Your heart matters by Dr. Justina Trott
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Your heart matters by Dr. Justina Trott

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This was a presentation made to the Rotary Club of Santa Fe on June 27, 2013 by Dr. Justina Trott , Director Women's Health Policy Robert Wood Johnson Foundation Center for Health Policy University of ...

This was a presentation made to the Rotary Club of Santa Fe on June 27, 2013 by Dr. Justina Trott , Director Women's Health Policy Robert Wood Johnson Foundation Center for Health Policy University of New Mexico.

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  • GRAPHIC SOURCE: Heart Disease and Stroke Statistics-2004 Update, American Heart Association. This slide from the American Heart Association shows mortality trends by gender. While mortality in males has been steadily declining over the past 15-20 years, cardiovascular mortality for women has remained flat or increased slightly(1). (1) Heart Disease and Stroke Statistics-2004 Update, American Heart Association.
  • GRAPHIC SOURCE: Heart Disease and Stroke Statistics-2004 Update, American Heart Association. Cardiovascular diseases are more prevalent in younger men. By the age of 65, however, the prevalence of cardiovascular disease begins to be higher in women (1). (1) Heart Disease and Stroke Statistics-2004 Update, American Heart Association.
  • GRAPHIC SOURCE: Heart Disease and Stroke Statistics-2004 Update, American Heart Association . Women identifying as Black or African-American are more likely to suffer from coronary heart disease or stroke than white women(1). African American women are at highest risk of death from heart disease among all racial, ethnic, and gender groups (1). African American women have higher rates of many risk factors for heart disease, including obesity, physical inactivity, metabolic syndrome, diabetes, and hypertension than white women (1) Among women of various racial and ethnic groups, African American women are less aware that smoking, high cholesterol, and family history increase their risk of cardiovascular disease (2) (1) Heart Disease and Stroke Statistics- 2004 Update, American Heart Association. (2) Mosca L, et al. Tracking women ’s awareness of heart Disease. Circulation. 2004;109:573-579.
  • First, clinicians should consider invasive measurement of coronary flow reserve in women with chest pain who do not have obstructive CAD diagnosed during coronary angiography. Second, the results of clinical trials that have evaluated treatment of patients with chest pain in the absence of CAD (e.g., L-arginine, estrogen) should be considered when evaluating women with this presentation.
  • Managing stress makes sense for your overall health. But current data don't yet support specific recommendations about stress reduction as a proven therapy for cardiovascular disease. Background "Stress" response describes the condition caused by a person's reaction to physical, chemical, emotional or environmental factors. Stress can refer to physical effort and mental tension. It's hard to define a high level of emotional or psychological stress to measure in a precise way. All people feel stress, but they feel it in different amounts and react to it in different ways. More and more evidence suggests a relationship between the risk of cardiovascular disease and environmental and psychosocial factors. These factors include job strain, social isolation and personality traits. But more research is needed on how stress contributes to heart disease risk. We don't know if stress acts as an "independent" risk factor for cardiovascular disease. Acute and chronic stress may affect other risk factors and behaviors, such as high blood pressure and cholesterol levels, smoking, physical inactivity and overeating. More research is also needed on stress's role in heart disease risk among women and minorities.  Also, only a few studies have examined how well treatment or therapy works to reduce the effects of stress on cardiovascular disease. Studies using psychosocial therapies to prevent secondheart attacks are promising. After a heart attack or stroke, people who feel depressed, anxious or overwhelmed by stress should talk to their doctor or other healthcare professional. These feelings are relatively common, and help is available.

Your heart matters by Dr. Justina Trott Your heart matters by Dr. Justina Trott Presentation Transcript

