Heart Disease in WOMEN Amanda Ryan, DO, Interventional Cardiologist Heart Care Centers of Florida April 13th, 2013

Transcription

1 Heart Disease in WOMEN Amanda Ryan, DO, Interventional Cardiologist Heart Care Centers of Florida April 13th, 2013

2 Objectives Prevention - Discuss strategies to assess and stratify women into high risk, at risk, and ideal health categories for cardiovascular disease (CVD) Detection - Review symptoms and tests to identify heart disease in women Treatment - Innovative treatment options for CVD

3 What is Heart Disease Includes numerous problems, many of which are related to a process called atherosclerosis. Atherosclerosis is a condition that develops when a substance called plaque builds up in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can stop the blood flow. This can cause a heart attack or stroke.

4 Classes of Cardiovascular Disease Coronary heart disease (also ischemic heart disease or CAD) Cardiomyopathy - diseases of cardiac muscle Hypertensive heart disease - diseases of the heart secondary to high blood pressure Heart failure symptoms include shortness of breath, fluid overload Cardiac dysrhythmias such as atrial fibrillation Inflammatory heart disease Stroke and cerebrovascular disease Valvular heart disease Peripheral arterial disease

5 Prevalence Facts Heart disease is the #1 killer of American women Heart disease kills more women than all forms of cancer combined Heart disease can permanently damage your heart and your life Over 10,000 women under age 45 suffer an acute myocardial infarction every year If heart disease is not treated, serious complications can develop

6 CVD and Other Major Causes of Death for Women in the United States: , ,928 Number 400, , , , ,000 81, ,000 66,689 0 Total CVD Source: Roger CHD Stroke Cancer 6 Asthma + COPD

7 Heart Disease The leading killer of women at all ages

8 Mortality Rates in Women At Every Age, More Women Die From Heart Disease Than From Cancer Coronary artery disease Stroke Lung cancer Breast cancer Colon cancer Endometrial cancer Mortality Rate per 100, % of women (1 in 2) will die from CVD compared with 4% (1 in 25) who will die from breast cancer Age (years)

9 So how long have we known that heart disease kills women???

10 Women CHD Prevalence Nearly 37 percent of all female deaths in America occur from CVD, which includes coronary heart disease (CHD), stroke and other cardiovascular diseases. In 2008, CVD claimed the lives of 421,928 females; cancer (all forms combined) 270,018. At age 40 and older, 23 percent of women compared with 18 percent of men will die within one year after a heart attack

11 OKAY HEART DISEASE IN IT S MANY FORMS IS COMMON IN WOMEN! AM I AT RISK?

12 Risk Factors Hyperlipidemia Hypertension Diabetes Tobacco use Poor diet Obesity Physical inactivity Genetics

13 Risk Factors Continued Sleep apnea Stress or depression Too much alcohol Birth control pills (particularly for women who are over age 35 and smoke) Anemia Metabolic syndrome

14 Metabolic Syndrome Any 3 of the following: Abdominal obesity (waist circumference 35 inches) High triglycerides 150 mg/dl Low HDL-C cholesterol < 50 mg/dl Elevated BP 130/85 mm Hg Fasting glucose 100 mg/dl

15 The Multiplier Effect - 1 risk factor doubles your risk - 2 risk factors quadruple your risk - 3 or more risk factors can increase your risk more than tenfold

16 We understand the risk factors what can we do to prevent and/or detect heart disease?

17 AWARENESS The Red Dress The national symbol for women and heart disease awareness.

18 Create Awareness 2006 SWHR & WomenHeart joined forces to address women s heart health: Society for Women s Health Research (SWHR), a national organization whose mission is to improve the health of all women through research, education and advocacy WomenHeart: The National Coalition for Women with Heart Disease, the nation s only patient centered organization serving the 8 million American women living with heart disease

19 Top 10 Women Heart Disease Goals They created a top ten question set of topics that needed addressed in order to promote women s cardiovascular research and care. In 2011, a lack of progress in the area prompted the combined groups to reassess and issue a new executive summary of topics that need to be addressed through research and awareness in order to improve early detection, and the accurate diagnosis and treatment for women living with or at risk of heart disease. (Women Heart 2011)

20 1. What factors influence or explain disparities in cardiovascular disease epidemiology and disease outcomes between men and women? 2. What are the best strategies to assess, modify, and prevent a woman s risk of heart disease? 3. What are the most accurate and effective approaches to assess and recognize chest pain and other symptoms suggesting coronary heart disease in women? 4. What role does a woman s reproductive history and menopausal hormone therapy play in the development of heart disease? 5. What are the risk factors for cardiovascular disorders associated with pregnancy and how are they best treated?

21 6. What is the best method for studying sex differences in vascular injury so that cardiovascular repair therapies may be improved? 7. What are the most effective treatments for diastolic heart failure (heart failure with preserved pumping function of the heart) in women? 8. Why are young women more likely than men to die after a heart attack or after surgical revascularization procedure? 9. How do psychosocial factors affect cardiovascular disease in women? 10. What biological variables are most influential in the development and clinical outcomes of heart disease and what can be done to reduce mortality rates in women?

