Heart Disease in Women How to Protect Yourself

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Heart Disease in Women How to Protect Yourself

• Banu Mahalingam MD, FACC, RCS.
• Cardiology Associates Of Princeton

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Heart disease in women

• Facts about heart disease in women
• How does the heart work?
• How to diagnose heart disease?
• What are the risk factors for heart disease?
• What is the role of hormone replacement therapy?
• What are the latest updates?
• What to expect in the future?

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Coronary Heart Disease

• Prevalent and preventable
• 600,000 deaths of which coronary heart disease is
  the direct cause of 460,000
• 1.1 million myocardial infarction/heart attacks
  of which 650,000 are first infarctions
• An economic burden of 101 billion
• From 1988 to 1998, death rate from CAD has
  declined

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Comparison of deaths from CV disease and breast
cancer, by age
Heart Disease
Breast Cancer
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Heart disease in women

• More women present with atypical symptoms
• More frequent silent MI
• Mortality rate of MI and bypass surgery are 50
  higher in women
• Cholesterol lowering has shown similar efficacy
• Cardioprotective agents have similar efficacy
• Treatment rates tend to be lower
• Diabetes is a particularly serious risk factor

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Compared with Men

• 38 of women and 25 of men will die within one
  year of a first recognized heart attack
• 35 of women and 18 of men heart attack
  survivors will have another heart attack within
  six years
• 46 of women and 22 of men heart attack
  survivors will be disabled with heart failure
  within six years

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Compared with Men

• Women are almost twice as likely as men to die
  after bypass surgery
• Women are less likely than men to receive
  beta-blockers, ACE inhibitors or even aspirin
  after a heart attack
• Women constituted less than 25 of the research
  patient population

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At-Risk

• The age-adjusted rate of heart disease for
  African American women is 72 higher than for
  white women
• Women who smoke risk having a heart attack 19
  years earlier than non-smoking women
• Women with diabetes are two to three times more
  likely to have heart attacks

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At-Risk

• High blood pressure is more common in women
  taking oral contraceptives, especially in obese
  women
• 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
• 23 of white women, 38 of black women, and 36
  Mexican American women are obese

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Compared with Men

• More women than men die of heart disease each
  year, yet women receive only
• 33 of angioplasties, stents and bypass surgeries
  
• 28 of implantable defibrillators and
• 36 of open-heart surgeries
• Women comprise only 25 of participants in all
  heart-related research studies

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Normal Coronary Anatomy
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Current Path in Cardiac Muscle
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Microscopic Pathology of Atherosclerosis
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What is a Heart Attack?

• 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
• This is usually caused by the buildup of
  cholesterol plaque.

What causes a Heart Attack?
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During a Heart Attack
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Myocardial Infarction
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Detecting Coronary heart disease

• EKG
• Stress testing
• Echocardiogram
• Cardiac Catheterization/Coronary angiogram
• CAT scan- calcium score
• MRI of the heart

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Normal Thallium Stress Test
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Abnormal Stress Test
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Cardiac Catheterization

• Catheters are also used to inject dye into the
  coronary arteries. This is called coronary
  angiography
• It's also used to get information about the
  pumping ability of the heart muscle.

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Coronary Blockage
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Risk Factors for Heart Disease

• High Blood Pressure - Hypertension
• High Blood Sugar - Diabetes Mellitus
• High Cholesterol
• Smoking
• Age/Gender
• Family History
• Obesity

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High Blood Pressure

• Silent Killer
• Uncontrolled high blood pressure can lead to
  stroke, heart attack, congestive heart failure or
  kidney failure
• The only way to tell if you have high blood
  pressure is to have your blood pressure checked

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High Blood Pressure

• One in four adult Americans has high blood
  pressure, and nearly one-third of them don't know
  they have it
• Remember, high blood pressure has no symptoms, so
  if you haven't had it checked in a while, make an
  appointment now.
• Normal BP 120/80

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Hypertension

• Know what your Blood Pressure is
• Educate yourself on self measurement of BP
• Understand the role of Diet and Exercise in
  maintaining BP

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Diabetes Mellitus

• Diagnosed by checking Fasting Blood Sugars
• Can be silent/asymptomatic
• Leading cause of complication from coronary
  artery disease
• Completely negates the positive effect of
  estrogen in pre-menopausal women

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Diabetic Patient

• If you are a diabetic know your
• Hemoglobin A1C

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Cigarette Smoking

• Most preventable cause of Heart Attacks
• Responsible for 400,000 premature deaths in the
  U.S. annually
• Nonsmokers and former smokers have significantly
  lower rates of Heart attacks than smokers
• 7-47 reduction in mortality following smoking
  cessation

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Dietary Management of Heart Disease
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Diet modification

• More complex carbohydrate
• More fruits, vegetables and legumes
• More fish
• Less meat
• Less whole milk products
• Alpha-linolenic acid enriched canola oil
  margarine

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Lipid panel

• Total cholesterol lt200
• LDL cholesterol lt130
• HDL cholesterol gt40
• Triglycerides lt200

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Benefits of Cholesterol Reduction
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Effect of Aspirin on Survival
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Estrogen/Progestin Therapy also Resulted in

• 41 increase in strokes
• 29 increase in heart attacks
• Doubled rates of blood clots in legs and lungs
• 37 less colorectal cancer
• 34 fewer hip fractures and 24 less total
  fractures

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Recommendations

• the therapy should not be continued or started to
  prevent heart disease
• for osteoporosis prevention, women should consult
  their doctor and weigh the benefits against their
  personal risks
• the therapy for relief of menopausal symptoms may
  reap more benefits than risks

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HRT

• Symptom relief should be the primary reason for
  taking hormone replacement therapy
• 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
• Hormone therapy should not be used to prevent
  heart disease women should take other measures
  to reduce that risk
• 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

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HRT

• 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
• Doctors should consider prescribing low-dose HRT
  whenever possible
• 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
• 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

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Top Tips for Heart Health

• Reduce total fat, favor mono-unsaturated fats
  over saturated fats and above all, eat moderate
  portions
• Learn how to be more stress resilient
• Get moving today
• Smoking cessation
• Being a good weight for your height
• Eating healthy and exercising regularly

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Whats new

• Markers for inflammation
• C- reactive protein
• Homocysteine
• Lipoprotein (a)
• Drug coated stent
• Minimally invasive surgery
• Off pump open heart surgery

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What to expect in the future

• Super HDL coronary infusion therapy
• Non invasive visualization of coronary arteries
• Focusing on inflammation as risk reduction in
  heart disease

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Online resources

• www.womenheart.org
• National coalition of women with heart disease
• The Heart Truth Awareness campaign of the
  National Heart, Lung, and Blood Institute
• American Heart Association Organization fighting
  heart disease and stroke

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Heart Disease in Women