HEART DISEASE Dr. KULBIR BAJWA NorthBay Center for Primary Care Compassionate Care, Advanced Medicine, Close to Home. NorthBay.org (707) 624-7500
FACTS • 8.6 million women worldwide die each year from heart disease • One in four American women die annually from heart disease • Accounts for 1/3 of all deaths in women
HEART DISEASE • 8 million American women live with heart disease • Leading cause of death in American women • Kills six times as many as breast cancer
HEART DISEASE • Annually 435,000 women have heart attacks • 83,000 (20%) are under 65, • 35,000 < 55 age ( 8%)
HEART DISEASE • Under age 50, heart attacks in women are twice as likely to be fatal as men’s • 2/3 of all women die with no previous symptoms of chest pain
UNIQUE CHALLENGES IN SOLANO COUNTY • Demographic profile that is multi-ethnic and diverse • With race, risk factors for heart disease change
SOLANO COUNTY • Highest rate of death from stroke (total 58 counties) • Obesity- 60% of adults • Smoking – 20% (one in 5 smoke)
MYTHS ABOUT HEART DISEASE • Heart disease happens largely in men • Only tense and irritable people have to worry about developing high blood pressure • Heart and stroke risk are mainly determined by genes • Large weight gain is needed before your health risk increases
MYTHS • Plaques in arteries begin in adulthood • Damage to heart tissue is not permanent • It is not necessary to seek immediate help for chest discomfort or pain
SYMPTOMS • Non-classical • Nausea • Fatigue • Anxiety • Shortness of breath • Burning in chest • Throat pain, shoulder or upper back pain
SYMPTOMS • Classical • Chest heaviness • Nausea and vomiting • Numbness in left arm • Sweating • Palpitations
UNIQUE CHALLENGES FOR WOMEN • 3 million women with heart disease have normal angiograms • They are believed to be low risk INCORRECTLY • Called coronary microvascular syndrome where EKG, ENZYMES and STRESS TESTS are normal
UNIQUE CHALLENGES FOR WOMEN • Women are unique with stressors (emotional) that can contribute to increased risk of heart disease
DEPRESSION/STRESS • More prevalent in women than men • Increases risk cad 2-3 times • Multifactorial
DEPRESSION/STRESS • 17,415 healthy middle-aged women who women’s health study, national heart, lung and blood institute. • Women who reported high job strain faced a 40 percent increase in cardiovascular and an 88 percent increase in risk for heart attacks alone.
MODIFIABLE • SMOKING • ELEVATED CHOLESTEROL • ELEVATED BLOOD PRESSURE • PHYSICAL INACTIVITY • OBESITY • DIABETES • LOW HDL • DRUGS- METAMPHETAMINES, COCAINE
NON MODIFIABLE • AGE • GENDER • RACE • FAMILY HISTORY OF PREMATURE HEART DISEASE • GENETICS. C-REACTIVE PROTEIN, LPa
FAMILY HISTORY • If a first-degree male relative (e.g. father, brother) has suffered a heart attack before the age of 55, or if a first-degree female relative has suffered one before the age of 65, you are at greater risk of developing heart disease.
FAMILY HISTORY • If both parents have suffered from heart disease before the age of 55, your risk of developing heart disease can rise to 50% compared to the general population
GENETICS • One of the inherited factors is high cholesterol level, known as familial hypercholesterolemia. you will experience a build up of low-density lipoprotein cholesterol in the blood. This can lead to coronary heart disease.
C REACTIVE PROTEIN • C-reactive protein, or CRP, test, measures the amount of a protein in the blood that correlates to levels of inflammation in the body. • High levels of CRP may be a sign of infection or long-term heart disease.
SMOKING • Smoking is one of the top risk factors. Because it causes inflammation, hardening and stiffening of the lining of the blood vessels in the brain, the heart and throughout the body, leading to increased risk for stroke and heart attack.
