Pdnational Black Women Healthproject

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  • Section I: Cardiovasular disease: Growing causes for concern Cardiovascular disease: Leading cause of death Content points: • The need for more effective therapy to reduce cardiovascular risk is underscored in current epidemiological data that identify cardiovascular disease as a continuing public health problem. • In 1998, cardiovascular disease (CVD) claimed the lives of 445 692 men and 503 927 women, accounting for 40.6% of all deaths. 1 • Heart disease has been the leading cause of death in this country since 1921. 2 The most recent statistics from the American Heart Association show that CVD is responsible for more deaths than the next four leading causes of death combined.

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  • 1. Women and Heart DiseaseUnequal Burden of Disease. Patricia Davidson, MD.
  • 2. Heart Disease Mortality Among Women Per 100,000 Population200 Native American150 Hispanic African American100 Asian American 50 White 0
  • 3. Atherosclerosis/ hardened arteries: PREVENTABLE BEGINS IN THE FETUS IF THE MOTHER HAS HIGH CHOLESTEROL OR THE FIRST DECADE OF LIFE NOT A NATURAL PROCESS OF AGING
  • 4. RISK FACTORS:HOW DO THEY DIFFER?
  • 5. Classification of OverweightBased on Body Mass Index Overweight >20 BMI Obese >30 BMI BMI= kg/m2 NHANES 111
  • 6. Overweight Women by Ethnicity African American 68.3% Asian 10.1% White 46.8%
  • 7. Percent of Overweight Hispanic Women  Hispanic 33%  Mexican 69.3%  PuertoRican 40.2%  New immigrant 25%
  • 8. Diabetes Prevalence Among Women MIDDLE AGED OLDER Native Am. 21.8 31.8 Mexican Am. 7.7 29.9 African Am . 14.5 25.4 White 8.5 14.5
  • 9. Diabetes DM may explain the increased risk of CAD in African American women. Insulin resistance contributes to the development of CAD long before clinical DM. Insulin resistance is more prevalent in African American women. NHANES 1
  • 10. Diabetes African American women develop DM at a lower BMI than other women. DM is increasing fastest in ethnic groups. 80% of children diagnosed are obese. Screening should begin by age 10. NHANES 1
  • 11. ExercisePHYSICAL ACTIVITY of FEMALE ADOLESCENTS ( %) Vigorous moderate sportsHispanic 45.2 27.6 27.3Afr. Am. 41.2 26.4 34.9White 56.7 16.8 47.1 MMWR 9/27/98
  • 12. Percent of High School Students Smoking403530 White W25 White M20 Af.Am W15 Af.Am M10 Hisp. W Hisp. M 5 0 White Af.Am Hisp. W W W
  • 13. Racial and Gender Referral Bias
  • 14. Rates of Bypass Surgery (CABG) Per 10,000 Medicare Patients:  White men 40.4  White women 16.2  African American men 9.3  African American women 6.4 JAMA 3/18/92
  • 15. Variation in Use of Cardiac Procedures in the Veterans Affairs Health System: Effect of Race African American men after acute MI were less likely to undergo the following procedures: Cardiac cath 33% PTCA 42% CABG 54% JAMA 4/20/94, NEMJ 1993, JACC 1994
  • 16. Effect of Race and Sex on Physicians Recommendations for Cardiac Catheterization Study design: 720 physicians viewed video tapes of actors presenting the same cardiac history and all having positive stress tests. African American women were the least likely to be referred for cardiac catheterization. NEJM 2/25/99
  • 17. Missed Diagnoses of Acute Ischemia in the ER Risk of being sent home; Acute ischemia- 2 times higher among African American patients. Acute MI- 4 times higher compared to Caucasian patients. NEJM 4/20/00
  • 18. Lessons From CanadaSocioeconomic Status and Access to Care In Ontario, despite Canada’s universal health care system, socioeconomic status had pronounced effects on access to specialized cardiac services as well as on mortality one year after acute myocardial infarction. NEMJ 10/18/99.
  • 19. WHAT CAN WE DO?RETURN TO OUR ROOTS.
  • 20. SELF HELP GROUPS ENCOURAGE HEALTHY LIFE STYLES DISEMMINATE INFORMATION GIVE EMOTIONAL SUPPORT
  • 21. TOPICS TO DISCUSS DURING PANEL QUESTIONS: HORMONE REPLACEMENT DIABETIC GOALS CHOLESTEROL GOALS, OPTIMAL VERSUS NATIONAL GUIDELINES HYPERTENSION DRUG THERAPY MYTHS BASED ON RACE
  • 22. TOPICS TO DISCUSS DURING PANEL QUESTIONS: HORMONE REPLACEMENT DIABETIC GOALS CHOLESTEROL GOALS, OPTIMAL VERSUS NATIONAL GUIDELINES HYPERTENSION DRUG THERAPY MYTHS BASED ON RACE
  • 23. FOOD FOR LIFE WHICH FOODS PROMOTE HEALTHY ARTERIES WHICH FOODS PROMOTE DISEASE