Dr. Suzanne Steinbaum Director, Women and Heart Disease Lenox Hill - PowerPoint PPT Presentation

Dr. Suzanne Steinbaum Director, Women and Heart Disease Lenox Hill Hospital New York

500,000 398,563 432,709 400,000 290,069 269,819 300,000 Deaths 200,000 42,658 78,941 65,323 59,260 100,000 51,281 36,006 0 A B C D E A B D F C Males Females A CVD (I00-I99; Q20-Q28) D Chronic Lower Respiratory Diseases B Cancer E Diabetes Mellitus C Accidents F Alzheimer’s Disease CVD and other major causes of death for all males and FEMALE DEATHS(United States: 2006). Source: NCHS and NHLBI .

200 Per 100,000 Population 150 130.0 101.5 100 57.0 41.1 41.1 39.0 31.6 50 22.9 0 Coronary Heart Stroke Lung Cancer Breast Cancer Disease White Females Black Females Age-adjusted death rates for CHD, stroke, lung and breast for white and black females ( United States: 2006). Source: NCHS.

Menopause and the Risk of Coronary Heart Disease (modified data from “Menopausal status as a risk for coronary artery disease” Arch Intern Med 1995;155:57-61 4 3.5 Annual Occurence of 3 Heart Attack/1000 2.5 Before menopause 2 After menopause 1.5 1 0.5 0 40 - 45 45 - 49 50 - 54 Age (in years)

African-American Women & Heart Disease � African-American women have a higher risk for heart disease than Caucasians and are less aware of their risk factors, including: � Obesity (53.9% obese and 73.1% overweight and obese)¹ � Physical Inactivity (65.4% of African-American women get no leisure time physical activity)¹ � High Blood Pressure¹ � Diabetes (15.4% have diabetes)¹ � Diet (Sodium Intake)¹ � 47% of African-American women over the age of 20 have high blood pressure¹ � African-American women bear a disproportionate burden of stroke, heart failure, and kidney disease, all due to undiagnosed, or poorly controlled high blood pressure.²⁻³ 1 Go A S, Mozaffarian, D, Roger, V L, Benjamin E J, et al. Heart Disease and Stroke Statistics 2013 Update: A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2013; e39-e90 2 Jha AK, Varosy PD, Kanaya AM, et al. Differences in Medical Care and Disease Outcomes Among Black and White Women With Heart Disease. Circulation . 2003;108:1089-1094 . E39-e90 3 Pleis JR, Lucas JW. Summary health statistics for U.S. adults: National Health Interview Survey, 2007. Vital Health Stat 10. 2009; No. 240: 1-159. www.womenheart.org 5

Hispanic-American Women & Heart Disease � Hispanic-American Women also have a slightly higher risk for heart disease than Caucasians, and are less aware of their risk factors. � Obesity Among Mexican-American women, 44.8% are overweight and 78.2% are � overweight or obese¹ � Physical Inactivity � High Blood Pressure Among Mexican-American women over the age of 20, 28.8% have high blood � pressure.¹ � Diabetes (12% have diabetes … Nearly 2x higher than Caucasian women) ¹ � Diet (Sodium Intake) � Among Mexican-American women, 30.7% have cardiovascular diseas e ¹ 1 Go A S, Mozaffarian, D, Roger, V L, Benjamin E J, et al. Heart Disease and Stroke Statistics 2013 Update: A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2013; e60- e111 www.womenheart.org 6

Awareness trends of Heart Disease as leading cause of death in women: FEBRUARY 10, 2010 � 60% WHITE WOMEN � 43% AFRICAN-AMERICAN WOMEN � 44% HISPANIC � 34% ASIAN � 50% women ages 25-34 **** NEED FOR PREVENTION

Epidemic of Heart Disease has reached the younger Population of women: October 2009 Archives of Internal Medicine -Women younger than 55 years old- there was a greater increase in the risk of heart disease and stroke 1988-1994 1999-2004 MEN 2.5% MEN 2.2% WOMEN 0.7% WOMEN 1% *increase is due to an increase in diabetes in this population *there has been a 93% decline of mortality of younger women compared to men due to better recognition and management of coronary artery disease and its risk factors *the disease process is escalating in a younger population. We need to aggressively empower these women to achieve the lifestyle goals that diminish their risk factors in order to prevent this disease from presenting itself, not only at such a young age, but also in a woman's lifetime.

Low rate of sex-specific reporting in Cardiovascular trials � Major journals- cardiology and internal medicine � from July 1 st through December 31, 2004 � Result reporting for primary outcomes for women � NIH funded-51%- 1993 act of inclusion � General medical- 37% � Cardiology- 23% � SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY AND INTERVENTIONS SCAI 2011- ONLY 25% OF NIH TRIALS TRACK GENDER SPECIFIC OUTCOMES

Differences in Referral for Testing and Treatment : Gusto IIB P <0.01 for all 60 50 % of Pts Referred 40 30 Women Men 20 10 0 Stress Cardiac PTCA CABG Testing Cath Tamis et al. Circulation 1997;96:I-536.

