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Heart to Heart: What YOU Should Know about Heart Disease

Heart to Heart: What YOU Should Know about Heart Disease. Shannon J. Winakur , M.D., F.A.C.C. Maryland Cardiovascular Specialists Red Dress Sunday Symposium December 1, 2012. What are we talking about?. Cardiovascular diseases (CVD) Coronary artery disease (CAD) Heart failure Stroke

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Heart to Heart: What YOU Should Know about Heart Disease

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  1. Heart to Heart:What YOU Should Know about Heart Disease Shannon J. Winakur, M.D., F.A.C.C. Maryland Cardiovascular Specialists Red Dress Sunday Symposium December 1, 2012

  2. What are we talking about? • Cardiovascular diseases (CVD) • Coronary artery disease (CAD) • Heart failure • Stroke • High blood pressure Heart Disease and Stroke Statistics - 2012 Update, AHA

  3. Why do we care? • Heart disease is the biggest killer of women • Cardiovascular disease is BY FAR the biggest killer of women • Almost 420,000 deaths/year from CVD (vs. 392,000 men) • 189,100 deaths/year from CAD • Vs. roughly 40,500 deaths from breast cancer Heart Disease and Stroke Statistics - 2012 Update, AHA

  4. Why do we care? • 64% of women with sudden cardiac death had no previous symptoms (vs 50% of men). Heart Disease and Stroke Statistics - 2012 Update, AHA

  5. Why do we care? • CVD accounts for a third of all female deaths • Maryland ranks 33rd in death rate due to CVD, 40th in death rate due to CAD • CVD and CAD disproportionately affect African-American and Latina women CDC data and Heart Disease and Stroke Statistics - 2012 Update, AHA

  6. Why do we care? • Coronary heart disease is the number one killer of women over 25… • Cardiovascular disease kills ONE WOMAN EVERY MINUTE in the U.S.! • BUT most women don’t understand the significant health threat that CVD and CAD represent!

  7. Why do we care? • Awareness gap • 57% of women surveyed by AHA knew that heart disease is the leading cause of death (an increase!) • Lower among women of color • The majority of respondents expressed confusion about basic prevention strategies

  8. Why do we care? • Several studies show worrisome awareness rates: • Women Veterans Cohort: 8-20% of women aware that CAD is the major cause of death • Study of physicians: less than 1 in 5 docs knew that more women die from CVD than men each year

  9. Why do we care? • After a heart attack, women are more likely than men: • To die • To have another heart attack • To have heart failure • To have a stroke

  10. Why do we care? • MANY OF THE RISK FACTORS ARE MODIFIABLE! • MUCH OF CARDIOVASCULAR DISEASE IS PREVENTABLE!

  11. How are we getting the word out?

  12. How are we getting the word out?

  13. Saint Agnes Women’s Heart Center “60 minutes for $60” • 60 minutes of screening and education • Personal risk assessment • EKG • Blood work: lipid profile, hemoglobin A1c

  14. AHA Guidelines “Prevention of CVD is paramount to the health of every woman and every nation. Even modest control could have an enormous impact…Fortunately, most CVD in women is preventable.” Circulation. 2007; 115: 1481-1501

  15. SYMPTOMS

  16. What are the symptoms? Chest discomfort Radiation to the arms, neck or back

  17. What are the symptoms? Shortness of breath

  18. What are the symptoms? Fatigue

  19. What are the symptoms? Palpitations

  20. What are the symptoms? Nausea

  21. What are the symptoms? Sweating

  22. RISK FACTORS

  23. Risk Factors for CAD HIGH BLOOD PRESSURE • 46% of African-American women • 29% of Mexican-American women

  24. Risk Factors for CAD HIGH CHOLESTEROL • 41% of African-American women • 47% of Mexican-American women

  25. Risk Factors for CAD DIABETES • 15% of African-American women • 13% of Mexican-American women

  26. Risk Factors for CAD SMOKING

  27. Risk Factors for CAD FAMILY HISTORY OF PREMATURE CAD

  28. Risk Factors for CAD OBESITY • 51% of African-American women • 43% of Mexican-American women

  29. Risk Factors for CAD PHYSICAL INACTIVITY • Roughly 75% of African-American and Latina women

  30. OTHER RISK FACTORS • Stroke/TIA • Peripheral arterial disease • Abdominal Aortic Aneurysm • Chronic kidney disease • Postmenopausal state • History of pre-eclampsia, stillbirth, or multiple miscarriages

