Massachusetts Womens Legislative Caucus Women and Heart Disease

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Massachusetts Womens Legislative Caucus Women
and Heart Disease
Paula A. Johnson, MD, MPH Brigham and Womens
Hospital
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Who We Are

• Mary Horrigan Connors Center for Womens
  Health and Gender Biology at Brigham and Womens
  Hospital
• Womens Health Policy and Advocacy Program
• Center for Cardiovascular Disease in Women

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Why heart disease?

• Heart disease is the leading killer of women in
  Massachusetts and the United States
• Women experience heart disease differently from
  men, but these differences are not well
  understood
• By taking measures to prevent heart disease,
  women can protect themselves from a whole host of
  chronic illnesses

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Women heart disease - 1936

• Mistaken diagnoses of coronary artery disease
  in women are common because of the erroneous
  interpretation of symptoms, such as precordial
  pain with or without radiation to the left arm, a
  sense of choking, and fear of death. Such
  symptoms are common in the absence of organic
  heart disease. - Levy and
  Boas. JAMA 1936

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Women heart disease - 2004

• Half of all U.S. women will die of heart disease
  or stroke
• Heart disease claims the lives of more women than
  the next seven causes of death combined
• Significant racial and ethnic disparities exist
  among women
• Only 13 of US women believe that heart disease
  and stroke are their greatest health threats

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Source Massachusetts Department of Public Health
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Differences between women men

• More women than men die each year from heart
  attacks and the gap is growing
• Women tend to get heart disease later in life
• Women are, on average, ten years older than men
  at the time of their first heart attack
• Women are much more likely to die from their
  first heart attack than men
• Women can experience different symptoms of heart
  attack than men

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Why are there differences?

• Do women delay going to the hospital because they
  dont recognize their symptoms?
• Are health care providers not recognizing womens
  symptoms or treating the symptoms less
  aggressively?
• Do medications or treatments for heart attacks
  have different affects on women?
• We still have more questions than answers

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Prevention The Key to Heart Health

• Approximately 80 of cardiovascular disease
  can be prevented by modifying preventable risk
  factors including
• cigarette smoking
• being overweight or obese
• lack of physical activity
• diabetes
• high blood pressure
• high cholesterol

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Smoking

• Tobacco is responsible for 17 of all female
  deaths in the U.S.
• Smoking is the most preventable risk factor for
  heart attack
• Women who smoke one to four cigarettes per day
  are at almost twice as likely to develop heart
  disease than nonsmokers
• A woman who smokes is at risk for heart attack 19
  years earlier than one who does not smoke
• Women of all ages who quit smoking greatly reduce
  their risk of dying prematurely

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Women, girls tobacco

• Tobacco companies market to women and girls by
• creating brands and types of cigarettes
  specifically for women and girls
• suggesting that smoking will make women girls
  feel attractive, slim less stressed
• advancing the myth that low-tar, low-nicotine
  brands are less harmful
• Smoking accounts for an estimated 4.4 billion
  annually in health care costs and lost
  productivity in Massachusetts

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Overweight Obesity

• Obesity is a widespread, disabling, and costly
  risk factor for heart disease.
• The number of excessively heavy adults in MA
  increased 30 from 1990 to 2000
• In MA, black and Hispanic women experience the
  highest rates of overweight and obesity
• Women with low education and incomes have higher
  rates of overweight and obesity
• The percentage of overweight children has doubled
  over the past 20 years. Overweight children are
  10 times more likely to be overweight as adults

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Source CDC, National Center for Health
Statistics, Health, United States, 2002
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Source CDC, National Center for Health
Statistics, Health, United States, 2002
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Estimated Percent of Americans ?18 Years Who
Report No Leisure-time Activity
Physical Activity
1991 National Health Interview Survey 2000
Heart Stroke Facts AHA
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Diabetes
Adjusted Risk of Heart Attack among Diabetic vs.
Non-Diabetic Adults
Davidson MB. Diabetes Mellitus Diagnosis and
Treatment. 4th ed. Philadelphia WB Saunders
1998.
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High Blood Pressure

• High blood pressure, also known as hypertension,
  greatly increases the chances of developing
  cardiovascular diseases, and it is the most
  important risk factor for stroke. Even slightly
  high levels double your risk.
• More than half of American women will develop
  high blood pressure at some point in their lives.
  

