Published on

Published in: Healthcare, Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide


  1. 1. PERCEPTIONS Vs REALITY: WOMEN AND HEART DISEASE Dr.Jayasree.H.Nambiar DCH,DNB(Paed),DNB(Cardio),FIC(AIMS),FICC. Consultant Interventional Cardiologist BMH, Calicut.
  2. 2. What is Heart Disease? • Heart : The most hard-working muscle of our body – pumps 4-5 liters of blood every minute during rest • Supplies nutrients and oxygen rich blood to all body parts, including itself. • Coronary arteries surrounding the heart keep it nourished with blood
  3. 3. What is Atherosclerosis? What is Coronary Artery disease? • Over time, fatty deposits called plaque build up within the artery walls. The artery becomes narrow. This is atherosclerosis • When this occurs in the coronary arteries, heart does not get sufficient blood, the condition is called coronary artery disease, or coronary heart disease
  4. 4. What are the symptoms of Coronary artery disease? • No symptoms for long period • Chest pain for short period on exertion also known as Angina or minor heart attack • Myocardial Infarction or major heart attack-Severe chest pain, death of heart muscle, heart failure, irregular heart beats • Sudden Death
  5. 5. How Big is the Problem ? No. 1 killer disease worldwide 12 Million deaths annually. During last 30 years large declines in developed countries -rising health awareness and government programmes Alarming increase in developing countries especially India
  6. 6. Why Should I (Indian) be Worried ? • Indians More susceptible than any other ethnic group – 3.4 times more than Americans – 6 times more than Chinese – 20 times more than Japanese – Occurs even at lower cholesterol levels • Get the disease at much younger age - 5-10 years earlier than other communities • Disease follows more severe and malignant course – 3 times higher rate of second heart attack and two times higher mortality than whites
  7. 7. Kerala - Statistics • 110 People die of heart disease daily. • 38,000 people die of heart attack every year(ICMR, WHO) • 50% of total death due to Cardiovascular disease • (28% in India) • ↑se to 2/3 by 2020
  8. 8. Kerala – Statistics… • 87.2Lakhs Hypertensives • 34.8 Lakhs Diabetes(ICMR-WHO) • >20 years – 22% Diabetic 36% Hypertensive 66% Cholesterol >200
  9. 9. What do we need to Know? WOMEN AND HEART DISEASE
  10. 10. Gender Bias in the Treatment of Women ―… The community has viewed women‘s health almost with a ‗bikini’ approach, looking essentially at the breast and reproductive system, and almost ignoring the rest of the woman as part of women‘s health ….‖
  11. 11. Heart Disease is the #1 Killer of Women • Coronary heart disease is the single leading cause of death and a significant cause of morbidity among women. • In 1997 CHD claimed the lives of 502,938 women (men had less deaths) • Since 1984, CVD has killed more women than men each year.
  12. 12. Death From Breast Cancer or Heart Disease in Women in the US US Vital Statistics, 1990
  13. 13. CVD Mortality Trends (1979-1999) American Heart Association. 2002 Heart and Stroke Statistical Update. 2001 DeathsinThousands
  14. 14. In Perspective: • 1 in ―2‖ women will die of heart disease. • 1 in ―25‖ women will die of breast cancer.
  15. 15. Coronary Heart Disease in Women • Presentation and differences from men • 2/3 of women who die suddenly have no previously recognized symptoms. • Women are more prone to non-cardiac chest pain….. • In fact they may experience little or no squeezing chest pain in the center of the chest, lightheadedness, fainting, or shortness of breath with an MI (as seen on ―ER‖).
  16. 16. Not So Straight Forward • Because of these atypical symptoms, women seek medical care later than men and are more likely to be misdiagnosed. • Women presenting with MI and CAD are more likely to be older, have a history of DM, HTN, Hyperlipids, CHF, and unstable angina than male counterparts. • Because of these comorbid conditions, there tends to be diagnostic confusion.
  17. 17. Misperceptions and Missed Opportunities Leading to Access Inequity • Women were less likely to have an EKG or be admitted to the telemetry floors. • Women are under-diagnosed and can therefore get a false sense of security. • Less aspirin, beta-blockers, statins, anti arrhythmic treatment, cardiac cath, PTCA, CABG • Women were less likely to enroll in cardiac rehabilitation after an MI or bypass surgery.
