Men & Women: Differences in Heart Disease

Transcription

1 Men & Women: Differences in Heart Disease February 18, 2010 Suzanne Sims, M.D., M.P.P. LifeConnections Health Center Physician

2 Summary of Topics Heart Disease Statistics Risk factors for heart disease, including by gender A couple of interesting studies on salt and exercise Screening tests and preventative treatments available at LCHC Mechanism and symptoms of a heart attack Emergency procedures at work

3 The Statistics Heart Disease is the #1 killer in women 500,000 deaths in the U.S. per year More women die of heart disease than men Heart Disease is the #1 killer in men (In East Asian-American men, heart disease is second to cancer) 1 in every 4 deaths 50% who died suddenly had no previous symptoms South Asians have a 4x higher risk for heart disease

4 Risk Factors in Both Genders Age Men > 45 (younger in South Asians) Women > 55 High blood pressure 135/85 is the cutoff, the lower the better Can be made worse by salt intake High cholesterol Elevated LDL Decreased HDL cholesterol (more important risk in women than men) Fixing them can halt or reverse heart disease

5 How does salt increase blood pressure? Ouabain Secreted by the adrenal gland Regulates sodium and calcium in the smooth muscles of the arteries Causes increased artery smooth muscle contraction Oversecreted when you each to much salt

6 Before you reach for the salt Typical American consumes about 3400mg salt/day Reduced sodium means the product is down 25% from the original version No added salt doesn t mean salt free Salt can increase the reactivity of platelets (clotting cells) even without hypertension Potassium in fresh fruits and vegetables helps to balance the effect of sodium

7 Risk Factors in Both Genders Age Men > 45 Women > 55 High blood pressure Common in women >55 Can be made worse by salt intake High cholesterol Elevated LDL Decreased HDL cholesterol (more important risk in women than men) Fixing these levels can halt or reverse heart disease

8 Risk Factors in Both Genders Family history Especially if family member <60 yo Especially if family member was a sister or brother Smoking Includes long term exposure to second hand smoke Damages artery walls and increases risk of blood clots Accounts for the majority of heart attacks in women <45 yo Alcohol use Binge drinking in the past year (3 or more drinks within a 2 hour period) increases the risk of death after a heart attack Excessive drinking causes increased blood pressure, increased triglycerides

9 Risk Factors in Both Genders Obesity BMI >= 30 More common in postmenopausal women than in men the same age Metabolic Syndrome (At least 3 of 5 of the following) Abdominal obesity» Waist > 35 inches in women» Waist> 40 inches in men Triglycerides >150 HDL» <50 in women» <40 in men Fasting glucose>=110 Blood pressure >= 130/85

10 Risk Factors in Both Genders Physical Inactivity More common in postmenopausal women than in men the same age (Women tend to be caregivers-don t prioritize regular exercise) Stress Increases mortality, lipids, inflammation, obesity, risk of metabolic syndrome 2.67-fold increase in risk for a heart attack Use of stimulant drugs Cocaine Amphetamines

11 Recent study on sedentary lifestyle Owen, et al in Circulation, January 12, people in Australia tracked for an average of 6 years Participants averaged minutes of exercise/day Average age 50 Study measured number of hours of TV watching/day and related it to mortality

12 Recent study on sedentary lifestyle Owen, et al in Circulation, January 12, 2010 Those who reported watching TV for more than 4 hours a day: 46% more likely to die of any cause 80% more likely to die of cardiovascular disease Compared to those watching <2 hours/day Even if exercising regularly Even when adjusting for age, gender, waist circumference There was also an increased risk for watching >=2hours/day (13% and 19% increase respectively)

13 Physiological results of being sedentary After a few hours of inactivity, Lpa which pulls fat from the blood, shuts down After just one day of inactivity, levels of HDL can fall by as much as 20% Consider standing up while working on the computer which causes muscle contraction, get up and walk around, fold laundry while watching TV, don t use the remote to change channels

14 Risk Factors in Both Genders Physical Inactivity More common in postmenopausal women than in men the same age (Women tend to be caregivers-don t prioritize regular exercise) Stress Increases mortality, lipids, inflammation, obesity, risk of metabolic syndrome 2.67-fold increase in risk for a heart attack Use of stimulant drugs Cocaine Amphetamines

