterol >40Triglycerides <200
Benefits of Cholesterol Reduction
Effect of Aspirin on Survival
Estrogen/Progestin Therapy also Resulted in:
41% increase in strokes
29% increase in heart attacks
Doubled rates of blood clots in legs and
lungs
37% less colorectal cancer
34% fewer hip fractures and 24% less
total fractures
Recommendations
the therapy should not be continued or started to prevent heart disease
for osteoporosis prevention, women should consult their doctor and weigh the benefits against their personal risks
the therapy for relief of menopausal symptoms may reap more benefits than risks
HRT
Symptom relief should be the primary reason for taking hormone replacement therapyProgestins should be added to estrogen therapy only to prevent endometrial cancer. If a woman has had a hysterectomy, there is no need for progestins in her hormone therapyHormone therapy should not be used to prevent heart disease; women should take other measures to reduce that riskHormone therapies have been shown to help build stronger bones; however, women should weigh the risks of hormone therapy before taking it to prevent osteoporosis
HRT
A woman should take HRT for the shortest amount of time possible, based on her symptoms, the benefits she's getting from the therapy, and her personal health risks Doctors should consider prescribing low-dose HRT whenever possibleDoctors should consider alternate ways of giving HRT other than orally -- such as patches and creams, but should know that studies are not clear on the long-term risks and benefitsEvery woman's personal health risks should be evaluated before any form of hormone therapy is prescribed. Women should be sure they understand the known risks
Top Tips for Heart Health
Reduce total fat, favor mono-unsaturated fats over saturated fats and above all, eat moderate portions
Learn how to be more stress resilient
Get moving today
Smoking cessation
Being a good weight for your height
Eating healthy and exercising regularly
What’s new
Markers for inflammationC- reactive proteinHomocysteineLipoprotein (a)Drug coated stentMinimally invasive surgeryOff pump open heart surgery
What to expect in the future
Super HDL coronary infusion therapyNon invasive visualization of coronary arteriesFocusing on inflammation as risk reduction in heart disease
Online resources
www.womenheart.orgNational coalition of women with heart disease
The Heart Truth Awareness campaign of the National Heart,
Lung, and Blood Institute
American Heart AssociationOrganization fighting heart disease and stroke
Heart Disease in Women