  18. 18. CHD Mortality in Younger Women 2.9 4.1 5.7 8.2 10.7 14.4 18.4 21.8 25.3 6.1 7.4 9.5 11.1 13.4 16.6 19.1 21.5 24.2 0 5 10 15 20 25 30 < 50 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 DeathduringHospitalization(%) Men Women Figure 1. Rates of death during hospitalization for Myocardial Infarction among w omen and men, according to age. The interaction betw een sex and age w as significant (P<0.001). Women under 65 suffer the highest relative sex-specific CHD mortality
  19. 19. Women vs Men • Mortality from CABG- particularly among younger women-is double that among men. • More women than men die 1 year after an MI. • CHD is Largely Preventable • We need to address risk factors earlier and more aggressively, thereby reducing women‘s cardiovascular risk.
  20. 20. Women and Heart Disease Risk Factors
  21. 21. What Increases Risk? • High Cholesterol • Smoking • High Blood Pressure • Diabetes • Obesity • Alcohol • Physical Inactivity
  22. 22. • Family history of cardiovascular disease. • If your parents have cardiovascular disease (especially if they were diagnosed before age 50), you have an increased risk of developing it.
  23. 23. Emerging Risk Factors • Lipoprotein (a) • Homocysteine • Prothrombotic factors • Proinflammatory factors • Impaired fasting glucose • Subclinical atherosclerosis – Other clinical forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, and symptomatic carotid artery disease) – Abnormal internal or common carotid CIT, ankle- arm index <0.9, coronary Ca2+
  24. 24. Gender Differences in CAD Risk Factors • Increasing recognition that atherosclerosis is an inflammatory process • Ridker PM, et al: A prospective case- controlled study among 28,263 postmenopausal women – Among 12 markers of inflammation, C reactive protein was the strongest univariate predictor of the risk of CV events Ridker PM, et al. N Engl J Med. 2000
  26. 26. CHOLESTEROL ( A TYPE OF FAT) • Everybody needs cholesterol, it serves a vital function in the body. • It circulates in the blood. • Too much cholesterol can deposit in the arteries in the form of plaque and block them • No symptoms till heart attack
  27. 27. WHERE DOES IT COME FROM ? • Two sources of cholesterol: Food & made in your body • Food sources: All foods containing animal fat and meat products 65% 35%
  28. 28. GOOD VS. BAD CHOLESTEROL • LDL cholesterol – known as bad cholesterol. It has a tendency to increase risk of heart disease – major component of the plaque that clogs arteries • HDL cholesterol – known as the good cholesterol. Increases with exercise – helps carry some of the bad cholesterol out of arteries.
  29. 29. Know your Number! Desirable numbers • Total Cholesterol < 200; • LDL < 100 • HDL > 40 • Triglycerides < 200 • Get the levels tested routinely and keep them under control • The only thing worse than finding out that you have one of these conditions is…….NOT finding out that you have it!! And that’s not your Mobile Number!
  30. 30. Look before your eat • Eat a variety of fruits and vegetables every day. (5 servings - they are naturally low in fat and high in vitamins and minerals and anti oxidants). Eat colored vegetables and fruits • Eat a variety of grain products • Choose nonfat or low-fat products. • Use less fat meats- chicken, fish and lean cuts  Switch to fat-free milk—toned/skimmed milk
  31. 31. Smoking
  32. 32. Cigarette Smoking • Increases blood pressure • Decreases HDL • Damages arteries and blood cells • Increases heart attacks • Cigarette smoke contains more than 4,000 chemicals, and 200 of these chemicals are poisonous
  33. 33. Preventable Risk- Smoking • A. 50% of heart attacks among women are due to smoking. Smokers tend to have their first heart attack 10 years earlier than nonsmokers. • B. If you smoke, you are 4-6x‘s more likely to suffer a heart attack and increase your risk of a stroke. • C. Women who smoke and take OCP‘s increase their risk of heart disease 30x‘s.
