Dr Sandra Birchem Cardiologist Cardiovascular Division Mayo Clinic Rochester and Mayo Clinic Health System MFMER slide-1
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1 Dr Sandra Birchem Cardiologist Cardiovascular Division Mayo Clinic Rochester and Mayo Clinic Health System 2011 MFMER slide-1
2 Heart Disease in Women and Why we are concerned 6,600,000 US women >440,000 heart attacks/year >500,000 die each year #1 killer of women (>10x more than breast ca) 1 in 3 women die of heart disease
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4 63 % of women who died suddenly of CHD had NO previous symptoms MFMER slide-3
5 Heart Disease is Different for Women Breathlessness Chronic fatigue Dizziness Edema Fluttering Gastric upset 2011 MFMER slide-4
6 Cardiovascular Diseases Higher Prevalence in Women Acute Coronary Syndromes Myocardial Infarction with non obstructive CAD Ischemic Heart Disease/CAD SCAD--Spontaneous Coronary artery Dissection Takotsubo Syndrome-stress induced cardiomyopathy Heart Failure with Normal EF Peripheral Vascular Disease/AAA 2011 MFMER slide-7
7 2011 MFMER slide-8
8 2011 MFMER slide-9
9 What are the Challenges for Women with Heart Disease? Delays in symptom recognition and Rx Misdiagnosis Treatment Less counseling and risk factor control Less representation in clinical trials 2011 MFMER slide-5
10 Prevention is the Most Powerful Rx EVERYONE should know their: Blood Pressure Weight (BMI) Lipid profile Blood Sugar Smoking Family History Framingham Risk Score 2011 MFMER slide-6
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12 Hypertension Women develop HTN decade after men No sex differences outside of pregnancy related HTN 2017 ACC/AHA Guideline BP categories NL <120/80mmHg, Stage 1 BPs mmHg or BPd 80-89mmHg Stage 2 BPs 140mmHg or BPd at least 90mmHg HTN Crisis BPs >180 and or BPd over 120mmHg
13 Diabetes Diabetic women 3X excess fatal CAD risk in women with T2DM compared with nondiabetic women 44% greater risk in women compared to Men Growing evidence suggest increase risk of Impaired endothelium-dependent vasodilation Hypercoagulable state Worse atherogenic dyslipidemia Increase Metabolic Syndrome
14 Dyslipidemia in Women Highest population adjusted among Women 47% compared will all other known riskfactors Lifestyle modifications-diet/exercise Pharmacological therapy for secondary prevention equally effective women/men ACC/AHA Guidelines Primary Prevention statin tailored sex specific Secondary Prevention used with modhigh ASCVD risk 2011 MFMER slide-13
15 Obesity and Overweight 2 in 3 adults in US Prevelance higher among Women 64% Men 46% BMI greater than 30 WAIST MEASUREMENTS <35 (women) <40 (men)
16 122 Million US Adults are Overweight or Obese
17 Smoking Women have 25% increase risk for CAD by cigarette smoking compared to men. Combination of smoking with oral contraceptives has synergestic effect on risk of acute MI, CVA, DVT
18 Physical In activity Guidelines for Americans recommend adults 150minutes/week moderate intensity activity Or 75minutes/week vigorous intensity aerobic activity Muscle strength training activities 2 days week Higher levels of activity and lower rates of many chronic diseases including CVD and increase longevity 2011 MFMER slide-17
19 Diagnostic Tests for Heart Disease Non invasive tests are similar in women and men Choosing Wisely - appropriateness of tests Pretest Probability for CAD by Age, Sex, Symptoms Functional Testing Anatomic Testing Invasive Testing
20 Treatment are there differences? Despite beneficial effect medical therapies such as ASA, ACE/ARB s, BB, Aldosterone inhibitors and statins are frequently delayed in women Antithrombotic and antiarrhythmic agents are metabolized differently in women and may increase risk of adverse affects need for dose adjustments area needing further research 2011 MFMER slide-19
21 Summary what is new for Prevention? We know average lifetime risk of developing CVD in Women at 50 yrs age is 40% and risk increases as the number of risk factors. We need to focus on Primary Prevention of CVD in order to reduce CVD mortality We need to identify and treat risk factors keeping in mind non-traditional risk factors as well as educate public MFMER slide-20
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