It's Time for a Heart to Heart

Women of Summa: It’s Time for a Heart to Heart Vivian von Gruenigen, BSN, MD Chair Obstetrics and Gynecology Women’s Service Line Director Summa Akron City Hospital

5 Leading Cause of Death in All Females, All ages
Heart Disease 27%
Cancer 22%
Stroke 8%
Respiratory Disease 5%
Alzheimers 4%

Differences in gender
Women get heart disease later in life
Symptoms more subtle
Women are much more likely to die from their first heart attack than men
Women hesitate to call 911, and get to the hospital ~60 minutes later than men
In the past, CV research was done in men
Women experience a unique increase in lipids after menopause
Matthews KA et al. J Am Col Cardio 2009

Differences in Gender
The signs and symptoms are more subtle than the obvious crushing chest pain often associated with heart attacks
This may be because women tend to have blockages not only in their main arteries, but also in the smaller arteries that supply blood to the heart — a condition called small vessel heart disease.

What Is Heart Disease?
Coronary Heart Disease
High Blood Pressure
Heart Failure
Valve Disease
Diseases of Pulmonary Circulation

What Have We Learned?
Risk Factors
Factors leading to heart disease can start in young women and develop over time
The Disease
Heart disease can strike women at any age
Prevention and Treatment
Healthy lifestyle changes can prevent or postpone heart disease

Why Is It Important?
Cardiovascular disease kills 1 in 3 women
Tens of millions
64% of women who die suddenly from coronary heart disease have no previous symptoms
80% of cardiovascular disease is preventable

What is a heart attack?
A heart attack occurs when the blood flow to a part of the heart muscle is blocked
Most heart attacks start slowly , with mild pain or discomfort
Interrupted blood flow to your heart can damage or destroy a part of the heart muscle .

What Is A Heart Attack?
Warning Signs
Chest discomfort
Discomfort in upper body
Shortness of breath
Cold sweat
Nausea
Lightheadedness

Signs
Women may experience fewer typical symptoms than men, most commonly shortness of breath, weakness, a feeling of indigestion, and fatigue
Women also have more symptoms compared to men (2.6 on average vs 1.8 symptoms in men)
Approximately one quarter of all myocardial infarctions are silent , without chest pain or other symptoms.
The onset of symptoms in myocardial infarction (MI) is usually gradual , over several minutes, and rarely instantaneous.
Emergency

Stroke Warning Signs
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion , trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking , dizziness, loss of balance or coordination
Sudden, severe headach e with no known cause

Am I at risk?
Vascular injury accumulates from adolescence , making primary prevention efforts necessary from childhood.
Risk factors can be modified, treated or controlled and some can’t
The more risk factors you have, the greater your chance of developing coronary heart disease
“ Deadly quartet” of chronic conditions that includes
Diabetes,
Obesity,
Blood pressure
Cholesterol

Am I At Risk? If you have any of these risk factors, you are at risk for heart disease.

Your Risk: High Blood Cholesterol
Cholesterol is a soft, fat-like substance found in the bloodstream and in all your body’s cells
The saturated fats, trans fats and cholesterol you eat may raise your blood cholesterol
Cholesterol can build up in the walls of arteries, narrowing the flow
If a narrowed artery gets blocked by a clot or other particle , the heart or brain loses its blood supply, resulting in a heart attack or stroke
www.3dchem.com

Your Risk: High Cholesterol- Lipid Profile
Includes:
Total Cholesterol
LDL [low-density lipoprotein] (bad)
HDL Cholesterol (good)
Triglycerides

Total Cholesterol Level
Desirable = Less than 200
Borderline high = 200 to 239
High = 240 and above
~ 50% of women have a total cholesterol of 200 mg/dL
and above, which puts them at risk for heart disease.
www.nhlbi.nih.gov

HDL – the higher your HDL, the better
HDL Cholesterol Risk Levels
Less than 50 mg/dL for women
Therefore, want > 50
LDL – is the main carrier of harmful cholesterol
LDL Cholesterol Risk Levels
> 130 mg/dL Borderline, >160 high, > 190 very high
Therefore, want between 100-130

Your Risk: High Blood Pressure
High blood pressure = hypertension (HTN)
Blood pressure, is simply the pressure of the blood as it circulates
No one knows exactly what causes most cases of HTN
HTN is called the “silent killer,” because it increases the risk for
heart attack, angina, stroke, kidney failure , heart failure and peripheral artery disease (PAD)
1 in 3 adults has HTN, tens of millions

Risk Factors
Genetics
African Americans
Over age 35
Overweight
Physical inactivity
Nutrition
Salt, alcohol
Diabetes, kidney disease
Pregancy

Normal Blood Pressure
Around 120/80
Hypertension
Above 140/90

Classification of Blood Pressure in Adults
OPTIMAL: <120 systolic and <80 diastolic
PREHYPERTENSION
120-139 systolic or 80-89 diastolic
STAGE 1 HYPERTENSION
140-159 systolic or 90-99 diastolic
STAGE 2 HYPERTENSION
>160 systolic or >100 diastolic

Your Risk: Diabetes
Incidence is increasing
Type I Diabetes – also called juvenile
The body fails to make insulin
Type II
The most common
95% of Americans Middle-aged.
Linked with obesity and physical inactivity.
The body doesn’t make enough.

