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10 Things. Every Woman Should Know About Heart Disease. Heart Disease in Women. Susan P. D’Anna ARNP Clinical Instructor in Medicine Section of Cardiology - DHMC. #1 Cardiovascular Disease Is the Number 1 Cause of Death in American Women . Myth: Heart disease is a man’s disease Fact:

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heart disease in women

10 Things

Every Woman Should Know About Heart Disease

Heart Disease in Women

Susan P. D’Anna ARNP

Clinical Instructor in Medicine

Section of Cardiology - DHMC

1 cardiovascular disease is the number 1 cause of death in american women
#1 Cardiovascular Disease Is the Number 1 Cause of Death in American Women


  • Heart disease is a man’s disease


  • Each year heart disease kills more women than men
  • 38% of women die within one year of suffering a heart attack (compared to 25% of men)

CDC National Vital Statistics Report, Vol.49, No., 11 2001

Adapted from the American Heart Association website, 2002

heart disease affects women in every age group

Estimated Prevalence of CVD by Age and Gender

U.S.: 1988 - 1994

Heart Disease Affects Women in Every Age Group

AHA 2003 Heart and Stroke Statistical Update; 2002:8.


Women Do Not Perceive Heart Disease as Their Major Health Threat

Cancer (net)

Cancer (net)

Heart Disease

Heart Disease

Female Perception of TheirGreatest Health Risk


Women still fear cancer most









Awareness ofLeading Cause of Deathfor Women


But, awareness is improving









Source: Tracking Women’s Awareness of Heart Disease – AHA National Study; Circulation 2004;109:573-579.


Cardiovascular Disease 41%

Cancer 22%

Source: National Vital Statistics Report, Vol. 50, No. 15, September 16, 2002


#2Risk Factors Help Predict Who Is at Risk to

Develop Coronary Artery Disease

  • Age: As women grow older, the chance of developing heart disease increases (especially after the onset of menopause) – The risk of CAD increases 2 to 3 times after menopause
  • Race: African-American women have a higher risk of death from heart disease than white women



Cholesterol:Low blood levels of “good” cholesterol (HDL) and high triglycerides are stronger predictors of heart disease death in women than in men


Blood Pressure:More than half of all women over 55 have high blood pressure, which increases their risk of heart disease, stroke and other serious conditions

  • Diabetes:Increases the risk of heart disease 3-7 fold

A more powerful risk for heart disease in women than in men

Jneid and Thacker, Cleveland Clinic J of Med. 2001: 441-448


why women don t take action against heart disease
Why Women Don’t Take Action Against Heart Disease
  • They don’t put their health as a top priority
  • They think they’re not old enough to be at risk
  • They feel too busy to make changes in their lives
  • They’re already feeling stressed
  • They don’t have the familial and social support
3 women s experience of heart disease is different than men s
#3 Women’s Experience of Heart Disease Is Different Than Men’s
  • Women are more likely to die within one year after a heart attack
  • Women are less likely to survive coronary artery bypass surgery
  • Women are more likely to experience complications after angioplasty
  • Women are more likely to have life threatening arrhythmias (irregular heart beats)

These differences may be partially due to hormones, a woman’s smaller heart size and advanced age at diagnosis

Wenger, N.K., J. Am. Med. Women’s Assoc. 1994:49:181 Wenger, N.K., Int. J. Fertile Women’s Med. 1998; 43:84

traditional heart attack warning signs
Traditional Heart Attack Warning Signs
  • Pressure, burning, squeezing in the center of the chest
  • Discomfort in one or both arms, shoulders, neck, jaw, stomach, or back
  • Shortness of breath
  • Fatigue, cold sweat, nausea, weakness

Adapted from the Harvard Medical School website – www.harvard.health.edu

symptoms of coronary heart disease can differ in women

Women’s signs are non-specific and more easily overlooked.

Symptoms of Coronary Heart Disease Can Differ in Women
  • Pain in upper back, jaw or neck
  • Shortness of breath
  • Flu-like symptoms: nausea or vomiting, cold sweats
  • Fatigue or weakness
  • Feelings of anxiety, loss of appetite, discomfort

Adapted from the Harvard Medical School website – www.harvard.health.edu

severity of heart disease men and women
Severity of Heart Disease: Men and Women

Men Women

AHA 2003 Heart and Stroke Statistical update; 2002:12, 14, 17


61 million Americans with CVD

48% are men

52% are women



Yet, more men are being treated than women






1. The AHA 2001 Heart and Stroke Statistical Update 3. PTCI: J Am Coll Card 2002 Apr 3; 39(7):1096-103

2. CABG: Ann Thorac Surg 2001 Feb; 71(2):512-20 4. Estimated from internal Guidant records

heart disease gender bias or sex difference
Heart Disease Gender Bias or Sex Difference?
  • Data used for the care of women derived from studies conducted in middle-aged men
  • Initial efforts for prevention focused more on men than women
  • Women and doctors often attribute chest pain in women to noncardiac causes

Exploring the Biological Contributions to Human Health-Does Sex Matter: Institute of Medicine 2001

heart disease gender bias or sex difference1
Heart DiseaseGender Bias or Sex Difference?
  • Women tend to have heart attacks later in life than men
  • Women present more often than men with atypical symptoms
  • Some diagnostic tests and procedures may not be as accurate in women
  • Heart disease may be different in women and men

Exploring the Biological Contributions to Human Health-Does Sex Matter: Institute of Medicine 2001


