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  1. 1. Heart Disease in Women How to Protect Yourself Banu Mahalingam MD, FACC, RCS. Cardiology Associates Of Princeton
  2. 2. Heart disease in women <ul><li>Facts about heart disease in women </li></ul><ul><li>How does the heart work? </li></ul><ul><li>How to diagnose heart disease? </li></ul><ul><li>What are the risk factors for heart disease? </li></ul><ul><li>What is the role of hormone replacement therapy? </li></ul><ul><li>What are the latest updates? </li></ul><ul><li>What to expect in the future? </li></ul>
  3. 3. Coronary Heart Disease <ul><li>Prevalent and preventable </li></ul><ul><li>600,000 deaths of which coronary heart disease is the direct cause of 460,000 </li></ul><ul><li>1.1 million myocardial infarction/heart attacks of which 650,000 are first infarctions </li></ul><ul><li>An economic burden of $101 billion </li></ul><ul><li>From 1988 to 1998, death rate from CAD has declined </li></ul>
  4. 5. Comparison of deaths from CV disease and breast cancer, by age Heart Disease Breast Cancer
  5. 6. Heart disease in women <ul><li>More women present with atypical symptoms </li></ul><ul><li>More frequent silent MI </li></ul><ul><li>Mortality rate of MI and bypass surgery are 50% higher in women </li></ul><ul><li>Cholesterol lowering has shown similar efficacy </li></ul><ul><li>Cardioprotective agents have similar efficacy </li></ul><ul><li>Treatment rates tend to be lower </li></ul><ul><li>Diabetes is a particularly serious risk factor </li></ul>
  6. 7. Compared with Men <ul><li>38% of women and 25% of men will die within one year of a first recognized heart attack </li></ul><ul><li>35% of women and 18% of men heart attack survivors will have another heart attack within six years </li></ul><ul><li>46% of women and 22% of men heart attack survivors will be disabled with heart failure within six years </li></ul>
  7. 8. Compared with Men <ul><li>Women are almost twice as likely as men to die after bypass surgery </li></ul><ul><li>Women are less likely than men to receive beta-blockers, ACE inhibitors or even aspirin after a heart attack </li></ul><ul><li>Women constituted less than 25% of the research patient population </li></ul>
  8. 9. At-Risk <ul><li>The age-adjusted rate of heart disease for African American women is 72% higher than for white women </li></ul><ul><li>Women who smoke risk having a heart attack 19 years earlier than non-smoking women </li></ul><ul><li>Women with diabetes are two to three times more likely to have heart attacks </li></ul>
  9. 10. At-Risk <ul><li>High blood pressure is more common in women taking oral contraceptives, especially in obese women </li></ul><ul><li>39% of white women, 57% of black women, 57% of Hispanic women, and 49% Asian/Pacific Islander women are sedentary and get no leisure time physical activity </li></ul><ul><li>23% of white women, 38% of black women, and 36% Mexican American women are obese </li></ul>
  10. 11. Compared with Men <ul><li>More women than men die of heart disease each year, yet women receive only: </li></ul><ul><ul><li>33% of angioplasties, stents and bypass surgeries </li></ul></ul><ul><ul><li>28% of implantable defibrillators and </li></ul></ul><ul><ul><li>36% of open-heart surgeries </li></ul></ul><ul><li>Women comprise only 25% of participants in all heart-related research studies </li></ul>
  11. 12. Normal Coronary Anatomy
  12. 13. Current Path in Cardiac Muscle
  13. 14. Microscopic Pathology of Atherosclerosis
  14. 15. What is a Heart Attack? <ul><li>A heart attack occurs when the blood supply to part of the heart muscle itself - the myocardium - is severely reduced or stopped. The medical term for heart attack is myocardial infarction </li></ul><ul><li>This is usually caused by the buildup of cholesterol plaque. </li></ul>What causes a Heart Attack?
