1 Women & Heart Disease Julia C. Orri, Ph.D. Biol. 330 November 21, 2006

2 Objectives  List the trends in heart disease for women  Name the risk factors for CAD  Define atherosclerosis, MI  Compare MI signs between men and women  Explain gender differences in heart disease  Describe strategies to decrease CAD risk in women

3 233,886 41,566 67,894 American Heart Association, 2006 Deaths From Breast Cancer, CAD, and lung Cancer (2003)

4 Women & CVD Only 13% of women in America believe that CAD and stroke are the greatest health threats to women.

CDC, 2006

6 Women & CVD Facts  Nearly 39% of all female deaths occur from CVD  The death rate due to CVD is substantially higher in African American women than in Caucasian women

38% of women compared to 25% of men will die within 1 year after a heart attack. American Heart Association, 2006

Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sex NHANES: American Heart Association. Heart Disease and Stroke Statistics-2005 Update

10 ALOHA to Heart Disease  A- Assess your risk

11 Positive Risk Factors for CAD  Family history  Hypercholesterolemia  Hypertension  Cigarette smoking  Impaired fasting glucose  Obesity  Physical inactivity

12 Quiz  Holly, 42 years old  MI Runner Non-smoker Non-HT Low cholesterol

13 Daily Physical Activity (PA) Every U.S. adult should accumulate 30 min or more of moderate-intensity physical activity on most, preferably all, days of the week. (U.S Surgeon General, CDC, ACSM)

14 ALOHA to Heart Disease  A- Assess your risk  L- Lifestyle change  O- Other interventions  H- Highest risk women: highest priority  A- Avoid… Mosca. Circulation, 2004; 109:

15 LDL DIABETES MELLITUS HT SMOKING

16 Coronary Artery Disease (CAD)

Normal?

Coronary Artery Disease (CAD) AtherosclerosisNormal

19 CAD (con’t)

20 CAD (con’t)  Atherosclerosis Plaque narrows coronary arteries Results in ischemia Leads to myocardial infarction (MI)

21 Thrombosis of Coronary Artery

CAD (con’t) Myocardial Infarction

Myocardial Infarction (MI)

24 MI Signs  Severe chest pain/pressure  Sweating, nausea, vomiting   cardiac enzymes  ECG changes

25 The Female Heart

26 What’s your diagnosis?  Stella, aged 68  Symptoms Sleep disturbance Unexplained fatigue SOB Indigestion/nausea Pain in back and high chest

27 The Female Heart  38.2 million women have CVD  Silent MI more common  Atypical chest pain  Delayed diagnosis  Underutilized prevention & research

28 Female Heart (con’t)  45 million women older than 50 yr  Smoking cessation rates declining slower than among men  Abdominal obesity  3-7x  in CAD risk if diabetic

More visceral abdominal fat (light) = greater health risk

30 Female Heart (con’t)  Worse prognosis for women with CAD than men  Women had 2x in-hospital mortality rate  Age, size of coronary arteries, severity of sickness at presentation Fatality rate

31 Take-Home Message  Women have worse prognosis and die more often than men after MI or bypass  CAD is largely preventable  Major emphasis on lifestyle modifications: smoking cessation, regular PA, maintenance of healthy weight, lipid lowering therapy

32 Thank you! Any questions? 