  31. OTHER RISK FACTORS • Autoimmune disease (lupus, rheumatoid arthritis) • History of cancer treatments (chemotherapy and radiation) • History of trauma or abuse

  32. YOU CAN DO SOMETHING TO POSITIVELY IMPACT THESE RISK FACTORS!!

  33. Know Your Numbers • Blood pressure: 120/80 or less • Blood sugar: less than 100 mg/dl (fasting) • Body Mass Index: less than 25 kg/m2 • Waist circumference: less than 35 in. • Exercise: at least 30 min./day, most days of the week

  34. CHOLESTEROL • Total cholesterol • Triglycerides • HDL (“good”) • LDL (“bad or Lousy”)

  35. CHOLESTEROL Why does it matter?

  36. Treatment of cholesterol • Decrease intake of saturated fat, trans fat, and refined carbohydrates • Exercise • Quit smoking • Medications

  37. Lifestyle Recommendations • Smoking cessation • Diet • Physical activity • Weight management

  38. Smoking • Recent studies: • Smoking seems to be a more significant risk factor in women than in men • Female smokers had triple the risk of early death, and quitting before 40 decreased this risk by 90%

  39. Diet

  40. Diet • Rich in fruits and vegetables • Whole grains and high fiber foods • Fish at least twice a week • Limit saturated fat to <10% • As little trans fat as possible • Limit alcohol to 1 drink a day • Limit sodium to 2.3 g/day

  41. Diet • Watch portion sizes • Be aware of calories • Have healthy snacks around the house instead of junk food • Don’t drink your calories

  42. Lifestyle Recommendations • Physical activity • At least 30 minutes of moderate activity on most, if not all, days a week • 60-90 minutes a day for weight loss or maintenance

  43. Strong Evidence: Lower risk of: Early death CAD Stroke HTN High cholesterol Type 2 Diabetes Metabolic syndrome Colon and breast CA Strong evidence: Weight maintenance or loss Improved fitness Prevention of falls Reduced depression Better cognitive function THE BENEFITS OF EXERCISE US Dept of Health and Human Services, 2008 guidelines

  44. Moderate to Strong Evidence: Better functional health Reduced abdominal obesity Moderate evidence: Lower risk of Hip fracture Lung CA Endometrial CA Weight maintenance after wt. loss Increased bone density Improved sleep quality THE BENEFITS OF EXERCISE US Dept of Health and Human Services, 2008 guidelines

  45. Lifestyle Recommendations • Physical activity • Take the stairs • Park farther away • Take a walk after dinner • Make exercise appointments • Find an exercise partner • Check out “Choose to Move” (www.choosetomove.org)

  46. Lifestyle Recommendations • Weight management • BMI between 18.5-24.9 • www.nhlbisupport.com/bmi

  47. Take-home points • Average lifetime risk for CVD in women is very high, approaching 50%. • Women need to be aware that they are at risk. • Prevention can make a big difference, both in individuals and in populations. • Lifestyle measures are the foundation of prevention!

  48. Take-home points • MUCH OF CARDIOVASCULAR DISEASE IS PREVENTABLE! • MUCH OF CARDIOVASCULAR DISEASE IS PREVENTABLE! • MUCH OF CARDIOVASCULAR DISEASE IS PREVENTABLE!

  49. Take-home points • SPREAD THE WORD! • TELL YOUR FRIENDS AND FAMILY!

  50. THANK YOU!

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