Heart Disease in BC WomenKarin Humphries, MSc MBA, DScUBC-HSF Professor in Women’s Cardiovascular Health
Outline• Overview of the Epidemiology of CVD in Women• Trends in CVD and CVD death• Sex Differences• Disease• Presentation• Treatment• Outcomes• Research Priorities over the Next Decade
CVD Mortality Trends by SexAHA Heart and Stroke Statistics 2011
Canadian Statistics• In 2008 cardiovascular disease accounted for:• 29% of all deaths in Canada (69,648 deaths)• 28% of all male deaths• 29.7% of all female deathsStatistics Canada 2008
Trends in Hospitalization and Death aftera Heart Attack• Overall hospitalization rates are declining, except inyounger adults (France, Canada, US, BC)• Women < 60 years age increased by 13.7%• Men < 60 years increased by 10.9%• All other age and sex groups declined by 2.1 – 8.9%• Overall 30-day mortality is also declining• 1995-2010 30-day death declined from 11.3% to 4.4% inFrance• Canadian data and BC show similar trends
Mortality rates are not declining inyounger womenPuymirat E et al JAMA 2012
Drug TherapyUse of aspirin, beta-blockers, ACE-I, statins after a heart attackcan reduce the risk of another heart attack or death by up to80%Are these drugs equally effective in women and men?• Beta-blockers trials were done decades ago whenwomen were rarely if ever included in studies• ACE-I/ARBs appear to be equally efficacious in women• Statins are equally effective for secondary prevention,but in primary prevention there is still some debate• Aspirin for primary prevention reduces risk of stroke inwomen, but MI in men.
CoronaryInterventions• If women get cardiac catheterization post heart attack,there is no sex difference in use of PCI• Current era, no sex difference in outcomes following PCI;initially women had worse outcomes• Women more likely to die after open heart surgery, butthe gap is closing….• Benefits of Drug Eluting Stents are generalizable towomen
Top Seven Research Questions toImprove CVD Outcomes in Women1. What factors influence or explain disparities incardiovascular disease epidemiology and disease outcomesbetween men and women?2. What are the best strategies to assess, modify, and prevent awoman’s risk of heart disease?3. What are the most accurate and effective approaches toassess and recognize chest pain and other symptomssuggesting CHD in women?
Top Seven Research Questions toImprove CVD Outcomes in Women4. What role does a woman’s reproductive history andmenopausal hormone therapy play in the development ofheart disease?5. What biological variables most influence the developmentand clinical outcomes of HD and what can be done toreduce mortality rates in women?6. Why are young women more likely than men to die afterMI?7. How do psychosocial factors affect CVD in women?