2. It is important for women to talk to their nurse or doctor about the health of their heart and blood vessels It is important for women to talk to their nurse or doctor about symptoms of heart problems Women need to tell other women about heart health and important risk factors Why “Tell A Friend”?

3. Heart disease is the #1 cause of death in women Stroke is the #5 cause of death in women Know the symptoms of heart attack and stroke, and seek medical attention promptly Prevention is important for everyone! Key Messages for Women

4. CVD & Other Causes of Death More than 1 in 4 women will die of heart disease 1 in 30 women will die of breast cancer

5. Women are Getting the Message What is the leading cause of death in women? We know the answer: Heart Disease! In 1997, only 30% (less than 1 out of 3) women knew the right answer. In 2012, 57% of women knew the right answer. *However, in 2012, only 36% Hispanic and Black women were aware. 45% women ages 25-60 did not know heart disease is their #1 killer.

6. Women are more likely to die in the first year following a heart attack than men the same age – 1 of 4 men will die in the first year – More than 1 of 3 women will die in the first year We don’t know all the reasons for this difference The government requires that heart disease researchers: – include women as research subjects – report how men and women respond to treatments Death After a Heart Attack

7. Cholesterol profile numbers Blood pressure reading Blood sugar: blood test for diabetes BMI or Waist Circumference Always Know Your Numbers!

8. Guidelines put women in 1 of 3 classes: – Low Risk – Moderate Risk – High Risk The same things that increase risk for a heart attack can increase the risk for a stroke Ask your nurse or doctor to help you make a plan to lower your risk level Risk Factors for Heart Disease

9. Physical Activity Life Stress High Blood Pressure Obesity Diabetes High Cholesterol & Triglycerides Smoking Unhealthy Diet (HIGH in saturated fat & calories; LOW in fresh fruit, veggies, whole grains & fish) What are the Risk Factors? Age Gender Family History What You Can ChangeWhat You Can’t Change

10. Small Changes Can Make a Difference Long Term Study of 90,000 women (ages 27-44) from 1991-2011 reduced their risk for HD over 90% over 20 years. 6 Healthy Lifestyle Habits – Not smoking – Exercising at least 2.5 hours a week – Maintaining a normal weight – Eating a healthy diet – Watching 7 or less hours of TV a week – Limiting alcohol to no more than 1 drink a day

11. Previous heart attack or stroke Angina (chest pain or pressure due to blocked arteries) Circulation problems Diabetes Chronic kidney disease Signs You’re at HIGH RISK for Heart Disease

12. One or more of the following risk factors: – High cholesterol – Smoking – High blood pressure – Family history of heart disease or stroke at a young age (<50 for men; <60 for women) Metabolic Syndrome-a cluster of risk factors that often occur together-more about this later! Signs You’re at MODERATE RISK for Heart Disease

13. Rheumatoid arthritis or Lupus A history of high blood pressure in pregnancy, diabetes in pregnancy or preeclampsia If you can only exercise for a short time during a treadmill test performed by your nurse or doctor More Signs You’re at MODERATE RISK for Heart Disease

14. “Optimal Risk” No major risk factors Healthy Diet Daily Exercise No Smoking Healthy weight (BMI 19-25) Signs You’re at LOW RISK for Heart Disease

15. Tackling a Risk Factor: HIGH BLOOD PRESSURE

16. High blood pressure is very common as women get older Even women who had good blood pressure all their lives are at risk for high blood pressure as they age High blood pressure is called the “silent killer” because it doesn’t have any symptoms Recognizing High Blood Pressure

17. Blood Pressure Recommendations You May Be Familiar With Optimal<120 systolic and <80 diastolic Pre-Hypertension120-139 systolic or 80-89 diastolic Stage 1 Hypertension 140-159 systolic or 90-99 diastolic Stage 2 Hypertension >160 systolic or >100 diastolic

18. Blood Pressure Treatment Goals JNC-7 Treat to BP <140/90 mmHg. Treat to BP <130/80 mmHg in patients with diabetes or chronic kidney disease. Majority of patients will require two medications to reach goal.

19. When you lower your blood pressure, you lower your risk of: – Stroke by 40% – Heart Attack by 25% – Heart Failure by 50% Lowering Your Blood Pressure: Good Things Can Happen!

20. Make healthy habits – Take a 30 minute walk everyday – Avoid being overweight – Lower salt in your diet – Follow a heart-healthy diet (low fat, lots of fruits/ veggies and 2-3 servings of low fat dairy products every day) – Limit alcohol to one drink per day Take the right medicines – There are many good and safe medicines – Most people will need more than one Lowering Your Blood Pressure: What Can You Do?

21. Tackling a Risk Factor: HIGH CHOLESTEROL

22. Cholesterol (Lipid) Recommendations You May Be Familiar With Total Cholesterol Goal:<200 mg/dL “Bad Cholesterol” LDL Goal: (Low Density Lipoprotein Cholesterol) <100 mg/dL “Good Cholesterol” HDL Goal: (High Density Lipoprotein Cholesterol) >50 mg/dL Triglycerides Goal:<150 mg/dL

23. Newer Cholesterol Recommendations (2013) Who should be taking cholesterol medication? 1. If you have had a heart attack or a stroke 2. If you have diabetes (Type 1 or 2) and are 40-75 years old 3. If your LDL-C is higher than 190 mg/dl 4. If your estimated 10 year risk of developing a heart attack is greater than 7.5 % and you are 40-75 years old

24. Main Target of Treatment = LDL Cholesterol Healthy behaviors are important! If you already have heart disease or diabetes, or if your cholesterol level or risk is high, you might need medicine to lower your cholesterol Note: Women who are pregnant, nursing, or who may become pregnant should not be prescribed cholesterol-lowering medications Lowering Your Cholesterol: What Can You Do?

