Julie J Ramos, MD presents background and personal research on racial and gender disparities in cardiovascular health at Columbia University Medical Center
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Women's Cardiovascular Health Disparities
1. Disparities in Women's
Cardiovascular Health
Julie J Ramos, MD
Center for Interventional Vascular Therapeutics
Columbia University Medical Center
Obstetrics/Gynecology Grand Rounds
February 1, 2018
1
2. OUTLINE OF DISCUSSION
• Overview of cardiovascular disease in women
• Overview of women cardiovascular risk factors
• Focus on CUMC existing disparities
• How to decrease disparities
• Elicit questions, conversation, and future collaboration
2
5. Pregnancies Middle Age
Population with complicated pregnancies
Healthy population
Threshold for vascular or metabolic disease
Age
Vascular
Risk
Factors
Source: Sattar & Greer, 2002;. Adapted from Deborah Ehrenthal, MD, FACP
Pregnancy: Is A Stress Test
14. Where is Intervention Needed?
• Team approach
• Cardiologists
• Ob/Gyns
• Focus on Missed Opportunities - PPV
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15. How are We Doing in a High
Risk Postpartum Population?
15
16. 16
Incident Coronary Heart Disease After Preeclampsia
Journal of the American Heart Association. March 6, 2017
17. Adverse Pregnancy Outcomes
• What is the incidence of non-attendance to the postpartum
visit?
• Identify predictors for postpartum visit non-attendance?
• Associated co-morbidities and postpartum non-attendance
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18. Study Design
•Retrospective cohort study
– Patients were identified using Clinical Looking Glass
•Inclusion criteria
– Live births occurring in 2013
•Outcomes
– Attendance of a postpartum visit within 12 weeks
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19. Women with adverse pregnancy outcomes
have higher baseline comorbidities
Rosser, Zhang, Ramos, 2015
P<0.001
APO N = 6,457 ; Normal Pregnancy N = 21,971
1.0%
19
20. Obesity Trends Among Women
Delivered Each Year
Rosser, Zhang, Ramos, 2015
P<0.001
12.7%
16.8%
21.3%
27.6%
30.7%
2010 2011 2012 2013 2014
p<0.001 20
21. Gestational Diabetes Trends Among Women
Delivered Each Year
Rosser, Zhang, Ramos, 2015
P<0.001
6.1%
7.9%
9.0%
10.2%
9.7%
2010 2011 2012 2013 2014
p<0.001 21
22. Pre-Eclampsia Trends Among Women
Delivered Each Year
Rosser, Zhang, Ramos, 2015
P<0.001
8.0%
6.5%
7.9% 7.7%
11.4%
2010 2011 2012 2013 2014
p<0.001 22
23. Preterm Birth Trends Among Women
Delivered Each Year
Rosser, Zhang, Ramos, 2015
P<0.001
6.0%
6.8%
6.3%
8.2%
8.6%
2010 2011 2012 2013 2014
p<0.001 23
24. Intrauterine Growth Restriction Trends
Among Women Delivered Each Year
Rosser, Zhang, Ramos, 2015
P<0.001
6.0%
6.8%
6.3%
8.2%
8.6%
2010 2011 2012 2013 2014
p<0.001 24
25. 2010-2014 Postpartum visit rates
Rosser, Zhang, Ramos, 2015
APO N = 6,457 ; Normal Pregnancy N = 21,971
p<.00010 25
26. 45 Day Postpartum visit rates
Rosser, Zhang, Ramos, 2015
P<0.001
APO N = 6,457 ; Normal Pregnancy N = 21,971
*
*
* p<0.0001 26
27. Results- Deliveries
12 month study period
•6489 women delivered live births
•The majority of women did not attended a PPV
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28. Limitations
Lack of access to data outside of present medical network
– Attending Prenatal Visit or PPV elsewhere
– Overestimation of non-attendance rate
Exclusion of variables due to incomplete data
– Gestational Age
– Parity
– Education
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37. Visits
• PPV should be time to capture high risk women
• Cardiovascular risk reduction should be addressed annually
• Blood pressure monitoring
• Body mass index calculation, and
• Lifestyle modification involving exercise and dietary instruction
• Lipid and glucose measurements should be measured every five
years
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38. Addressing Disparities
• Educating healthcare professionals
• Cross Specialty collaboration
• Decrease healthcare cultural barriers
–Clinical care
–Research
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39. Future Collaboration to Improve
Women’s Cardiovascular Disease
• Screen
• Educate
• Research
• Collaborate
39
Figure 1. Trends in perceived leading cause of death among women. Numbers are percentages. Shown are the 1997 survey (n=1000), 2000 survey (n=1004), 2003 survey (n=1024), and 2005 survey (n=1008).