  34. 34. Cigarette Smoking If you think YOU are smoking the cigarette, you are mistaken… “It’s the other way round”!
  35. 35. SMOKING: • Stop!!!!!(avg. attempt = 8 times) • Women who have other smokers in their household have a 2.5 X's greater likelihood of relapse. Circulation 2002:106 • Smoking cessation was associated with a 36% reduction in mortality among patients with CHD. JAMA 2003:290
  36. 36. Quit Smoking  In just 20 mins after quitting , blood pressure decreases  After 24 hrs the chance of heart attack decreases  Within 1 year of quitting, CHD risk decreases, within 2 years it reaches the level of a non smoker.
  38. 38. HYPERTENSION • 65% of all hypertension remains either undetected or inadequately treated. • People who are nor motensive at 55 have a 90% lifetime risk of developing HTN. • Prevalence increases with age and women live longer- hypertension is more common in females. • HTN is more common with OCP and obesity.
  39. 39. CONTROLLING BLOOD PRESSURE • Adults should have their blood pressure checked at least once every two years, as there are no symptoms to tell if you have high blood pressure • Optimal levels : 120 /80 mm Hg • If high – Modify your lifestyle – Diet, Weight, Exercise, Salt restriction – Adhere to the prescribed medication without fail, to decrease chances of getting heart disease – Do not stop your medicines without consulting your doctor, even if the blood pressure becomes normal
  40. 40. Weight Management  On average, ~ 1/2 to 1mm decrease in blood pressure for each pound weight loss in obese hypertensives (up to ~20# loss)  Weight reduction can raise HDL-cholesterol  Obesity is the major risk for CHD
  41. 41. Exercise • 30-45 mins of walking 5x‘s/week reduces risk of MI in females 50%. • Helps control BP, increases HDL, decreases body fat, DM risk, possibly prostate, breast and uterine cancers.
  42. 42. Diabetes
  43. 43. Diabetes • At any given cholesterol level, diabetic persons have a 2 or 3 x higher risk of heart attack or stroke • A diabetic is more likely to die of a heart attack than a non-diabetic • ~80% Diabetics die from heart disease • Risk of sudden death from a heart attack for a diabetic is the same as that of someone who has already had a heart attack.
  44. 44. Diabetes Creates Higher Risks for Women With CAD • 65% of diabetics die from heart disease or stroke • 4.2 million American women have diabetes – Diabetes increases CAD risk 3-fold to 7- fold in women vs 2-fold to 3-fold in men – Diabetes doubles the risk of second heart attack in women but not in men • Every year, heart disease kills 50,000 more American women than men • Statistics are particularly high among African American women American Heart Association Centers for Disease Control and Prevention Manson JE, et al. Prevention of Myocardial Infarction. 1996
  45. 45. Reported Causes of Death in People With Diabetes C
  46. 46. Controlling Blood Sugar • Normal blood sugar: • Fasting < 100; Post meals <140 • Keep HBA1C < 6.5% • If high – Modify your lifestyle – Diet, Weight, Exercise – Adhere to the prescribed medication without fail, to decrease chances of getting heart disease – Do not stop your medicines without consulting your doctor, even if the blood sugar becomes normal
  47. 47. Obesity
  48. 48. Obesity • People who are overweight (10-30 % more than their normal body weight) • Obese have 2 to 6 times the risk of developing heart disease • Normal Waist Circumference <88cm in females < 92cm in males • Pears or apples?
  49. 49. Obesity A. 1/3 of adult women are obese and its increasing B. Active women have a 50% risk reduction in developing heart disease.