  • Latest Research Findings on Heart Health in Women 27 June 2013 Justina Trott, MD, FACP Senior Fellow RWJF Center for Health Policy University of New Mexico Senior Fellow NM CARES Health Disparities Center Director Women’s Health Policy Unit, RWJF Center for Health Policy University of New Mexico Clinical Professor of Medicine University of New Mexico
  • The Heart Truth • Heart disease is the #1 killer of American women— no matter what their race or ethnicity • Heart disease kills 1 of every 3 American women • Heart disease can permanently damage your heart —and your life
  • What Is Heart Disease? • Coronary heart disease—affects arteries of the heart • Heart doesn’t get enough nutrient-rich blood • Chronic—develops over years • Atherosclerosis—arteries harden as cholesterol, fat, and other substances build up in artery walls • Blockage can result in heart attack
  • No Quick Fix • Worsens if not treated—leads to disability or death • Not “fixed” by surgery or procedures, such as bypass and angioplasty
  • Why Me? Why Now? Risk rises ages 40–60 • Estrogen level drops during menopause Risk factors • Smoking • High blood pressure • High blood cholesterol • Overweight/obesity • Physical inactivity • Diabetes • Family history of early heart disease • Age (55 and older for women)
  • Heart Disease Risk Factors • Multiply their effects • Same lifestyle steps prevent/control many of the risk factors
  • Cardiovascular Disease Mortality Trends for Males and Females United States: 1979-2001
  • Trends in Heart Disease
  • Acute MI Mortality by Age and Sex 0 5 10 15 20 25 30 <50 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 Age Death During Hospitalization (%) Men W omen
  • Prevalence of Cardiovascular Disease NHANES III: 1988-94 Americans Age 20 and Older by Age and Sex
  • Age Adjusted Death Rates for Coronary Disease, Stroke, Lung and Breast Cancer White and Black Females United States 2001
  • Why Are There Such Disparities? • Differences in frequency of evaluation in men and women • Information about women and heart disease is not well studied and not widely published • Heart disease can be different in women and men
  • Description A new study by researchers at the Medical College of Wisconsin in Milwaukee and Johns Hopkins University has found that race, gender and insurance differences factor strongly in the evaluation of patients with chest pain seen in emergency departments Medical College of Wisconsin Released: Tue 30-Jan-2007 Emergency Departments Test Chest Pain Patients Differently, Based on Race, Gender, Insurance Differences in Frequency of Evaluation
  • Mayo Clinic Proceedings …in a sample of recent articles, a minority (37% in general medical journals and 23% in cardiology journals) reported sex-specific results. Blauwet LA, Hayes SN, McManus D, Redberg RF, Walsh MN. Low rate of sex-specific result reporting in cardiovascular trials. Mayo Clin Proc. 2007;82:166-170. Lack of Information
  • http://health.allrefer.com/pictures-images/coronary-artery-balloon-angioplasty-series.html Heart Disease Differences in Women and Men
  • Heart Attack Warning Signs • Chest discomfort • Usually in the center of the chest • Lasts for more than a few minutes, or goes away and comes back • Can feel like uncomfortable pressure, squeezing, fullness, or pain • Discomfort in other areas of the upper body, including pain or discomfort in one or both arms, the back, neck, jaw, or stomach
  • Heart Attack Warning Signs • Shortness of breath • Other symptoms, such as breaking out in a cold sweat, nausea, or light-headedness
  • Differences in Mechanism of Heart Disease http://health.allrefer.com/pictures-images/coronary-artery-balloon-angioplasty-series-4.html
  • Differences in Mechanism of Heart Disease http://health.allrefer.com/pictures-images/atherosclerosis.html
  • How Heart Disease is Different in Women and Men
  • Differences in Diagnosis of Heart Disease
  • CONCLUSIONS: In this large, primary-prevention trial among women, aspirin lowered the risk of stroke without affecting the risk of myocardial infarction or death from cardiovascular causes Differences in Treatment
  • Women and Ischemia Syndrome Evaluation (WISE) Recent studies of the implications of coronary microvascular dysfunction can be used to improve the diagnosis and treatment of women with chest pain.
  • Hopeful Good News • Heart disease can be prevented or controlled • Treatment includes lifestyle changes and, if needed, medication
  • Key Tests for Heart Disease Risk • Blood pressure • Blood cholesterol • Fasting plasma glucose (diabetes test) • Body mass index (BMI) and waist circumference • Electrocardiogram • Stress test
  • Risk Stratification • Calculate 10 year risk for all patients with two or more risk factors that do not already meet criteria for CHD equivalent • Use electronic calculator for most precise estimate: www.nhlbi.nih.gov/guidelines/cholesterol/
  • Risk Assessment Tool for Estimating 10 -year Risk of Developing Hard CHD (Myocardial Infarction and Coronary Death) The risk assessment tool below uses recent data from the Framingham Heart Study to estimate 10 -year risk for “hard” coronary heart disease outcomes (myocardial infarction and coronary death). This tool is designed to estimate risk in adults aged 20 and older who do not have heart disease or diabetes. Use the calculator below to estimate 10 -year risk. Age: years Gender: Female Male Total Cholesterol: mg/dL HDL Cholesterol: mg/dL Smoker: No Yes Systolic Blood Pressure: mm/Hg Currently on any medication to treat high blood pressure. No Yes Calculate 10-Year Ri sk
  • Why Women Don’t Take Action Against Heart Disease • They don’t put their health as a top priority • They think they’re not old enough to be at risk • They feel too busy to make changes in their lives • They’re already feeling stressed • They’re tired
  • Where to Start –What You Can Do? • Ask your doctor about your risk of heart disease • Draw up a list of questions before your visit • Write down or tape record what the doctor says • Tell your doctor your lifestyle behaviors, such as smoking or being physically inactive • Tell your doctor any symptoms you feel
  • How To Lower Heart Disease Risk • Begin today • Be physically active—30 minutes of moderate- intensity activity on most days of the week • Follow a healthy eating plan • Low in saturated fat and cholesterol and moderate in total fat • Limit salt and sodium • If you drink alcoholic beverages, have no more than one a day
  • How To Lower Heart Disease Risk • Maintain a healthy weight • Balance calories taken in with those used up in physical activity • Stop smoking • Manage diabetes • Take medication, if prescribed
  • To Survive a Heart Attack • Call 9-1-1 within minutes—5 minutes at most • Emergency medical personnel will begin treatment at once • Don’t drive yourself to the hospital • Uncertainty is normal—don’t be embarrassed by a false alarm • Plan ahead • Learn the warning signs
  • It All Begins With You • Take one step at a time • Replace unhealthy habits with healthier ones • Eat for heart health • Remember that calories count • Start walking—try 10 minutes and add time gradually to get 30 minutes a day
  • How To Keep Going • View changes as new lifestyle, not quick fixes • Set realistic goals • Buddy up • Don’t worry about a slip • Reward your success • Be your own advocate—ask questions and seek information
  • Stress and Heart Disease Can managing stress reduce or prevent heart disease? http://www.americanheart.org
  • The Heart Truth It’s up to you to protect your heart health—start today • Without blaming yourself • You and your community
  • Resources for a Healthy Heart National Heart, Lung, and Blood Institute • www.nhlbi.nih.gov/health/hearttruth American Heart Association Simple Solutions • www.americanheart.org/simplesolutions Office on Women’s Health, DHHS National Women’s Health Information Center • www.4woman.gov WomenHeart: the National Coalition for Women with Heart Disease − www.womenheart.org
  • Thank You Santa Fe 2007