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Age Adjusted Prevalence of High Blood Pressure
among US Females Age 20 Years and Older, 1998-94
High Blood Pressure
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Cholesterol

• Low blood levels of "good cholesterol (high
  density lipoprotein or HDL) appears to be
  a stronger predictor of heart disease death in
  women than in men in the over 65 age group
• High blood levels of triglycerides (another type
  of fat) may be a particularly important risk
  factor in women and the elderly

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Stress Depression

• Stress may be associated with an increased risk
  of heart disease in women for a number of reasons
• Occupational factors lower-level jobs with
  greater job strain, low pay, and unequal
• Economic factors More women live in poverty than
  men and may have fewer environmental resources
  for support
• Depression - the most common psychological
  disorder among women has also been found to
  increase the risk of heart disease

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Symptoms

• Early recognition of warning symptoms is critical
  to reducing death from heart disease, since
  interventions are most effective within six hours
  after a heart attack.
• Almost half of women having a heart attack do not
  experience typical heart disease symptoms
• Symptoms among women include indigestion,
  unexplained weakness and fatigue, sleeplessness,
  or shortness of breath
• Women experiencing symptoms of a heart attack are
  more likely to delay going to the hospital than
  men

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Treatment

• Women are less likely than men to be
• Referred for some heart disease treatment
  procedures
• Prescribed clot-busting therapies, aspirin and
  other medications after a heart attack
• Referred for cardiac rehabilitation

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Racial and Ethnic Disparities

• Black women
• Tend to develop heart disease at an earlier age
  and are more likely to die from heart disease
  than white women
• Are less likely to receive appropriate preventive
  therapy and adequate risk factor control than
  white women
• Are less likely to receive life-saving therapies
  after a heart attack than white women

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The cost of cardiovascular disease (CVD)

• CVD costs the U.S. 368 billion in direct and
  indirect costs in 2003
• CVD accounts for over half of all hospital
  charges in MA
• The estimated incremental lifetime medical cost
  of treating a woman with CVD is almost 3½ times
  greater than treating a woman without CVD

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What can you do?- personally -

• Reduce your risk for heart disease by keeping
  physically active, eating heart healthy foods,
  quitting smoking, and caring for your overall
  health
• Make sure your doctor is evaluating your risk for
  heart disease with the newest female specific
  criteria developed by the American Heart
  Association

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What can you do?- in your community -

• Work to increase awareness that heart disease is
  the leading killer of women and that there are
  lifestyle changes women can make to reduce their
  risk
• Create environments that contribute to our health
  safe streets and parks to walk in and reduced
  exposed to secondhand smoke

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What can you do?- to reduce smoking -

• Work to restore funding for smoking prevention
  and cessation initiatives in Massachusetts
• Advocate for health insurance coverage of smoking
  cessation aides
• Combat marketing of smoking products to women and
  girls
• Reduce access of minors to tobacco products

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What can you do?- to reduce overweight and
obesity -

• Work to improve access to healthy food sources
  for low-income families
• Increase the development and dissemination of
  culturally appropriate menus and meals
• Promote healthy eating and physical activity in
  schools and workplaces

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What can you do?- to improve heart care for
women -

• Invest in research to learn more about the
  differences between men and women in relation to
  heart disease
• Insure access to screening, diagnosis, treatment
  and rehabilitation of heart disease for uninsured
  MA residents
• Promote adoption of the American Heart
  Associations guidelines for the prevention of
  heart disease among women

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Discussion

• What is currently being done?
• Public Information Campaigns
• Promotion of Clinical Prevention Guidelines
• Community Initiatives
• National and State Policy
• Other
• What else should be done?

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Contact Information

• Paula A. Johnson, MD, MPH
• Chief, Division of Womens Health
• Executive Director, Connors Center for Womens
  Health Gender Biology
• Ph [phone], Fx [phone], Email
  pajohnson_at_partners.org
• Rachel A. Wilson, MPH
• Director, Womens Health Policy and Advocacy
• Ph [phone], Fx [phone], Email
  rwilson1_at_partners.org
• Rachael Fulp, MPH
• Administrative Director, Center for
  Cardiovascular Disease in Women
• Ph [phone] Fx [phone],
  Emailrfulp_at_partners.org
• Brigham and Womens Hospital
• 75 Francis Street, Boston, MA 02115