22 Focus on Goals Researchers and society in general must focus on understanding the current state of heart disease in women in the United States & achieving these goals.

23 Metrics of CV Health in AHA 2020 Impact Goals for CV Health Current smoking BMI Physical Activity Healthy diet pattern Total cholesterol, mg/dl Blood pressure Fasting plasma glucose, mg/dl

24 Okay we understand how common heart disease in women is & the risk factors. WHAT ARE THE POTENTIAL SYMPTOMS of a HEART ATTACK (MI)?

25 Chest pain or Angina Typical Angina: heaviness, pressure or squeezing sensation behind the breastbone with radiation across the chest, up the neck or down the left arm or strangling or suffocating sensation. caused or worsened by exercise and eased by rest usually lasts two to five minutes Atypical Angina (frequently encountered in women): shortness of breath extreme fatigue lightheadedness or fainting nausea and/or indigestion

26 Possible MI signs in Women Pain, pressure, burning or squeezing in the chest, jaw, shoulders, back, or arms, that lasts more than 5 to 10 minutes Unexplained shortness of breath lasting more than 5 to 10 minutes Sudden severe nausea, vomiting or indigestion Sudden sweating for no reason Sudden unexplained extreme fatigue Loss of consciousness or fainting Sudden, unexplained, panicky feeling of doom

27 Women s Early Warning Signs of a Heart Attack Weeks before Heart Attack (95% of women) Ø Unusual fatigue (70.7%) Ø Sleep disturbance (47.8%) Ø Shortness of breath (42.1%) Ø Indigestion (39.4%) Ø Chest pain (29.7 %) At time of Heart Attack Ø Shortness of breath (57.9%) Ø Weakness (54.8%) Ø Fatigue (42.9%) Ø Chest pain (57%) McSweeney, JC et al. Circulation 2003;

28 Annual Number of Deaths from Heart Attacks as of 2008

29 What Do I Do? Only 53% of women said they would call if experiencing the symptoms of a heart attack However, 79% said they would call if someone else was having a heart attack For themselves, 46% of women would do something other than call such as take an aspirin, go to the hospital, or call the doctor

30 TIME IS MUSCLE Certain heart attacks include a heart artery that is 100% blocked often called STEMI. The faster that artery is open the less chance heart muscle sustains any damage from lack of blood flow So important to have cath labs with trained interventional cardiologist and staff in our community hospitals.

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33 Prevention and Awareness Multiple techniques and approaches to identify, treat, and prevent heart disease Requires a comprehensive plan Knowledge is power, educate yourself Talk to your doctors Be willing to participate in research

34 Say ALOHA to Heart Disease in Women A Assess your risk: high, intermediate, or low? L Lifestyle recommendations are first priority O Other interventions prioritized according to expert panel rating scale H Highest priority for therapy is for women at highest risk A Avoid medical therapies called Class III where evidence is lacking

35 Modify Risk Factors That Are Controllable By doing just 5 things eating right being physically active not smoking keeping a healthy weight Controlling blood pressure you can lower your risk of heart disease by as much as 82 percent

36 TESTING FOR CAD Technique Assessment Angiography Heart Coronary anatomy Catheterization Coronary CT Coronary calcification Echocardiography Regional wall motion Nuclear Cardiology Regional blood flow stress testing Source: Charney 2002, Greenland 2007

37 Going Beyond the Basics Basic lipid panels (BLPs) may be inaccurate and inadequate at assessing residual risk in all patients 50% of patients hospitalized with coronary artery disease had normal cholesterol: admission low-density lipoprotein (LDL) cholesterol <100 mg/dl as measured by basic lipid panels Over 75% of patients with myocardial infarction (MI) fell within current guideline-recommended targets for LDL as measured by basic lipid panels Patients with diabetes are at increased risk for MI, stroke, amputation, and death Diabetes causes metabolic abnormalities that induce vascular dysfunction, which predisposes this population to atherosclerosis

38 VAP Lipid Panel Choose VAP Lipid Panel for patients with: Established atherosclerotic vascular disease Diabetes mellitus Framingham risk score over 5% An elevated inflammatory biomarker NCEP/ATP III risk factors Age 45 years in men and 55 years in women Family history of premature coronary heart disease History of cigarette smoking Hypertension Low HDL (<40 mg/dl)

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40 References Gaziano JM, ridker PM, Libby P. Primary and secondary prevention of coronary heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular MEdicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 49. Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 70. The Heart Truth Professional Education Campaign Website Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women update: A guideline from the American Heart Association. Circulation. 2011;123(11):

41 Working Together to Make Women s Cardiovascular Care A Priority Amanda Ryan, DO, Board Certified Cardiologist Heart care centers of florida, titusville, fl