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Your heart matters by Dr. Justina Trott


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This was a presentation made to the Rotary Club of Santa Fe on June 27, 2013 by Dr. Justina Trott , Director Women's Health Policy Robert Wood Johnson Foundation Center for Health Policy University of New Mexico.

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Your heart matters by Dr. Justina Trott

  1. 1. Latest Research Findings on Heart Health in Women 27 June 2013 Justina Trott, MD, FACP Senior Fellow RWJF Center for Health Policy University of New Mexico Senior Fellow NM CARES Health Disparities Center Director Women’s Health Policy Unit, RWJF Center for Health Policy University of New Mexico Clinical Professor of Medicine University of New Mexico
  2. 2. The Heart Truth • Heart disease is the #1 killer of American women— no matter what their race or ethnicity • Heart disease kills 1 of every 3 American women • Heart disease can permanently damage your heart —and your life
  3. 3. What Is Heart Disease? • Coronary heart disease—affects arteries of the heart • Heart doesn’t get enough nutrient-rich blood • Chronic—develops over years • Atherosclerosis—arteries harden as cholesterol, fat, and other substances build up in artery walls • Blockage can result in heart attack
  4. 4. No Quick Fix • Worsens if not treated—leads to disability or death • Not “fixed” by surgery or procedures, such as bypass and angioplasty
  5. 5. Why Me? Why Now? Risk rises ages 40–60 • Estrogen level drops during menopause Risk factors • Smoking • High blood pressure • High blood cholesterol • Overweight/obesity • Physical inactivity • Diabetes • Family history of early heart disease • Age (55 and older for women)
  6. 6. Heart Disease Risk Factors • Multiply their effects • Same lifestyle steps prevent/control many of the risk factors
  7. 7. Cardiovascular Disease Mortality Trends for Males and Females United States: 1979-2001
  8. 8. Trends in Heart Disease
  9. 9. Acute MI Mortality by Age and Sex 0 5 10 15 20 25 30 <50 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 Age Death During Hospitalization (%) Men W omen
  10. 10. Prevalence of Cardiovascular Disease NHANES III: 1988-94 Americans Age 20 and Older by Age and Sex
  11. 11. Age Adjusted Death Rates for Coronary Disease, Stroke, Lung and Breast Cancer White and Black Females United States 2001
  12. 12. Why Are There Such Disparities? • Differences in frequency of evaluation in men and women • Information about women and heart disease is not well studied and not widely published • Heart disease can be different in women and men
  13. 13. Description A new study by researchers at the Medical College of Wisconsin in Milwaukee and Johns Hopkins University has found that race, gender and insurance differences factor strongly in the evaluation of patients with chest pain seen in emergency departments Medical College of Wisconsin Released: Tue 30-Jan-2007 Emergency Departments Test Chest Pain Patients Differently, Based on Race, Gender, Insurance Differences in Frequency of Evaluation
  14. 14. Mayo Clinic Proceedings …in a sample of recent articles, a minority (37% in general medical journals and 23% in cardiology journals) reported sex-specific results. Blauwet LA, Hayes SN, McManus D, Redberg RF, Walsh MN. Low rate of sex-specific result reporting in cardiovascular trials. Mayo Clin Proc. 2007;82:166-170. Lack of Information
  15. 15. Heart Disease Differences in Women and Men
  16. 16. Heart Attack Warning Signs • Chest discomfort • Usually in the center of the chest • Lasts for more than a few minutes, or goes away and comes back • Can feel like uncomfortable pressure, squeezing, fullness, or pain • Discomfort in other areas of the upper body, including pain or discomfort in one or both arms, the back, neck, jaw, or stomach
  17. 17. Heart Attack Warning Signs • Shortness of breath • Other symptoms, such as breaking out in a cold sweat, nausea, or light-headedness
  18. 18. Differences in Mechanism of Heart Disease
  19. 19. Differences in Mechanism of Heart Disease