15 Additional Risk Factors in Men Low vitamin D Goal blood level should be 30ng/ml or higher Low testosterone (maybe)

16 Additional Risk Factors in Women Postmenopausal Having had ovaries surgically removed Use of older generation, high estrogen birth control pills, especially if also smoking Complicated pregnancy (Pregnancy induced HTN, DM, low birth weight)-possible, but very low, risk of heart attack during the pregnancy

17 Screening Tests Available at LifeConnections Health Center Fasting lipid panel Fasting glucose Vitamin D level Obtaining your family history Obtaining your history of tobacco, alcohol, and drug use Obtaining your diet & exercise history Referral for outside exercise treadmill test if symptomatic

18 Preventative treatments before a heart attack occurs Condition Management at the health center can help you achieve the following: Eat a diet low in saturated fat, trans fat, and cholesterol and moderate in total fat Limit salt and sodium If you drink alcoholic beverages, have no more than one a day (2 in men) Stop smoking Health Coach at LifeConnections can help you achieve the following: Lose weight Trainer at the Fitness Center can help you achieve the following: Get at least minutes of moderate exercise most days of the week

19 Additional preventative treatments EAP at LCHC can help you: Address stress, anxiety, depression A doctor at LCHC can prescribe the following: Blood pressure medication Cholesterol medication Blood sugar medication Aspirin» For men only, to prevent heart attack» After a heart attack, both genders should take it

20 How does a heart attack occur Plaque Inflammation Pressure Clot Damage and possibility of plaque rupture Vessels get more narrow the further downstream When tributary of stream blocked, that area of the heart does not receive oxygen and nutrients and is injured or dies

21 Unstable Plaque = Vulnerable Plaque Heart Center Online, 21

22 How does a heart attack occur Plaque Inflammation Pressure Clot Damage and possibility of plaque rupture Vessels get more narrow the further downstream When tributary of stream blocked, that area of the heart does not receive oxygen and nutrients and is injured or dies

23 Texas Heart Institute Heart Information Center, 23

24 How does a heart attack occur Plaque Inflammation Pressure Clot Damage and possibility of plaque rupture Vessels get more narrow the further downstream When tributary of stream blocked, that area of the heart does not receive oxygen and nutrients and is injured or dies

25 When should I worry? Chest pain (angina) Heavy, pressure, aching, burning, fullness, squeezing, discomfort Can radiate to left arm, neck, jaw, back Can be mistaken for heartburn Shortness of Breath* at rest or with minimal activity Palpitations (skipped beats) Rapid heart rate even though not exercising Weakness* Dizziness* Nausea Sweating* Symptoms last for 30 minutes or more and are not relieved by rest, medication

26 Emergency Procedures at Work Call Safety and Security (within 5 minutes if possible) who will activate the Emergency Response Team and call 911 Don t drive yourself to the hospital Paramedics can start treating you before you arrive to the hospital You could die while driving You could kill someone else when you die while driving Don t be embarrassed of a false alarm

27 Summary Everyone is at risk for heart disease Heart disease is mostly preventable Eat a healthy diet Exercise, exercise, exercise Treat your genetic risk factors All of us at the LifeConnections Health Center are here to help

28 Questions?

29 Free Blood Pressure Screening Event at LifeConnections Health Center Tuesday, February 23 rd 11 am 3 pm No appointment necessary Cisco employees and their families, and contractors welcome Sponsored by Kaiser Permanente and Plus One

30 References Women and the Risk Factors of Heart Disease Some risk factors affect women differently from men By Richard N. Fogoros, M.D., About.com Guide, Created: November 30, 2009 Symptoms of Heart Disease, WebMD.com Men and Heart Disease Fact Sheet A Salty Tale: Why We Need a Diet Less Rich in Sodium, Melinda Beck,WSJ, April 21, 2009 Salt Wars - Is Salt Restriction Necessary? A new spin on an old problem By Richard N. Fogoros, M.D., About.com Guide, Updated: November 30, 2009 SCIENTISTS UNCOVER HOW EXCESS SALT LEADS TO HYPERTENSION

31 References 2 Suppression of skeletal muscle lipoprotein lipase activity during physical inactivity: a molecular reason to maintain daily low-intensity activity, Lionel Bey and Marc T Hamilton, Physiol September 1; 551(Pt 2): Heart Attack Risk Factors Low Vitamin D Ups Heart Risk in Men Kelli Miller Stacy WebMD Health News The Toll Stress Takes on the Body Women's Heart Attack Symptoms Different from Men's: Symptoms may appear up to a month before attack By Robert Longley, About.com Guide