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- 1. Women and Heart Disease Thomas J. Stegmann, M.D., PhD., FETCS, FAHA AHA Luncheon, February 27, 2008
- 2. Women & Men: Different? Indeed, different...J
- 3. Women...
- 4. Women & Men: Differences... J
- 5. AHA – Heart Disease and Stroke Statistics – 2008 Update • Heart disease (CVD) is the leading cause of death of American women, accounting for 37.7 percent of all deaths per year. More than 459,000 women in America die every year of cardiovascular disease. • 8 million American women are currently living with heart disease and of those, 6 million have a family history of heart disease. • Fewer than half of all women are aware that heart disease is the number 1 killer of American women. Most women identify cancer as the leading cause of death.
- 6. AHA – Heart Disease and Stroke Statistics – 2008 Update • In the United States, all cardiovascular diseases combined claim the lives of more women every year than the next 16 causes of death combined - and almost twice as many as all forms of cancer. • One in six women will die from heart disease, while one in 30 women die from breast cancer. • Every year since 1984, more women than men have died of cardiovascular disease.
- 7. A Total CVD B Cancer C Accidents D Chronic Lower Respiratory Diseases E Diabetes Mellitus F Alzheimer’s Disease CVD and other major causes of death for all males and females (United States: 2004). Source: NCHS and NHLBI. 286,830 58,646 267,058 410,628 72,050 35,267 459,096 63,341 46,991 39,962 0 100,000 200,000 300,000 400,000 500,000 A B C D E A B D F C Deaths Males Females
- 8. Prevalence of CVD in adults age 20 and older by age and sex (NHANES: 1999-2004). Source: NCHS and NHLBI. These data include coronary heart disease, heart failure, stroke and hypertension. 14.8 39.1 71.3 9.4 39.5 75.1 83.0 92.0 0 20 40 60 80 100 20-39 40-59 60-79 80+ PercentofPopulation Males Females
- 9. Coronary Anatomy LCA - Woman LCA - Man
- 10. Post-MI Mortality Women - Men ! ! WISE Study, Part II, J Am Coll Cardiol 47: 21-29, 2006
- 11. CABG: Operative Mortality Women – 4.0 % Men – 3.2 % The Society for Thoracic Surgery Database, Ann Thorac Surg 71: 512-520, 2001 WISE Study, Part II, J Am Coll Cardiol 47: 21-29, 2006 441,542 patients, 28% women
- 12. Cardiac Syndrome X Key Points (Classical Definition) • Predominantly effort induced Angina • ST segment depression suggestive of myocardial ischemia during spontaneous or provoked angina • Normal coronary arteries at angiography • Absence of spontaneous or provoked epicardial coronary artery spasm • Absence of cardiac (for example, cardiomyopathy) or systemic (for example, hypertension, diabetes) diseases potentially associated with microvascular dysfunction• •
- 13. New Definition of Cardiac Syndrome X Lanza,G.A., Heart 93: 159-163, 2007 • Stable Angina, exclusively or predominantly induced by effort • Findings compatible with myocardial ischemia/coronary microvascular dysfunction on diagnostic investigation (ECG, SPECT, MRI, PET, Doppler) • Normal (or near normal) coronary arteries at angiography (mild stenosis ≤ 20%) • Absence of any other specific cardiac disease (valvular disease, cardiomyopathy)
- 14. Cardiac Syndrome X ECG, Coronary Angiogram
- 15. Cardiac Syndrome X Pathogenetic Mechanisms Coronary Microvascular Dysfunction Abnormal Cardiac Pain Sensitivity Individual Clinical Picture
- 16. Microvascular Dysfunction • Endothelial Cells (Endothelium) • Smooth Muscle Cells (Tunica media) • Estrogen-Level ↓ (and/or Changes) • Impaired Vasodilatation • Endothelium-independent • Endothelium-dependent • Increased Vasoconstriction • Low-Grade Inflammation
- 17. 58 yrs old Woman Plaque Erosion plus Thrombus Thrombus Plaque Medial Hypertrophy
- 18. 58 yrs old Woman Plaque Erosion plus Thrombus Fibrin Clot Plaque Coronary Artery Wall
- 19. 58 yrs old Woman Plaque Erosion plus Thrombus Total Vessel Occlusion - MI
- 20. Cardiac Syndrome X Symptoms • Chest pain or Angina, quite often at rest; the pain may spread to the left arm or the neck, back, throat, or jaw • Numbness or a loss of feeling in the arms, shoulders, or wrists • Variable duration of angina episodes • Coronary angiography demonstrates “normal” coronary arteries • Characteristic ischemic ECG changes during exercise testing • Inconstant or partial response to sublingual nitrates • Postmenopausal or menopausal status • Impaired quality of life
- 21. Cardiac Syndrome X Diagnostics • Baseline ECG • Exercise ECG – Stress test • Exercise radioisotope test (nuclear stress test, myocardial scintigraphy) • Echocardiography (including stress echocardiography) • Coronary angiography • Intravascular ultrasound • MRI scan
- 22. Cardiac Syndrome X Therapeutic Options • Symptom control only ? • Improving microvascular function ? • Decreasing chest pain perception ? Small number of patients Uncontrolled clinical trials ►
- 23. Cardiac Syndrome X Therapy • β-blockers • Nitrates • Calcium antagonists • Xanthine derivates (theophylline, bamiphylline) • Analgetics (imipramine) • Estrogens • α–antagonists (prazosine, doxazosine) • ACE-inhibitors • Statins (?) • Spinal cord stimulation (?)
- 24. New Treatment Option for CHD in Women: Angiogenesis
- 25. New Treatment for Coronary Syndrome X - Angiogenesis FGF-1 induced Angiogenesis: CAMA-Assay FGF-1 induced Angiogenesis: Human Heart
- 26. University of Cincinnati, Heart Center, Division of Cardiac Surgery
- 28. 3 Months after FGF-1 Treatment Pre-Treatment
- 29. Phase II Heart Trial In its Phase II Heart Trial - Diffuse Coronary Heart Disease, CVBT-141H - CVBT will include Equal Numbers of Women and Men!
- 30. These times are over... Lucas Cranach, 1472-1553 Judith & Holofernes
- 31. Thank you! • For supporting “Go Red For Women”! • For helping women live longer and having stronger lives!