Your Risk: Diabetes
Complications of Diabetes
Stroke, TIA
Blindness
Heart attack, angina
Kidney disease
High blood pressure
Erectile dysfunction
Loss of legs or feet
Nerve disease
People with diabetes are two to four times more likely to develop cardiovascular disease.

Your Risk: Diabetes
Prevention and Control
Control your weight and cholesterol (low-saturated fat and low-cholesterol diet)
If you take medicine, take it exactly as directed
Discuss exercise with your physician
Nutritionist consult/team

Your Risk: Obesity & Overweight
The majority of Americans are overweight
Excess Weight :
Strains your heart
Raises blood pressure and cholesterol
Can lead to diabetes

Your Risk: Obesity & Overweight
Set goals, potential roadblocks
Lifestyle change, not a diet
You may need help or support
Team approach
Keeping weight off can be as challenging as losing it

Your risk: Physical inactivity
Regular, moderate-intensity physical activity can lower your risk of
Heart disease and heart attack
HTN
High cholesterol
Overweight or obesity
Diabetes
Stoke
Cancer

Your risk: Physical inactivity
Inactive women:
White females – 38%
Black females – 52%
Hispanic females – 54%
All healthy adults ages should be getting at least 30 minutes of moderate intensity activity 5 days a week

Your risk: physical inactivity
Most Americans favor walking as their favorite physical activity
Many places - at home, local parks, YMCAs, travel…
Many types – swim, resistance, ski, golf…
Find your sole-mate or mates
Family, friends, colleagues
Stay motivated

Your Risk: Smoking
Benefits of Quitting
Within 1 to 2 years of quitting, the risk of coronary heart disease is substantially reduced
A smoker’s cough will go away
It is easier to be physically active
Second hand smoke is real

Your risk: Nutrition Quality
Be aware of calories
Low fat
Lean meats
Fiber, whole grains
Low fat dairy
Fruits and veggies
Diversify your colors
Whole foods versus processed
White food…sugar
Limit fast foods
Super size me

Decreasing your sodium intake: where is salt found in our diets?

Your risk: Depression
Depression is twice as common in women as in men, and it increases the risk of heart disease by 2-3 times
Depression makes it difficult to maintain a healthy lifestyle and follow recommended treatment
Talk to your doctor if you're having symptoms of depression

Your risk: HRT
Can estrogen replacement therapy reduce my risk for heart disease?
No. Estrogen replacement therapy, also called hormone replacement therapy (HRT
New studies have shown that when it comes to heart health, HRT may do more harm than good.
If you’re taking HRT to help prevent heart disease, talk to your doctor about whether you should stop.

First aid
Call for help
Aspirin
Oxygen
Nitroglycerin
Automated external defibrillator (AED)
Opiod painkillers
Air travel kits

Women in Recovery and Rehabilitation after a Heart Attack
The first year following a heart attack, women tend to
have a higher rate of disability and death , and show
poorer psychological adaptation than men.
Social support and mood were the best predictors
of overall quality of life at one year for women
Those with more social support tended to have a higher rate of persistency, while a belief in the positive health benefits of exercise increased the amount of exercise undertaken by the participant.
Moore SM et al J Cardio Rehab 2003

What Can I Do To Prevent Heart Disease?
Eat a healthy diet low in saturated fat, trans fat, cholesterol and sodium.
Keep your weight under control.
Be physically active at least 30 minutes on most or all days of the week.
Control your blood pressure and cholesterol levels.
Manage your blood sugar if you have diabetes .
Don’t smoke , and avoid tobacco smoke.
Taking your medicines as directed by your physician

What Can I Do To Prevent Heart Disease?
You are here
You are an advocate
You are educated
Teach those who are not as fortunate
Lead by example
Grass roots

“ Women, whether subtly or vociferously, have always been a tremendous power in the destiny of the world.” Eleanor Roosevelt

Be the kind of woman that when your feet hit the floor each morning the devil says~~ "Oh crap , She's up!“ Email from Aunt Jeanette

Questions?
YOU are beautiful, smart and have the power to make a difference

It's Time for a Heart to Heart

by Summa Health System on Feb 05, 2010

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