  20. 20. How Heart Disease is Different in Women and Men
  21. 21. Differences in Diagnosis of Heart Disease
  22. 22. CONCLUSIONS: In this large, primary-prevention trial among women, aspirin lowered the risk of stroke without affecting the risk of myocardial infarction or death from cardiovascular causes Differences in Treatment
  23. 23. Women and Ischemia Syndrome Evaluation (WISE) Recent studies of the implications of coronary microvascular dysfunction can be used to improve the diagnosis and treatment of women with chest pain.
  24. 24. Hopeful Good News • Heart disease can be prevented or controlled • Treatment includes lifestyle changes and, if needed, medication
  25. 25. Key Tests for Heart Disease Risk • Blood pressure • Blood cholesterol • Fasting plasma glucose (diabetes test) • Body mass index (BMI) and waist circumference • Electrocardiogram • Stress test
  26. 26. Risk Stratification • Calculate 10 year risk for all patients with two or more risk factors that do not already meet criteria for CHD equivalent • Use electronic calculator for most precise estimate:
  27. 27. Risk Assessment Tool for Estimating 10 -year Risk of Developing Hard CHD (Myocardial Infarction and Coronary Death) The risk assessment tool below uses recent data from the Framingham Heart Study to estimate 10 -year risk for “hard” coronary heart disease outcomes (myocardial infarction and coronary death). This tool is designed to estimate risk in adults aged 20 and older who do not have heart disease or diabetes. Use the calculator below to estimate 10 -year risk. Age: years Gender: Female Male Total Cholesterol: mg/dL HDL Cholesterol: mg/dL Smoker: No Yes Systolic Blood Pressure: mm/Hg Currently on any medication to treat high blood pressure. No Yes Calculate 10-Year Ri sk
  28. 28. Why Women Don’t Take Action Against Heart Disease • They don’t put their health as a top priority • They think they’re not old enough to be at risk • They feel too busy to make changes in their lives • They’re already feeling stressed • They’re tired
  29. 29. Where to Start –What You Can Do? • Ask your doctor about your risk of heart disease • Draw up a list of questions before your visit • Write down or tape record what the doctor says • Tell your doctor your lifestyle behaviors, such as smoking or being physically inactive • Tell your doctor any symptoms you feel
  30. 30. How To Lower Heart Disease Risk • Begin today • Be physically active—30 minutes of moderate- intensity activity on most days of the week • Follow a healthy eating plan • Low in saturated fat and cholesterol and moderate in total fat • Limit salt and sodium • If you drink alcoholic beverages, have no more than one a day
  31. 31. How To Lower Heart Disease Risk • Maintain a healthy weight • Balance calories taken in with those used up in physical activity • Stop smoking • Manage diabetes • Take medication, if prescribed
  32. 32. To Survive a Heart Attack • Call 9-1-1 within minutes—5 minutes at most • Emergency medical personnel will begin treatment at once • Don’t drive yourself to the hospital • Uncertainty is normal—don’t be embarrassed by a false alarm • Plan ahead • Learn the warning signs
  33. 33. It All Begins With You • Take one step at a time • Replace unhealthy habits with healthier ones • Eat for heart health • Remember that calories count • Start walking—try 10 minutes and add time gradually to get 30 minutes a day
  34. 34. How To Keep Going • View changes as new lifestyle, not quick fixes • Set realistic goals • Buddy up • Don’t worry about a slip • Reward your success • Be your own advocate—ask questions and seek information
  35. 35. Stress and Heart Disease Can managing stress reduce or prevent heart disease?
  36. 36. The Heart Truth It’s up to you to protect your heart health—start today • Without blaming yourself • You and your community
  37. 37. Resources for a Healthy Heart National Heart, Lung, and Blood Institute • American Heart Association Simple Solutions • Office on Women’s Health, DHHS National Women’s Health Information Center • WomenHeart: the National Coalition for Women with Heart Disease −
  38. 38. Thank You Santa Fe 2007