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    • Heart Disease in Women How to Protect Yourself Banu Mahalingam MD, FACC, RCS. Cardiology Associates Of Princeton
    • Heart disease in women
      • Facts about heart disease in women
      • How does the heart work?
      • How to diagnose heart disease?
      • What are the risk factors for heart disease?
      • What is the role of hormone replacement therapy?
      • What are the latest updates?
      • What to expect in the future?
    • Coronary Heart Disease
      • Prevalent and preventable
      • 600,000 deaths of which coronary heart disease is the direct cause of 460,000
      • 1.1 million myocardial infarction/heart attacks of which 650,000 are first infarctions
      • An economic burden of $101 billion
      • From 1988 to 1998, death rate from CAD has declined
    •  
    • Comparison of deaths from CV disease and breast cancer, by age Heart Disease Breast Cancer
    • Heart disease in women
      • More women present with atypical symptoms
      • More frequent silent MI
      • Mortality rate of MI and bypass surgery are 50% higher in women
      • Cholesterol lowering has shown similar efficacy
      • Cardioprotective agents have similar efficacy
      • Treatment rates tend to be lower
      • Diabetes is a particularly serious risk factor
    • Compared with Men
      • 38% of women and 25% of men will die within one year of a first recognized heart attack
      • 35% of women and 18% of men heart attack survivors will have another heart attack within six years
      • 46% of women and 22% of men heart attack survivors will be disabled with heart failure within six years
    • Compared with Men
      • Women are almost twice as likely as men to die after bypass surgery
      • Women are less likely than men to receive beta-blockers, ACE inhibitors or even aspirin after a heart attack
      • Women constituted less than 25% of the research patient population
    • At-Risk
      • The age-adjusted rate of heart disease for African American women is 72% higher than for white women
      • Women who smoke risk having a heart attack 19 years earlier than non-smoking women
      • Women with diabetes are two to three times more likely to have heart attacks
    • At-Risk
      • High blood pressure is more common in women taking oral contraceptives, especially in obese women
      • 39% of white women, 57% of black women, 57% of Hispanic women, and 49% Asian/Pacific Islander women are sedentary and get no leisure time physical activity
      • 23% of white women, 38% of black women, and 36% Mexican American women are obese
    • Compared with Men
      • More women than men die of heart disease each year, yet women receive only:
        • 33% of angioplasties, stents and bypass surgeries
        • 28% of implantable defibrillators and
        • 36% of open-heart surgeries
      • Women comprise only 25% of participants in all heart-related research studies
    • Normal Coronary Anatomy
    • Current Path in Cardiac Muscle
    • Microscopic Pathology of Atherosclerosis
    • What is a Heart Attack?
      • A heart attack occurs when the blood supply to part of the heart muscle itself - the myocardium - is severely reduced or stopped. The medical term for heart attack is myocardial infarction
      • This is usually caused by the buildup of cholesterol plaque.
      What causes a Heart Attack?
    • During a Heart Attack
    • Myocardial Infarction
    • Detecting Coronary heart disease
      • EKG
      • Stress testing
      • Echocardiogram
      • Cardiac Catheterization/Coronary angiogram
      • CAT scan- calcium score
      • MRI of the heart
    • Normal Thallium Stress Test
    • Abnormal Stress Test
    • Cardiac Catheterization
      • Catheters are also used to inject dye into the coronary arteries. This is called coronary angiography
      • It's also used to get information about the pumping ability of the heart muscle.
    • Coronary Blockage
    • Risk Factors for Heart Disease
      • High Blood Pressure - Hypertension
      • High Blood Sugar - Diabetes Mellitus
      • High Cholesterol
      • Smoking
      • Age/Gender
      • Family History
      • Obesity
    • High Blood Pressure
      • Silent Killer
      • Uncontrolled high blood pressure can lead to stroke, heart attack, congestive heart failure or kidney failure
      • The only way to tell if you have high blood pressure is to have your blood pressure checked
    • High Blood Pressure
      • One in four adult Americans has high blood pressure, and nearly one-third of them don't know they have it
      • Remember, high blood pressure has no symptoms, so if you haven't had it checked in a while, make an appointment now.
