Transcript Coronary Heart Disease in Women

‫‪Coronary Heart Disease‬‬
‫‪in Women‬‬
‫‪Dr.AHMAD ALAYED‬‬
‫د‪.‬أحمد العايد‬
‫إستشاري أمراض القلب و القثطرة القلبية‬
‫مركز الباسل ألمراض و جراحة القلب بدمشق‬
Death Rates in Women
At Every Age, More Women Die of Heart Disease Than Breast Cancer
Coronary Artery Disease
Stroke
Lung Cancer
Breast Cancer
Colon Cancer
Endometrial Cancer
6500
Death Rate per 100,000
4500
2500
1600
1200
800
400
0
45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Age (years)
Cardiovascular Disease Deaths: Trends for
Males and Females
United States: 1979-2001
Source: CDC/NCHS © AHA, 2004
What is Coronary Heart
Disease ?
Risk Factors for Coronary Heart Disease
For both men and women
• Smoking
• Diabetes
• High Cholesterol (in particular high LDL
•
•
•
and/or low HDL)
High Blood Pressure
Obesity
Sedentary Lifestyle
For women only
• Menopause
• Birth Control Pills in Combination with
Smoking
Perhaps the most important risk
factor for coronary heart disease is
the misperception that coronary
heart disease is a men’s disease
Mortality Rate (per 1000 women)
Coronary Disease Mortality and Diabetes
in Women
60
50
40
D iabetic Wome n
30
Nondiabetic
W om en
20
10
0
0-3
4 - 7 8 - 11
12 15
16 19
Dura tion of follow -up (yrs)
20 23
Menopause and
the Risk of Coronary Heart Disease
4
Annual Occurence of
Heart Attack/1000
3.5
3
2.5
Before menopause
After menopause
2
1.5
1
0.5
0
40 - 45
45 - 49
Age (in years)
50 - 54
Relative risk of a Heart Attack
Relation between Smoking, Use of Birth
Control Pills and the Risk of a Heart Attack
30
25
20
15
10
5
0
25+ cigarettes
Never smoked
current former
never
Use of Birth Control Pills
Never smoked
1-24 cigarettes
25+ cigarettes
Women at High Risk
–
–
–
–
–
Established coronary heart disease
Blockage of carotid artery
Circulation problems of the legs
Abdominal aortic aneurysm
Diabetes
Chronic kidney disease
Chest pain or Angina
Typical Angina:
heaviness, pressure or squeezing sensation behind the breastbone
with
radiation across the chest, up the neck or down the left arm
or “strangling” or “suffocating” sensation.
caused or worsened by exercise and eased by rest
usually lasts two to five minutes
Atypical Angina (frequently encountered in
women):
shortness of breath
extreme fatigue
lightheadedness or fainting
nausea and/or indigestion
Diagnosis
• EKG
• Stress Test
- Exercise or with Medication
- with or without Imaging
(Echo or Nuclear)
• Echocardiography (ultrasound of heart)
• Heart Catheterization
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%)
Treatment of a Heart Attack
• Most important: restoring of blood flow to the
blocked artery with either
- Administration of a Clot buster (i.e tPA or TNK) or
– Mechanically (Balloon angioplasty or so called Primary
Angioplasty) with or without stent placement
• Oxygen
• Medications such as Nitroglycerin, Beta-Blocker,
Morphine and Blood Thinners (i.e. Heparin)
Prevention of Coronary Heart
Disease
No Gender Difference !!!
• No Smoking
• Weight Reduction/Maintenance
• Regular Exercise
• Control of High Blood Pressure
• Reduction in High Cholesterol
Diet
• Consistently healthy eating
– Healthy food selections:
• Fruits and vegetables
• Whole grains
• Low-fat or nonfat dairy
• Legumes
• Low-fat protein
• Fish
Limit trans fatty acid intake (main dietary
sources are baked goods and fried foods)
Weight Maintenance/Reduction
Goals
• BMI between 18.5 and 24.9
• Waist circumference < 35 inches
• Weight loss goals
– 10% of body weight over six months or 1-2
pounds weight loss/week
– Reduce calories by 500-1,000 per day
Weight Reduction
• No optimal way of weight reduction found
(yet)
• Weight loss and weight maintenance
should be achieved slowly
• Weight cycling increases the risk of heart
disease
Recommendations of the AHA
for Physical Activity
• Aerobic exercise of moderate to vigorous
activity for 30-60 min 3-4 days/week, best
on all days
• Alternative: however count the minutes!!
walking >4 hours/week in form of
10-min intervals
Walking Compared with Vigorous Exercise for the
Prevention of Heart Disease in Women
Overweight as Compared with Physical
Activity in Predicting Death from Heart
Disease among Women
Frank B. Hu et al. NEJM 2004;351:2694-703
Body Mass
Index
< 25
25-30
>30
Age-adjusted RR
1.00
1.58
2.87
1.51
2.06
4.26
1.89
2.52
4.73
Active (>3.5 h)
Age-adjusted RR
1.0 – 3.5 h
Age-adjusted RR
Inactive (<1 h)
High Blood Pressure
• Optimal blood pressure
< 120/80 mm Hg
• Medication are indicated
when blood pressure
> 140/90 mm Hg or
> 130/80 mm Hg in the setting of diabetes
Lipids
(cholesterol and triglycerides)
• Optimal levels of lipids and
lipoproteins in women
– LDL < 100 mg/dL
– HDL > 50 mg/dL
– Triglycerides < 150 mg/d
– (total cholesterol not that important)
Interventions that are not
useful/effective and may be
harmful for the prevention
of heart disease
• Hormone Therapy
• Antioxidant supplements (Vitamin
E,C, and beta-carotene)
• Folic Acid (with or without B6 and
B12 supplementation)
Summary (1)
 Heart Disease is the leading cause of death in
women in the United States
 Most risk factors are the same for men and
women, but women are at particularly high
risk if they have diabetes mellitus.
Genderspecific risks are menopause and intake
of birth control pills while smoking
 Diagnosis of Heart Disease in women is very
difficult since many women have atypical
symptoms such as shortness of breath and
extreme fatigue
Summary (2)
 Prevention of heart disease is crucial
 Almost 50 % of heart disease problems can
be avoided by lifestyle changes
 Ineffective interventions such as
antioxidants and hormone replacement
therapy should be avoided
Summary (3)
In order to reduce heart disease in women,
the importance of heart disease in the
female population has to be recognized.