  50. 50. Obesity and Coronary Heart Disease Mortality 0 1 2 3 4 5 6 <19 19.0- 21.9 22.0- 24.9 25.0- 26.9 27.0- 28.9 29.0- 31.9 >32.0 Nurses‘ Health Study: Women who never smoked Relative Risk of Coronary Heart Disease mortality Body Mass Index (kg/m2)
  51. 51. Metabolic Syndrome Risk Factor Defining Level Abdominal Obesity Waist Circumference Men >40 inches Women >35 inches TG‘s >150 HDL Men <40 Women <50 BP >130/85 Fasting Glucose >100 mg/dl
  52. 52. Mortality Associated With Metabolic Syndrome Lakka H-M et al. JAMA. 2002;288:2709-2716. 18 9 6 8 3 2 0 2 4 6 8 10 12 14 16 18 20 All-cause mortality* CVD mortality* CHD mortality* Metabolic syndrome No metabolic syndrome Mortality(%ofpatients) 2003 PPS® *Adjusted for known CHD risk factors. POWERSEARCH PLUG-IN™ 2.0 Copyright © 2001-02 Accent Graphics, Inc. Slide Source: "R:NDEI-22004 GrantT108ARST095 ARS Case 2 FINAL-Baton Rouge 12-09-03.ppt" <OPEN> Last Modified: December 9, 2003 2:17:25 PM Slide Number: 19
  53. 53. Alcohol Consumption
  54. 54. Alcohol Consumption In small amounts it acts as a vasodilator-Good! 1-2 drinks In large amounts it acts as a vasoconstrictor-BAD! 3-4 drinks This is a very fine line!
  55. 55. Physical Inactivity Increasing physical activity has been shown to decrease blood pressure. Moderate to intense physical activity for 30-45 minutes on most days of the week is recommended.
  56. 56. Exercise and CVD Serves several functions in preventing and treating those at high risk. Reduces incidence of obesity. Increases HDL Lowers LDL and total cholesterol Helps control diabetes and hypertension Those at high risk should take part in a specially supervised program.
  57. 57. Exercise, Exercise, Exercise •Mortality is halved in retired men who walk more than two miles every day •Regular exercise can halve the risk of heart disease, particularly in men who walk briskly •Someone who is inactive has as great a risk of having heart disease as someone who smokes, has high blood pressure or has high cholesterol •Exercise significantly reduces the chances of diabetes and stroke •With regular exercise, blood pressure in those with hypertension is reduced by as much as 20mms Hg
  58. 58. How is cardiovascular disease associated with menopause? • After menopause, a woman‘s risk of cardiovascular disease increases. • In women who have undergone early menopause (before age 50) or surgical menopause, the risk of cardiovascular disease is also higher, especially when combined with other risk factors. • Estrogen helps a woman‘s body protect her against cardiovascular disease. • After menopause, cardiovascular disease becomes more of a risk for women because of the reduced level of estrogen.
  59. 59. Postmenopausal Hormone Therapy and Cardio protection • First randomized trial • HERS trial (Heart and Estrogen/Progestin Replacement Study) – Secondary CAD prevention trial – Randomized trial of placebo vs estrogen and medroxyprogesterone – Follow-up = 4 years – N = 2,763 women with an intact uterus HERS trial. JAMA. 1998.
  60. 60. Heart Disease • There is a continuum of CVD risk, it is not a ―have or have-not‖ condition. • CHD is less in women who control their risk factors. JAMA Oct. 6, 2004 • The average age of our population is increasing and so CHD will remain a major public health issue.
  61. 61. Other Heart Diseases In Women • RHD & Aortorto arteritis more common in women • Congenital heart diseases like ASD more in women. • Can cause morbidity & maternal/neonatal mortality during pregnancy and delivery. • Needs screening of pregnant women with Echo/Foetal Echo.
  62. 62. “GO RED” Conclusions Heart disease is a number one killer. Majority of the causes for heart diseases are known and can be modified. Adoption of guidelines for prevention of cardiovascular diseases can help people to have a lifelong low level of heart diseases and stroke.
  63. 63. Contd……..  Chances of Heart disease in women are high & that is on the increase.  Most of the risk factors have a higher impact in women than men.  Since younger women have a higher mortality than men(<40yrs) grave implications in family & society.  All females should be made aware of this through educative programmes starting at school & College levels.
  64. 64. Contd…  Preventive measures save economy & health.  Girl students be screened for RHD & Congenital Heart diseases through school health programmes.  Separate ‗Women & Child care‘ wings for Cardiology departments.  Concessional rate Cardiac check ups for women.  Realizing this ‗Cardiac Explosions‘ in women Govt. schemes on a ‗Go Red‘ Basis!!!.
  65. 65. THANK YOU!!!