Obstructed coronary artery

Diffuse narrowing in coronary artery

5 know which tests are more effective in women
#5 Know Which Tests are More Effective in Women

Shaw et al. Card. In Review, 2000: 65-74

6 estrogen and menopause may be related to heart disease
#6 Estrogen and Menopause May Be Related to Heart Disease
  • Estrogen increases production of “good” cholesterol (HDL)
  • As estrogen decreases, women experience lower levels of “good” cholesterol (HDL) and the flexibility in arteries decreases.
  • Women will live one third of their lives after menopause
  • Hormone Replacement Therapy (HRT) should not be used for the purpose of reducing the risk of cardiovascular disease in women

Jneid and Thacker, Cleveland Clinic J of Med. 2001: 441-448


Increased Risk

  • Heart attack 29%
  • Breast cancer 26%
  • Blood clots 2X
  • Strokes 41%
  • Dementia
  • Ovarian Cancer
  • Strokes
  • Probable dementia or memory loss*

Decreased Risk

  • Hip fractures 34%
  • Colorectal cancer 37%
  • Cancer of uterine lining
  • Hip fractures

No Effect

  • Quality of life
  • Number of deaths
  • Breast cancer
  • Heart disease

Estrogen plus progestin - July 2002

Estrogen alone – March 2004

WHI Had Unexpected Results

Source: JAMA 2002; 288:321-333

National Institutes of Health

* mdash study shows a trend toward increase in risk

conclusions of whi

After a 5.2 year follow up:

  • Health risks exceeded benefits of combined estrogen plus progestin
  • All-cause mortality was not affected
  • This regimen should not be initiated or continued for primary prevention of CHD.

JAMA 2002; 288:321-333

7 more research on women and heart disease is needed
#7 More Research on Women and Heart Disease Is Needed
  • Historically, women have been under-represented in clinical trials related to heart disease
  • There is little knowledge regarding the effects of commonly used cardiovascular drugs in women
  • Practice patterns are based on research in middle-aged men that may not apply to older women
  • There is limited information regarding therapies used to treat heart disease in the very elderly

Evelyn et al. “ Women's Participation in Clinical Trials and Gender-Related Labeling” FDA special report http://www.fda.gov/cder/reports/womens_health/women_clin_trials.htm

enrollment of women in cvd trials
Enrollment of Women in CVD Trials
  • 1993 – NIH mandated inclusion of women in federally funded clinical research
  • Enrollment increasing for women, but with single-sex trials excluded, enrollment rate was 38%, unchanged over time
  • No change in gender composition of cohorts in majority of studies
  • Federal efforts have been only moderately successful, mainly due to small number of large single-sex trials
  • Even when women are included in trials, rarely are the results broken-out

NEJM 2000;343-475


Representation of Women in Studies of CAD Testing

Adapted from Shaw LJ et al. Coronary Artery Disease In Women: What All Physicians Need to Know. 1999;372.

8 there are a variety of options available to treat heart disease
Medications – including Aspirin

Balloon angioplasty and stenting

Heart bypass surgery

Pacemakers for slow heart rhythms and defibrillators for rapid heart rhythms

#8 There Are a Variety of Options Available to Treat Heart Disease
9 women can take action to lower the risk of heart disease
#9 Women Can Take Action to Lower the Risk of Heart Disease
  • Know your risk factors
  • Stop smoking
  • Maintain a healthy body weight
  • Eat a nutritious balanced diet low in saturated fats
  • Monitor and manage blood pressure and diabetes
  • Exercise regularly
  • Limit alcohol intake
  • Learn stress management skills
  • Maintain social relationships
  • Know the warning signs for heart attack and stroke
10 women can save lives
#10 Women Can Save Lives
  • If you or someone you knowhasrisk factors for heart disease, adopt a heart healthy lifestyle and discuss a plan of care with your physician
  • If you experience symptoms of heart attack or stroke, call 911 immediately
why focus on women s cardiovascular health
Why Focus on Women’s Cardiovascular Health?
  • Cardiovascular disease is the largest killer of American women and CVD mortality in women is rising at a disproportionate rate compared to men
  • The majority of American women are unknowledgeable about their personal risk for CV disease
  • Changing a woman’s CV risk from higher risk to lower risk with present medical knowledge and tools reduces her chance of coronary events
  • Women are often decision makers for the family

Adapted from American Heart Association

and the Nurse’s Health Study

The following organizations can provide information on heart disease:

* American Heart Association



AHA's mission is to reduce disability and death from cardiovascular diseases and cardiovascular diseases and stroke. Several consumer publications are available through AHA, including the AHA Guide to Heart Attack Treatment, Recovery and Prevention.

* Health and Human Services

Office of Women's Health

1-800-994-WOMAN (96626)


OWH investigates a broad spectrum of women's health activities across governmental offices and agencies. It also sponsors the National Information Center, which links the general public to a wide variety of health-care resources and publications, including those related to heart disease.

* National Heart, Lung, and Blood Institute


http://www.4women.gov, www.hearttruth.gov

The NHLBI publishes the Healthy Heart Handbook for Women (http://www.nhlbi.nih.gov/health/public/heart/other/hhw/index.htm), which features the latest information on preventing cardiovascular diseases. The publication also helps women develop a personal action plan for reducing the major risk factors. In addition, The Heart Truth website contains helpful information.

* American Medical Women's Association


Mayo Clinic Health Oasis