Heart Disease in Women

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Heart Disease in Women
Daniel Krauss, M.D. West Suburban Cardiologists
www.westsubcardiology.com
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Heart Disease in Women What Are We Talking
About?

• The heart is a muscle that pumps blood so that
  the body can receive oxygen and nutrients.
• The coronary artery is a tubular blood vessel
  that delivers blood to the heart so that it can
  also receive oxygen and nutrients.

www.westsubcardiology.com
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Heart Disease in Women What is Coronary Heart
Disease?

• Coronary artery disease refers to the build-up
  of cholesterol inside the artery, restricting
  blood flow to a portion of the heart muscle and
  often resulting in exertional chest discomfort.
• A heart attack (myocardial infarction, or MI)
  occurs when the heart muscle is injured due to
  severely diminished or absent blood flow, usually
  due to a blood clot forming on a cholesterol
  plaque.

Coronary Artery Disease
Heart Attack
www.westsubcardiology.com
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Heart Disease in Women Whats Your Risk?

• High Risk ( 20 10yr CHD risk)
• Established CHD (coronary heart disease)
• Cerebrovascular disease
• Peripheral arterial disease
• Abdominal aortic aneurysm
• Diabetes mellitus
• Chronic kidney disease
• Intermediate Risk ( 10-20 10yr risk)
• Metabolic Syndrome
• Multiple Risk Factors
• Markedly elevated levels of a single risk factor
• First-degree relative with early onset CVD
• Lower Risk (

www.westsubcardiology.com
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Heart Disease in Women Lifestyle Interventions

• Stop smoking
• Exercise 30 mins most days
• Heart-healthy diet
• limit saturated fat
• cholesterol intake
• limit trans fatty acids
• Weight maintenance/reduction
• maintain BMI
• maintain waist circumference
• Supplements
• consider omega 3 fatty-acid or folic acid
  supplements in high-risk women

www.westsubcardiology.com
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Heart Disease in Women Risk Factor Interventions

• Blood pressure
• Optimal
• 140/90 drugs
• Lipids
• Optimal LDL 50, TG
• High risk
• sat fat
• drugs statins if LDL 100
• niacin when HDL is low
• Intermediate risk statins if LDL 130
• Low risk statin if LDL 160 (multiple risk
  factors) or 190 (0 or 1 risk factor)
• Diabetes keep sugars near normal!

www.westsubcardiology.com
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Heart Disease in Women Preventive Drug
Interventions

• Aspirin
• slows down clot production
• should be used in all high-risk women, and
  considered in all those at intermediate risk.
• Beta-Blockers
• used to treat high blood pressure and heart
  disease by lowering blood pressure and slowing
  the heart.
• should be used indefinitely in all women who
  have had heart attack.
• ACE Inhibitors
• prevents generation of a substance that
  increases salt and water retention in the body.
  Increased salt and water retention lead to high
  blood pressure. ACE inhibitors also make blood
  vessels relax, which helps lower blood pressure,
  and helps slow down further damage to the heart
  after heart attack.
• should be used in high-risk women

www.westsubcardiology.com
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Heart Disease in Women Noninvasive Testing

• Treadmill Testing
• ECG response is less predictive in women than in
  men
• less extensive CAD than men of the same age
• reduced exercise capacity limits cardiac
  stress
• exercise capacity and heart rate recovery
  improve test information
• Good for starters if you can exercise and have a
  normal baseline ECG

www.westsubcardiology.com
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Heart Disease in Women Noninvasive Testing

• Stress Testing with Imaging
• Stress Echo
• gives info on cardiac structure and function
• Stress Nuclear
• assesses coronary blood flow before / after
  stress
• Both improve predictive accuracy compared with
  treadmill ECG alone.

www.westsubcardiology.com
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Heart Disease in Women Noninvasive Testing

• Cardiac CT
• Coronary artery calcium (CAC)
• calcium does not occur in normal blood vessel
  walls, so calcification atherosclerosis
• CAC score parallels total plaque burden
• High CAC scores suggest increased risk of future
  CV events
• Most useful in women at intermediate risk.

www.westsubcardiology.com
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Heart Disease in Women Noninvasive Testing

• Multislice Cardiac CT- The Holy Grail?
• Can we visualize coronary arteries noninvasively?

Coronary Angiography
Multislice Cardiac CT
www.westsubcardiology.com
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Heart Disease in Women Noninvasive Testing

• Multislice Cardiac CT

www.westsubcardiology.com
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Heart Disease in Women New Directions?
www.westsubcardiology.com