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.
Pdnational Black Women Healthproject
Women and Heart DiseaseUnequal Burden of Disease. Patricia Davidson, MD.
Heart Disease Mortality Among Women Per 100,000 Population200 Native American150 Hispanic African American100 Asian American 50 White 0
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
Classification of OverweightBased on Body Mass Index Overweight >20 BMI Obese >30 BMI BMI= kg/m2 NHANES 111
Overweight Women by Ethnicity African American 68.3% Asian 10.1% White 46.8%
Percent of Overweight Hispanic Women Hispanic 33% Mexican 69.3% PuertoRican 40.2% New immigrant 25%
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
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
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
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
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
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
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
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.