The presentation will help you study the risk factors for Coronary Artery Disease.

1. Risk Factors for Coronary Artery Disease
in Lebanese/Armenian Women
Authors:
Mary Arevian MPH, RN
Marina Adra MS, RN
Loulou Koubessi BS MPH
Sponsored by the
Armenian Relief Cross in Lebanon

2. Significance
- Coronary Artery disease (CAD) is the
leading cause of Death among women over
50 years (American Heart Association, 1997).
- Women are 50% more likely to die during
hospitalization for a heart attack than men
(Hamilton, 1991; Stanhope, 2000).
- Women may delay seeking treatment,
expecting that heart disease involves much
more pain than they experience.

3. - Their complaint may not be taken seriously
by health providers, who may attribute
symptoms to stress.
- Women undergo fewer procedures than
men
when hospitalized for CAD (Ayanian and
Epstein, 1991).
- Women may be misdiagnosed until their
condition warrants emergency surgery
(Hawthorne, 1994).

4. - Women on average are 10 years older than
men when they initially present with
symptoms of cardiovascular disease (Lerner
and Kannel, 1986) are 20 years older at the
time of occurrence of a myocardial infarction
and they have more comorbid conditions
like diabetes and hypertension (Cannistra et
al., 1989).

5. - In Lebanon, though there are no accurate
statistics on the incidence of CAD, according
to hospital records, there are approximately
550-580 open heart surgeries of coronary
artery bypass graft (CABG) performed each
year at the American University Medical
Center. In addition there are eight other
hospitals that perform open-heart surgeries.

6. - Many patients are:
 Heavy smokers
 Hypertensive
 Diabetic
 Hypercholestrolemic
 Obese
- Approximately 20% of patients undergoing
upon heart surgery for CABAG are
estimated to be women.
- This rate may increase as more and more
Lebanese women are adopting Western life
style habits, such as smoking, use of oral
contraceptives, sedentary life style, etc...

7. Purpose
The purpose of this descriptive study was
to explore risk factors for CAD among
Lebanese/Armenian women.

8. The following questions were addressed:
1. What is the prevalence of CAD risk factors
in a sample of Lebanese/Armenian
women?
2. What is the nature/type of risk factor
(modifiable versus non-modifiable)?
3. What is the association between
hypertension and other CAD risk factors
in the sample?

9. Method
Design and Sample
This descriptive study explored risk factors for
coronary artery disease among Lebanese/
Armenian women. The setting was the Araxy
Boulghardjian socio-medical center (ABSM),
of Armenian Relief Cross in Lebanon (ARCL).
The ABSM is a primary health care center
located in the densely populated area of
Bourj-Hammoud in the Great Beirut region.

10. The population consists of mostly Armenian
ethnic minority group. This study was part of
a health promotive program targeting
Lebanese/Armenian women.
A convenience sample of 83 women were
recruited for the study. The participants were
adult women who attended regularly, at least
five of six panel discussions about risk
factors for CAD.

11. Instrument
Data was collected through a structured
questionnaire followed by clinical
examination.
The questionnaire consisted of 18 items
that addressed demographic data, lifestyle,
personal and family health history.
Demographic data included age and birth
date, educational level, occupation of women
and spouse.

12. Lifestyle and personal health history included
smoking, physical activity, history of hypertension and current use of antihypertensives,
and for their use of oral contraceptive pills,
their menopausal status and use of HRT.
Participants were asked whether they got
angry easily and how did they relieve their
anger, and type of oil used for cooking.
Participants were also asked if they had any
sudden deaths excluding accidents in their
families and the relation of the deceased to
them.

13. It was assumed that sudden deaths were due
mostly to coronary incidents, so their measure
was used as a proxy for family history of CAD
The second part of the instrument consisted
of clinical findings. For each participant
height in centimeters and weight in Kilograms
were taken and the BMI calculated. A BMI of
27.3 or greater classified the participants into
overweight category (Kugmarski et al., 1994).
Blood tests included fasting blood sugar
(FBS), total cholesterol, HDL and LDL
cholesterol and triglyceride values expressed
in mg/dl.

14. An FBS level of greater or equal to
138mg/dl, cholesterol level of greater or
equal to 200mg/dl, LDL level of greater or
equal to 130mg/dl, HDL level of less than
40mg/dl and triglyceride level greater than
230mg/dl classified the participants into
high risk group (Hudak, Gallo & Morton,
1998).

15. For each participant means of systolic and
diastolic blood pressures were calculated
from the readings. Participants whose mean
systolic pressures were greater than or equal
to 140mmHg and mean diastolic pressures
greater than or equal to 90mmHg were
classified as hypertensive (the VI Report of
the Joint National Committee on Prevention,
Detection, Evaluation and Treatment of High
Blood Pressure, 1997).

16. Procedure
During the first session of the panel
discussions, the height, weight and blood
pressure of the participants were taken and
recorded.
On subsequent sessions, only blood
pressures were taken.
When the panel discussions were over, those
participants who attended regularly received
free cards, as an incentive to do blood tests.
In addition they answered the interview.

17. Blood tests were taken, analyzed and
recorded by the same person for all
participants to enhance reliability.
A cardiologist was available for
consultations, physical exam, reporting of
laboratory findings and follow-up visits when
advisable.

18. Analysis
Frequency distributions were used to
present the demographic characteristics, life
style and personal and family health
histories. Cross tabulations were conducted
to test for the relationships of hypertension
states and age, lifestyle, personal and family
histories and clinical findings.
The Chi square was calculated and the
significance level was set up at P<0.05.

19. Results and Tables

26. Limitations
-
Small sample size
Convenience sample
Participants were seriously motivated
women who attended a series of panel
discussions to raise awareness about risk
factors of CAD.

27. Conclusion
The findings of this study show a high
prevalence of CAD risk factors in this sample.
The majority of the women were:
- 50 years and older
- menopaused and not taking HRT
- overweight
- hypertensive
- hypercholestrolemic, high levels of LDL, low
levels of HDL.
Although generalizations from this study is
limited, we can conclude that CAD is no more a
men's health problem but women's as well.

28. Recommendations
It is highly recommended that community
health nurses plan and implement.
- Programs for awareness, detection and
control of hypertension
- Advise women to quit smoking
- Avoid obesity
- Increase physical activity
- Reduce the ratio of total cholesterol to HDL
cholesterol.
Further studies with a larger and randomly
selected group of women are warranted.