SMOKING • Smoking increases heart attack risk by 3 times • Even smoking < 5 cigarettes a day doubles the risk of heart disease • Stop smoking can reduce your risk by 25% in 2 years
HIGH BLOOD PRESSURE • The major factor for heart disease • Only 31% have optimal control • Contributors • Central obesity • Post menopausal • Family history • Untreated high BP doubles risk of getting diabetes in 6 years • Understand that high BP is a silent killer
BLOOD PRESSURE • CATEGORY SYSTOLIC DIASTOLIC • NORMAL < 120 < 80 • Prehypertension 120-139 80-89 • Hypertension stage 1 140-159 90-99 • Hypertension stage 2 > 160 > 100
HDL CHOLESTEROL • <40 MG/DL LOW • >60 HIGH • HIGH HDL IS PROTECTIVE, AND COUNTS AS A NEGATIVE RISK FACTOR
LDL CHOLESTEROL • <100 MG/DL OPTIMAL WITH HEART DISEASE • 100-129 ABOVE OPTIMAL WITH HEART DISEASE • 130-159 BORDERLINE HIGH, WITH 2+ RISK FACTORS, • 160-189 HIGH, 0-1 RISK FACTOR, • >190 VERY HIGH
TRIGLYCERIDES • < 150 NORMAL • 150-199 BORDERLINE HIGH • 200-499 HIGH • > 500 VERY HIGH
OBESITY • More than 50% Americans are at least 20% above ideal weight • Pattern of weight distribution is important • Waist:hip >0.8 increases cardiac risk • Ideal BMI 18.5 to 24.9
OBESITY • 2 times increase in insulin resistance/metabolic syndrome • Increasing in adolescent population
METABOLIC SYNDROME OR INSULIN RESISTANCE THREE OR MORE OF • WAIST > 35 INCHES • TRIGYLCERIDES >150 • HDL < 50 FORWOMEN • B.P. > 130/85 • FASTING BLOOD SUGAR > 100
METABOLIC SYNDROME • 47 million people in USA meet this criteria • This syndrome doubles the risk of heart disease • Five times as likely to develop diabetes
PRE DIABETES • 54 MILLION PEOPLE IN USA • BLOOD SUGAR 100-125 MG/DL • 30% END UP WITH DIABETES • 2-3 X RISK OF HEART DISEASE
DIABETES • Women are 3-7 times more likely to have heart disease and heart attack • Women over 45 are twice as likely to develop diabetes based on weight • Deceases in population that exercises regularly • Interrelated to blood pressure, cholesterol and weight
EDUCATE • Presenting symptoms differ in women and men • Suboptimal education of the public and health care providers about risk factors, and treatment • Understanding unique risks that post menopausal women face • Evaluating psycho-social risks
CHOLESTEROL Know your own profile Women’s cholesterol tends to be higher than men from age 55 • High LDL increases risk of heart disease • High HDL is protective • Depending on risk profile, LDL needs to be modified individually
WATCH YOUR WEIGHT • Being overweight causes excess build up of cholesterol in your arteries. I.E atherosclerosis
PHYSICAL INACTIVITY • Increases chances of heart disease 2 times • 30-45 min at least 3 times a week can help lower risk • Inter-related to weight gain, high blood pressure, high cholesterol and diabetes
EXCERCISE • Risk of first heart attack is reduced by 30-40% in people who exercise more than 3 times a week • F - FREQUENCY • I - INTENSITY • T - TIME
LIFESTYLE CHANGES • Stop smoking • Decrease salt-decreases blood pressure • Be active • Control weight • Heart healthy diet- DASH • Omega 3 fatty acids may help • Take your medications • Get screening tests regularly
HEART HEALTHY FOOD Antioxidants in red wine are called resveratrol, it is one substance that MAY help prevent damage to blood vessels, reduces "bad" cholesterol and prevents blood clots. Dark chocolate with a cocoa content of 70 percent or higher contains resveratrol, which has been found to lower blood sugar.
ENJOY VALENTINES DAY • Red wine • Chocolates • Salmon/tuna • Flaxseeds • Oatmeal • Black or kidney beans • Walnuts and almonds • Blueberries/cranberries/raspberries/ strawberries
“ Food should be your medicine and Medicine should be your food.” ~ Hippocrates