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Women and Heart Disease Across the Lifespan What is Coronary Heart Disease?
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What is Coronary Heart Disease? Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease; Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD
Facts about Heart Disease • Number one cause of death for women over the age of 25. • Kills 1 out of every 3 women. • In 2005, 22,150 women died of heart disease. • Kills 1 in 4 women in Florida.
Prevalence of Heart Disease • 8,000,000 American women are living with heart disease. • 6,000,000 have a history of heart attack or angina or both. • 435,000 American women have heart attacks each year. (74 – avg. age) • 4,000,000 suffer from angina. • 47,000 were hospitalized in 1999.
Mortality • Leading cause of death of American women and the major cause of disability. • 43% of deaths in American women, or nearly 500,000, are caused by cardiovascular disease each year. • Kills 267,000 women a year. Six times as many women as breast cancer. • 31,837 women die each year of congestive heart failure. Women comprise 62.6% of all heart failure deaths.
Racial and Ethnic Groups • Leading cause of death for African Americans, Latinos, Asian Americans, Pacific Islanders, and American Indians. • African American women are at highest risk for death among all racial, ethnic and gender groups.
What is Atherosclerosis • Buildup of plaque on artery walls restricts blood flow. • Plaques can burst causing a blood clot leading to heart attack or stroke. • Develops gradually over time. • No symptoms until an artery is so clogged that the organs and tissues are not receiving adequate blood supply.
Causes of Atherosclerosis: • Starts with damage or injury to inner layer of the artery. • Platelets clump at injury site leading to inflammation. • Plaque may begin as early as childhood. • Accumulates at the injury site causing hardening and narrowing the arteries.
Blockage Occurs in Various Arteries • Coronary arteries: similar to heart attack, i.e. angina • Arteries leading to brain: stroke symptoms • Peripheral arteries: leg pain when walking or intermittent claudication
Complications • Angina or heart attack • Transient ischemic attack (TIA) or stroke • Peripheral artery disease • Aneurysms
Who is at Risk for Heart Disease? African American Women: • Have 72% higher rate of heart disease than white women. • Aged 55-64 are twice as likely as white women to have a heart attack. • Are 35% more likely to suffer from coronary artery disease.
Who else? • Women who smoke. • Women with diabetes. • Women using contraceptives that contain hormones. • Women who are sedentary and get no leisure time physical activity. • Women with a history of pre-eclampsia or eclampsia during pregnancy.
Uncontrollable Risk Factors • Increasing Age • Gender • Heredity • Previous Cardiovascular Event • Heart Attack • Stroke • TIA • Eclampsia
Modifiable Risk Factors • Modifiable risk factors • Smoking • High blood cholesterol • High blood pressure • Physical inactivity • Obesity and overweight • Diabetes
Smoking Smoking –increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot.
Cholesterol – Good and Bad • Used to form cell membranes, some hormones, and is needed for other functions. • Hypercholesterolemia is a major risk factor for coronary heart disease.
LDL Cholesterol • Transports cholesterol and triglycerides from the liver to peripheral tissues. • Can build up in the walls of the arteries and form plaque.
HDL Cholesterol • Carries cholesterol away from the arteries and back to the liver, where it's passed from the body. • May remove excess cholesterol from plaque formations. • Low HDL level (less than 40 mg/dL in men; less than 50 mg/dL in women) indicates a greater risk.
Triglycerides • Major source of energy and the most common type of fat in your body • The chemical form in which most fat exists in food as well as in the body • Present in blood plasma and, in association with cholesterol, form the plasma lipids
High Blood Pressure • Directly increases the risk of coronary heart disease. • Can occur in children or adults. • Particularly prevalent in • African Americans • Middle-aged and elderly people • Obese people • Heavy drinkers
Physical Inactivity • Exercise improves your mood and helps to relieve stress. • Regular exercise can help you prevent — or manage — high blood pressure. • Regular exercise lowers LDL and raises HDL. • Regular exercise helps you manage your weight. • Regular exercise strengthens your heart and lungs. • Regular exercise promotes better sleep.
Obesity and overweight Obesity is a major risk factor for coronary heart disease. • Raises blood cholesterol and triglyceride levels. • Lowers HDL. • Raises blood pressure levels . • Can induce diabetes.
Diabetes • 2 out of 3 people with diabetes die from heart disease or stroke. • Up to 60% of adults with diabetes have high blood pressure and nearly all have one or more lipid abnormalities.