���������������������������������� ������������� ������� 80% 78% 80% 67% 65% 60% ������ 50%50% ���� 40% 35% 33% 22% 20% 20% 0% 1 1 1 2 PTCI Peripheral Pacemakers ICDs CRT-D for HF 2 Int. Sources: 1-AHA: Heart Diseases and Stroke Statistics - 2004 Update 2-Guidant Internal Estimates

Low rate of sex-specific reporting in Cardiovascular trials � Major journals- cardiology and internal medicine � from July 1 st through December 31, 2004 � Result reporting for primary outcomes for women � NIH funded-51%- 1993 act of inclusion � General medical- 37% � Cardiology- 23% � SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY AND INTERVENTIONS SCAI 2011- ONLY 25% OF NIH TRIALS TRACK GENDER SPECIFIC OUTCOMES

Representation of Women in Pharma Heart Failure Trials CIBIS II 75% 32% 25% MERIT HF 77% 23% Val HeFT 80% 20% COPERNICUS 15% 80% 20% Men Women CIBIS-II Clinical Trial; Lancet; Circulation, 2001; 103; 3;375-380; MERIT HF Clinical Trial; Ghali, JK, Circulation, 2002;105; 1585-1591; Val Heft Clinical Trial; Cohn, JN, N Engl J Med, 2001; 345; 1667-1675; COPERNICUS Clinical Trial; Gust, H Bardy; ACC , March 8, 2004.

Physician awareness of CVD prevention guidelines by specialty 01 , ' 01 , ' 01 , ' 01 , ' ' ! 01 , ' ) ! ( ! 01 , ' � ! ��� ����� " ! �/��� ������������ # ! $ ! % ! & ! ' ! ! ������������ �������������� ��� ���������� ������� *�����+������,� ������������� & #-'''.$)),

Physician incorporation of CVD prevention guidelines by specialty among respondents who stated they were aware of the guidelines ' ! ) ! ( ! �����0������ � ! 01 , ' ��� 01 , ' 01 , ' 01 , ' ����� " ! 01 , ' ������������ 01 , ' # ! $ ! % ! & ! ' ! ! ������������ �������������� ��� ���������� ������� *�����+������,� ������������� & #-'''.$)),

The State of our Nation � 45% of US has 1 risk factor- high blood pressure, high cholesterol or diabetes � 13% has 2 risk factors � 3% have 3 risk factors � 15% of adults also had one or more of these conditions undiagnosed

Study Points to Declining Life Span for Some U.S. Women � Wall Street Journal � March 4, 2013 � University of Wisconsin study � 3,141 women over 10 years � In the South and West � “unclear reasons”- � Most often poor white women � Theories- obesity, diabetes � Women 81, men 76- women is dropping � Started in the late 80’s

AHA 2020 STRATEGIC GOAL � “To improve the cardiovascular health of all Americans by 20% while reducing the deaths from cardiovascular diseases and stroke by 20%” � Must create awareness to multicultural women and young women

WHAT IS CORONARY ARTERY DISEASE? � ATHEROSCLEROSIS � PLAQUE BUILDUP � CHOLESTEROL, FIBROUS TISSUE � INFLAMMATORY CELLS � BEGINS IN TEENS

Premature atherosclerosis (PDAY) Right coronary artery Abdominal aorta McGill HC Jr et al, Circulation 2002

Most Myocardial Infarctions Are Caused by Low-Grade Stenoses Pooled data from 4 studies: Ambrose et al, 1988; Little et al, 1988; Nobuyoshi et al, 1991; and Giroud et al, 1992. (Adapted from Falk et al.) Falk E et al, Circulation , 1995.

Atherosclerotic Plaque Rupture and Thrombus Formation Growth of thrombus Intraluminal thrombus Blood Flow Intraplaque thrombus Lipid pool Adapted from Weissberg PL. Eur Heart J Supplements 1999:1:T13–18

Women’s Early Warning Signs of a Heart Attack � Weeks before Heart Attack (95% of women) � Unusual fatigue (70.7%) � Sleep disturbance (47.8%) � Shortness of breath (42.1%) � Indigestion (39.4%) � Chest pain (29.7 %) � At time of Heart Attack � Shortness of breath (57.9%) � Weakness (54.8%) � Fatigue (42.9%) � Chest pain (57%) McSweeney, JC et al. Circulation 2003; 2619-2623

AHA 2/10 survey: 2,300 women interviewed Only 53% of women said they would call 9-1-1 if they thought they were having heart attack symptoms 56% of women saying chest pain and neck or arm pain 29% shortness of breath 17% chest tightness 15% nausea 7% fatigue