      • Normal BP: 120/80
    •  
    • Hypertension
      • Know what your Blood Pressure is
      • Educate yourself on self measurement of BP
      • Understand the role of Diet and Exercise in maintaining BP
    • Diabetes Mellitus
      • Diagnosed by checking Fasting Blood Sugars
      • Can be silent/asymptomatic
      • Leading cause of complication from coronary artery disease
      • Completely negates the positive effect of estrogen in pre-menopausal women
    • Diabetic Patient
      • If you are a diabetic know your
      • Hemoglobin A1C
    • Cigarette Smoking
      • Most preventable cause of Heart Attacks
      • Responsible for 400,000 premature deaths in the U.S. annually
      • Nonsmokers and former smokers have significantly lower rates of Heart attacks than smokers
      • 7%-47% reduction in mortality following smoking cessation
    • Dietary Management of Heart Disease
    • Diet modification
      • More complex carbohydrate
      • More fruits, vegetables and legumes
      • More fish
      • Less meat
      • Less whole milk products
      • Alpha-linolenic acid enriched canola oil margarine
    •  
    • Lipid panel
      • Total cholesterol <200
      • LDL cholesterol <130
      • HDL cholesterol >40
      • Triglycerides <200
    • Benefits of Cholesterol Reduction
    • Effect of Aspirin on Survival
    •  
    • Estrogen/Progestin Therapy also Resulted in:
      • 41% increase in strokes
      • 29% increase in heart attacks
      • Doubled rates of blood clots in legs and lungs
      • 37% less colorectal cancer
      • 34% fewer hip fractures and 24% less total fractures
    • Recommendations
      • the therapy should not be continued or started to prevent heart disease
      • for osteoporosis prevention, women should consult their doctor and weigh the benefits against their personal risks
      • the therapy for relief of menopausal symptoms may reap more benefits than risks
    • HRT
      • Symptom relief should be the primary reason for taking hormone replacement therapy
      • Progestins should be added to estrogen therapy only to prevent endometrial cancer. If a woman has had a hysterectomy, there is no need for progestins in her hormone therapy
      • Hormone therapy should not be used to prevent heart disease; women should take other measures to reduce that risk
      • Hormone therapies have been shown to help build stronger bones; however, women should weigh the risks of hormone therapy before taking it to prevent osteoporosis
    • HRT
      • A woman should take HRT for the shortest amount of time possible, based on her symptoms, the benefits she's getting from the therapy, and her personal health risks
      • Doctors should consider prescribing low-dose HRT whenever possible
      • Doctors should consider alternate ways of giving HRT other than orally -- such as patches and creams, but should know that studies are not clear on the long-term risks and benefits
      • Every woman's personal health risks should be evaluated before any form of hormone therapy is prescribed. Women should be sure they understand the known risks
    • Top Tips for Heart Health
      • Reduce total fat, favor mono-unsaturated fats over saturated fats and above all, eat moderate portions
      • Learn how to be more stress resilient
      • Get moving today
      • Smoking cessation
      • Being a good weight for your height
      • Eating healthy and exercising regularly
    • What’s new
      • Markers for inflammation
      • C- reactive protein
      • Homocysteine
      • Lipoprotein (a)
      • Drug coated stent
      • Minimally invasive surgery
      • Off pump open heart surgery
    • What to expect in the future
      • Super HDL coronary infusion therapy
      • Non invasive visualization of coronary arteries
      • Focusing on inflammation as risk reduction in heart disease
    •                                                              
    • Online resources
      • www.womenheart.org
      • National coalition of women with heart disease
      • The Heart Truth Awareness campaign of the National Heart, Lung, and Blood Institute
      • American Heart Association Organization fighting heart disease and stroke
    • Heart Disease in Women