  15. 16. During a Heart Attack
  16. 17. Myocardial Infarction
  17. 18. Detecting Coronary heart disease <ul><li>EKG </li></ul><ul><li>Stress testing </li></ul><ul><li>Echocardiogram </li></ul><ul><li>Cardiac Catheterization/Coronary angiogram </li></ul><ul><li>CAT scan- calcium score </li></ul><ul><li>MRI of the heart </li></ul>
  18. 19. Normal Thallium Stress Test
  19. 20. Abnormal Stress Test
  20. 21. Cardiac Catheterization <ul><li>Catheters are also used to inject dye into the coronary arteries. This is called coronary angiography </li></ul><ul><li>It's also used to get information about the pumping ability of the heart muscle. </li></ul>
  21. 22. Coronary Blockage
  22. 23. Risk Factors for Heart Disease <ul><li>High Blood Pressure - Hypertension </li></ul><ul><li>High Blood Sugar - Diabetes Mellitus </li></ul><ul><li>High Cholesterol </li></ul><ul><li>Smoking </li></ul><ul><li>Age/Gender </li></ul><ul><li>Family History </li></ul><ul><li>Obesity </li></ul>
  23. 24. High Blood Pressure <ul><li>Silent Killer </li></ul><ul><li>Uncontrolled high blood pressure can lead to stroke, heart attack, congestive heart failure or kidney failure </li></ul><ul><li>The only way to tell if you have high blood pressure is to have your blood pressure checked </li></ul>
  24. 25. High Blood Pressure <ul><li>One in four adult Americans has high blood pressure, and nearly one-third of them don't know they have it </li></ul><ul><li>Remember, high blood pressure has no symptoms, so if you haven't had it checked in a while, make an appointment now. </li></ul><ul><li>Normal BP: 120/80 </li></ul>
  25. 27. Hypertension <ul><li>Know what your Blood Pressure is </li></ul><ul><li>Educate yourself on self measurement of BP </li></ul><ul><li>Understand the role of Diet and Exercise in maintaining BP </li></ul>
  26. 28. Diabetes Mellitus <ul><li>Diagnosed by checking Fasting Blood Sugars </li></ul><ul><li>Can be silent/asymptomatic </li></ul><ul><li>Leading cause of complication from coronary artery disease </li></ul><ul><li>Completely negates the positive effect of estrogen in pre-menopausal women </li></ul>
  27. 29. Diabetic Patient <ul><li>If you are a diabetic know your </li></ul><ul><li>Hemoglobin A1C </li></ul>
  28. 30. Cigarette Smoking <ul><li>Most preventable cause of Heart Attacks </li></ul><ul><li>Responsible for 400,000 premature deaths in the U.S. annually </li></ul><ul><li>Nonsmokers and former smokers have significantly lower rates of Heart attacks than smokers </li></ul><ul><li>7%-47% reduction in mortality following smoking cessation </li></ul>
  29. 31. Dietary Management of Heart Disease
  30. 32. Diet modification <ul><li>More complex carbohydrate </li></ul><ul><li>More fruits, vegetables and legumes </li></ul><ul><li>More fish </li></ul><ul><li>Less meat </li></ul><ul><li>Less whole milk products </li></ul><ul><li>Alpha-linolenic acid enriched canola oil margarine </li></ul>
  31. 34. Lipid panel <ul><li>Total cholesterol <200 </li></ul><ul><li>LDL cholesterol <130 </li></ul><ul><li>HDL cholesterol >40 </li></ul><ul><li>Triglycerides <200 </li></ul>
  32. 35. Benefits of Cholesterol Reduction
  33. 36. Effect of Aspirin on Survival
  34. 38. Estrogen/Progestin Therapy also Resulted in: <ul><li>41% increase in strokes </li></ul><ul><li>29% increase in heart attacks </li></ul><ul><li>Doubled rates of blood clots in legs and lungs </li></ul><ul><li>37% less colorectal cancer </li></ul><ul><li>34% fewer hip fractures and 24% less total fractures </li></ul>
  35. 39. Recommendations <ul><li>the therapy should not be continued or started to prevent heart disease </li></ul><ul><li>for osteoporosis prevention, women should consult their doctor and weigh the benefits against their personal risks </li></ul><ul><li>the therapy for relief of menopausal symptoms may reap more benefits than risks </li></ul>
  36. 40. HRT <ul><li>Symptom relief should be the primary reason for taking hormone replacement therapy </li></ul><ul><li>Progestins should be added to estrogen therapy only to prevent endometrial cancer. If a woman has had a hysterectomy, there is no need for progestins in her hormone therapy </li></ul><ul><li>Hormone therapy should not be used to prevent heart disease; women should take other measures to reduce that risk </li></ul><ul><li>Hormone therapies have been shown to help build stronger bones; however, women should weigh the risks of hormone therapy before taking it to prevent osteoporosis </li></ul>
  37. 41. HRT <ul><li>A woman should take HRT for the shortest amount of time possible, based on her symptoms, the benefits she's getting from the therapy, and her personal health risks </li></ul><ul><li>Doctors should consider prescribing low-dose HRT whenever possible </li></ul><ul><li>Doctors should consider alternate ways of giving HRT other than orally -- such as patches and creams, but should know that studies are not clear on the long-term risks and benefits </li></ul><ul><li>Every woman's personal health risks should be evaluated before any form of hormone therapy is prescribed. Women should be sure they understand the known risks </li></ul>
  38. 42. Top Tips for Heart Health <ul><li>Reduce total fat, favor mono-unsaturated fats over saturated fats and above all, eat moderate portions </li></ul><ul><li>Learn how to be more stress resilient </li></ul><ul><li>Get moving today </li></ul><ul><li>Smoking cessation </li></ul><ul><li>Being a good weight for your height </li></ul><ul><li>Eating healthy and exercising regularly </li></ul>
  39. 43. What’s new <ul><li>Markers for inflammation </li></ul><ul><li>C- reactive protein </li></ul><ul><li>Homocysteine </li></ul><ul><li>Lipoprotein (a) </li></ul><ul><li>Drug coated stent </li></ul><ul><li>Minimally invasive surgery </li></ul><ul><li>Off pump open heart surgery </li></ul>
  40. 44. What to expect in the future <ul><li>Super HDL coronary infusion therapy </li></ul><ul><li>Non invasive visualization of coronary arteries </li></ul><ul><li>Focusing on inflammation as risk reduction in heart disease </li></ul>
  41. 45.                                                              
  42. 46. Online resources <ul><li> </li></ul><ul><li>National coalition of women with heart disease </li></ul><ul><li>The Heart Truth Awareness campaign of the National Heart, Lung, and Blood Institute </li></ul><ul><li>American Heart Association Organization fighting heart disease and stroke </li></ul>
  43. 47. Heart Disease in Women