1. Women & Heart Disease Julia C. Orri, Ph.D. Biol. 330 November 21, 2006

2. Objectives • List the trends in heart disease for women • Name the risk factors for CAD • Define atherosclerosis, MI • Compare MI signs between men and women • Explain gender differences in heart disease • Describe strategies to decrease CAD risk in women

3. Deaths From Breast Cancer, CAD, andlung Cancer (2003) 233,886 41,566 67,894 American Heart Association, 2006

4. Women & CVD Only 13% of women in America believe that CAD and stroke are the greatest health threats to women.

5. CDC, 2006

6. Women & CVD Facts • Nearly 39% of all female deaths occur from CVD • The death rate due to CVD is substantially higher in African American women than in Caucasian women

7. 38% of women compared to 25% of men will die within 1 year after a heart attack. American Heart Association, 2006

9. Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and SexNHANES: 1999-2002 American Heart Association. Heart Disease and Stroke Statistics-2005 Update

10. ALOHA to Heart Disease • A- Assess your risk

11. Positive Risk Factors for CAD • Family history • Hypercholesterolemia • Hypertension • Cigarette smoking • Impaired fasting glucose • Obesity • Physical inactivity

12. Quiz • Holly, 42 years old • MI • Runner • Non-smoker • Non-HT • Low cholesterol

13. Daily Physical Activity (PA) Every U.S. adult should accumulate 30 min or more of moderate-intensity physical activity on most, preferably all, days of the week. (U.S Surgeon General, CDC, ACSM)

14. ALOHA to Heart Disease • A- Assess your risk • L- Lifestyle change • O- Other interventions • H- Highest risk women: highest priority • A- Avoid… Mosca. Circulation, 2004; 109: 158-160

15. LDL DIABETES MELLITUS HT SMOKING

16. Coronary Artery Disease (CAD)

17. Normal?

18. Coronary Artery Disease (CAD) Normal Atherosclerosis

19. CAD (con’t)

20. CAD (con’t) • Atherosclerosis • Plaque narrows coronary arteries • Results in ischemia • Leads to myocardial infarction (MI)

21. Thrombosis of Coronary Artery

22. CAD (con’t) Myocardial Infarction

23. Myocardial Infarction (MI)

24. MI Signs • Severe chest pain/pressure • Sweating, nausea, vomiting •  cardiac enzymes • ECG changes

25. The Female Heart

26. What’s your diagnosis? • Stella, aged 68 • Symptoms • Sleep disturbance • Unexplained fatigue • SOB • Indigestion/nausea • Pain in back and high chest

27. 38.2 million women have CVD Silent MI more common Atypical chest pain Delayed diagnosis Underutilized prevention & research The Female Heart

28. Female Heart (con’t) • 45 million women older than 50 yr • Smoking cessation rates declining slower than among men • Abdominal obesity • 3-7x  in CAD risk if diabetic

29. More visceral abdominal fat (light)= greater health risk

30. Female Heart (con’t) Fatality rate • Worse prognosis for women with CAD than men • Women had 2x in-hospital mortality rate • Age, size of coronary arteries, severity of sickness at presentation

31. Take-Home Message • Women have worse prognosis and die more often than men after MI or bypass • CAD is largely preventable • Major emphasis on lifestyle modifications: smoking cessation, regular PA, maintenance of healthy weight, lipid lowering therapy

32. Thank you!Any questions? • jorri@usfca.edu