Characteristics: Abdominal obesity Atherogenic dyslipidemia Hypertension Insulin resistance or glucose intolerance Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood) Proinflammatory state (e.g., elevated C-reactive protein in the blood) Metabolic Syndrome
Other Risk Factors Excessive alcohol intake can lead to: • Elevated triglycerides • Hypertension • Heart failure • Increased calorie intake and obesity
Stress • May lead to hypertension and elevated lipid levels. • Persistently elevated levels of adrenaline and cortisol lead to high blood pressure and increased abdominal fat. • Linked to changes in the way blood clots.
Periodontal Disease • Oral bacteria may attach to fatty plaques in the coronary arteries and contribute to clot formation. • Inflammation caused by periodontal disease may increase plaque build up. • People with periodontal disease almost twice as likely to suffer from coronary artery disease.
Prevention Begins in Childhood "Thirty to 60 percent of children in the United States exhibit at least one risk factor for cardiovascular disease by the age of twelve." Philip R. Nader, M.D., UCSD Professor of Pediatrics, Emeritus, Child and Adolescent Trial for Cardiovascular Health .
Prevention Begins in Childhood • Overweight children as young as four are exhibiting hypertension, diabetes and hyperlipidemia. • Habits are generally created in childhood. Children learn both good and bad habits from their parents.
Women of Childbearing Age “Women 35-to-44 have always been thought of as being very low-risk, by the traditional standards. And we know that this isn't always true”. Dr. Suzanne Steinbaum, head of the Women's Heart Program at New York's Lenox Hill Hospital
Women of Childbearing Age • Know your family history. • Be aware of your blood pressure and blood sugar readings. • Reduce your stress levels whenever possible. • Get regular exercise.
Women of Childbearing Age • Get the recommended amount of B-Vitamins and Folic Acid. • Don’t smoke, especially if you use any form of hormonal contraceptives. • Tell your doctor if you experienced pre-eclampsia or eclampsia during pregnancy.
Lower Your Riskfor Heart Disease – GO RED for WomenWearing red in February is the first step to awareness, but don’t stop there. Take a few more steps for wellness, and lower your risk for heart disease Find out: ·your risk for a heart attack. You may be surprised. ·how to lower your risk for heart disease. It’s simpler than you think. ·what your body mass index (BMI) is. ·how easy it is to get 30 minutes of physical activity most days. ·what the signs and symptoms of a heart attack are. ·what questions to ask your health care provider. ·where you can learn more.
What to Ask You Health Care Provider • What are my numbers and what do they mean? • Blood Pressure • Cholesterol HDL and LDL • Triglycerides • BMI • Am I at risk for heart attack or stroke? • What do you recommend to reduce my risk?
Healthy Lifestyle: A Family Affair Eat a Heart Healthy Diet • Include a variety of fruits, vegetables, whole grains, dairy products, fish, legumes, poultry and lean meat. • Limit high fat foods after the age of 2. • Limit salt intake to less than 6g a day. • Limit the intake of sugar.
Healthy Lifestyle: A Family Affair • Physical activity has the strongest protective effect against heart disease. • 22% of adult Americans get the recommended amount of physical activity. • 2 hours and 30 minutes (150 minutes) of moderate intensity aerobic activity every week. • Muscle strengthening activities on 2 or more days a week. *CDC 2008 Physical Activity Guidelines for Americans
Healthy Lifestyle: A Family Affair • Children should be physically active each day. • Include at least 60 minutes of moderate to vigorous fun physical activities. • Limit sedentary time watching TV, playing video games, talking on the phone, etc. to less than 2 hours a day.
Healthy Lifestyle: A Family Affair • Don't smoke or use tobacco products. • Maintain a Healthy Weight. • Manage stress in constructive ways. • Know your family history.
Gender Discrepancies in Care Women receive fewer interventions to prevent and treat heart disease including: • Fewer cholesterol screenings • Fewer lipid-lowering therapies • Less use of heparin, beta blockers, and aspirin during heart attack • Fewer referrals to cardiac rehabilitation
Gender Discrepancies in Care More women than men die of heart disease each year, yet women receive: • 33% of angioplasties, stents and bypass surgeries • 28% of implantable defibrillators. • 36% of open-heart surgeries • Women comprise only 25% of participants in all heart-related research studies.
Physical Evidence of Heart Disease Signs of narrowed, enlarged, or hardened arteries • Weak/absent pulse below narrowed area of artery • Decreased BP in affected limb • Bruits over arteries • Aneurysm in abdomen or behind knee • Evidence of poor wound healing in areas where blood flowrestricted
Blood tests: cholesterol and blood sugar Doppler ultrasound Ankle-brachial index electrocardiogram (ECG) Angiogram Ultrasound CT scan MRA (magnetic resonance angiogram) Diagnostic Tests