25. Tackling a Risk Factor: DIABETES

26. Type 2 diabetes increased 50% in the last 10 years A woman with diabetes has 5x the risk of heart disease than a woman without diabetes Women with diabetes get heart disease at a younger age If you have diabetes, it is important to have ALL of your risk factors treated: – Blood Pressure – Cholesterol – No Smoking! Women and Diabetes

27. Know Your Numbers: Diabetes Guidelines* Optimal fasting blood sugar level:<100 mg/dL Impaired fasting glucose: Prediabetes 100-125 mg/dL *American Diabetes Association Guidelines You have diabetes if: Your fasting blood sugar is 126 or more (and tests at that level or higher on a second reading on a different day)

28. Research shows that diabetes can be prevented, or at least postponed by improving diet, losing weight, and increasing physical activity People at risk for diabetes who follow a diet and exercise can decrease their risk of developing diabetes by more than 50% – This has been proven in a trial where the people lost an average of less than 10 pounds. Small steps make a BIG difference! Lowering Your Risk for Diabetes: What can you do?

29. Other Risk Factors

30. Women who smoke have 2-6 times the risk of sudden cardiac death than non-smokers That risk is even higher for heavy smokers Second-hand smoke increases health risks, too Health benefits begin as soon as you quit! Talk to your nurse or doctor about how to stop: – Quitting is difficult – Nicotine replacement or medications may be helpful – Get Support: Call 1-800-Quit Now or visit www.SmokeFree.gov Smoking: The #1 Preventable Risk

31. A growing problem in the United States Being overweight increases risk of: – High blood pressure – Cholesterol abnormalities – Diabetes Exercise recommendations to lose weight: – 60-90 minutes of moderate-intensity activity everyday All women should reduce saturated fat intake to less than 7% of calories Overweight and Obesity

32. Choose fat free milk instead of whole milk Park far away, so you can walk When eating out, share an entrée or save half for the next day Portion Control: Fill up half of your plate with veggies or salad, smaller amounts of carbs and low fat protein Wear a pedometer to count your steps – then increase your steps gradually (2,000 steps = 1 mile) Walk to a co-worker’s desk instead of emailing Easy Ways to “Cut” and “Spend” Calories

33. Certain risk factors tend to “go together” and increase your risk for getting diabetes or heart disease: – Overweight, especially when carried around the waist – High blood pressure – Cholesterol abnormalities (low HDL or high triglycerides) – Elevated blood glucose People with these risk factors need to be treated very aggressively for heart disease prevention Heart healthy habits are key! The Metabolic Syndrome

34. Risk Factors Add Up!

35. Exercise helps: Lower blood pressure Prevent diabetes Lower LDL (bad cholesterol) and raise HDL (good cholesterol) Weight management Manage stress and depression Bone health Exercise is Key!

36. Postmenopausal Hormone Therapy (HT) is NOT recommended to prevent heart disease. Research trials have failed to demonstrate that HT lowers risk. It may increase stroke Women should focus on the things we know really work to improve heart health Hormone therapy may still be used to treat menopause symptoms – talk to your nurse or doctor What About Postmenopausal Hormone Therapy?

37. When Prevention Isn’t Enough: HAVING A HEART ATTACK

38. Uncomfortable pressure, fullness, burning or squeezing sensation in the chest Pain in your chest, neck, arms, or back Unusual shortness of breath Nausea, vomiting, dizziness, sweating Unusual fatigue Feeling of doom – a sense that something really bad is happening, or about to happen How Do You Know: Symptoms of a Heart Attack

39. You may not have all symptoms Symptoms are different for everyone It may not be as dramatic as on TV or movies You know your body – trust your instincts! Immediate treatment that can limit the amount of heart muscle damage is crucial SYMPTOMS REQUIRE IMMEDIATE ACTION! CALL 9-1-1 How Do You Know: Symptoms of a Heart Attack

40. When Prevention Isn’t Enough: HAVING A STROKE

41. Sudden numbness or weakness in your face, arm, or leg – especially on one side of your body Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one eye, or both Sudden trouble walking, dizziness, loss of balance or coordination Sudden, severe headache with no known cause How Do You Know: Symptoms of a Stroke

42. A stroke is a brain attack Emergency treatment that can limit the amount of brain damage must be started quickly It is usually not the person experiencing the stroke that calls 9-1-1 Make your family aware of the symptoms SYMPTOMS REQUIRE IMMEDIATE ACTION! CALL 9-1-1 How Do You Know: Symptoms of a Stroke

43. Key Take-Aways

44. Know the symptoms of heart attack and stroke Know your risk factors for heart disease Work with your nurse or doctor to reduce your risk: – Avoid tobacco products and second-hand smoke – Have your blood pressure and cholesterol profiles measured (and blood sugar if at risk for diabetes) – Follow their advice to manage risks with healthy behavior changes and medicine, if needed – Eat a heart healthy diet – low in “bad” fat and salt – Exercise – walking for 30 minutes each day is perfect Key Take-Aways

45. SPREAD THE WORD: TELL A FRIEND, NEIGHBOR, SISTER OR CO-WORKER Key Take-Aways

46. Online Resources National Heart Lung and Blood Institute: www.nhlbi.nih.gov (information about cholesterol and blood pressure)www.nhlbi.nih.gov Heart Truth Campaign: www.nhlbi.nih.gov/health/hearttruth/www.nhlbi.nih.gov/health/hearttruth/ American Heart Association (AHA): www.heart.orgwww.heart.org AHA Go Red for Women: www.goredforwomen.orgwww.goredforwomen.org WomenHeart: National Coalition for Women with Heart Disease: www.womenheart.orgwww.womenheart.org Preventive Cardiovascular Nurses Association: www.pcna.net www.pcna.net