The Heart of a Woman Karen E. Friday, M.D. Associate Professor of Medicine Section of Endocrinology Louisiana State University School of Medicine
American Heart Association Women, Heart Disease and Stroke Statistics More than 1 in 3 women has some form of CVD Since 1984, the number of cardiovascular deaths for women exceeded males 2006: 53% of cardiovascular deaths were women and 26% of female deaths are cardiovascular 64% women with sudden CHD death had no symptoms 23% of women, 18% men die < 1 year post M I Stroke survivors : 3.9 million US women (3.1% white, 4.3% black and 3.1% of hispanic women > 20 y American Heart Association -2010 Update
Prevalence of CVD in adults 20 years of age by age and sex (NHANES: 2005 2008). 100 90 86.7 80 70 72.6 71.9 80.1 Percent of Population 60 50 40 39.3 37.2 30 20 10 14.2 9.7 0 20-39 40-59 60-79 80+ Men Women Source: NCHS and NHLBI. These data include CHD, HF, stroke, and hypertension. 2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010
Prevalence of Stroke in US 2006-2008 Prevalence of stroke by age and sex (NHANES: 2005 2008). 18 16 14 14.5 14.8 Percent of Population 12 10 8 6 7.2 8.2 4 2 0 2.4 1.6 0.3 0.5 20-39 40-59 60-79 80+ Age Men Women Source: NCHS and NHLBI. 2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010
Cardiovascular Disease Mortality Trends for Men and Women United States: 1979-2004 520 Deaths in Thousands 500 480 460 440 420 400 3800 79 80 85 90 95 00 04 Years Males Females
Heart Disease in Women-CDC
Women and Heart Disease in Louisiana-CDC/AHA Statistics 31% deaths due to heart disease and stroke 17 women die of heart and stroke deaths daily 61% of women overweight or obese 19% smoke cigarettes
Putting the risk of breast cancer in perspective Causes of Death in Women: Ontario, 1995 (For each group, value is expressed as percentage of total number of deaths among women in that age group. The proportion of deaths due to breast cancer never exceeded 20%. Data from the Ontario Cancer Registry.) Percentage of All Deaths 60 50 40 30 20 10 0 0 4 5 9 10 14 15 19 Deaths from cardiovascular disease Deaths from lung cancer Deaths from breast cancer 20 24 25 29 30 34 35 39 Deaths from breast cancer 40 44 Phillips K-A et al. N Engl J Med. 1999;340:141. 45 49 50 54 55 59 Age Group (y) 60 64 65 69 70 74 75 79 Deaths from cardiovascular disease Deaths from lung cancer 80 84 >85
AHA Hypertension Statistics in US Women over age 20 31 % of White Women 46% of Black Women 29% of Mexican-American Women
AHA Statistics: Cigarette Smoking in Women > age 18 21% White Women 19% 17% Black Women smokers non-smokers 9% Hispanic Women
AHA Statistics: Cholesterol >200 mg/dl Women age 20-74 53,800,000 US women 47% White Women 41% Black Women 47% Mexican-American Women 17% of White women with cholesterol > 240 13% of Black women with cholesterol > 240 14% Mexican-American women with TC > 240
Trends in mean total serum cholesterol among adolescents 12 17 years of age by race, sex, and survey year (NHANES: 1988 1994*, 1999 2004 and 2005-2008). 180 175 174 170 Mean Total Blood Cholesterol 165 160 155 150 163 159 154 165 161 157 166 163 163 161 162 158 155 160 158 145 140 NH White Males NH Black Males NH White Females NH Black Females Mex. Am. Males Mex. Am. Females 1988-94 1999-2004 2005-2008 Source: NCHS and NHLBI. NH indicates non-hispanic. Mex. Am. indicates Mexican American. * Data for Mexican Americans not available. 2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010
Statin Trials: Therapy Reduces Major Coronary Events in Women % 10 5 0-5 -10-15 -20-25 -30-35 -40-45 -50 Major coronary events* -34 P=0.012-46 ** P=0.001-46 4S (n=827) CARE (n=576) AFCAPS/TexCAPS (n=997) n = number of women enrolled. 2 Prevention 1 Prevention * 4S = primarily CHD death and nonfatal MI; **vs -20% in CARE men CARE = coronary death, nonfatal MI, angioplasty, or bypass surgery; AFCAPS/TexCAPS = fatal/nonfatal MI, unstable angina, or sudden cardiac death. Miettinen TA et al. Circulation. 1997;96:4211-4218. Lewis SJ et al. J Am Coll Cardiol. 1998;32:140-146. Downs JR et al. JAMA. 1998;279:1615-1622.
AHA Statistics: Obesity Overweight (BMI > 25) and Obesity (BMI >30) White: 59% overweight, 35% obese Black: 78% overweight, 51% obese Mexican-American: 75% overweight, 43% obese
Worsening Trends in Diabetes and Obesity Diabetes Obesity 8 22 Prevalence (%) 7 6 5 Prevalence (%) 20 18 16 14 12 4 10 Mokdad et al. JAMA. 1999;282:1519; Mokdad et al. Diabetes Care. 2000;23:1278; Mokdad et al. Diabetes Care. 2001;24:412; Mokdad et al. JAMA. 2001;286:1195; Mokdad et al. JAMA. 2000;284:1650.
PREVENTION OF OBESITY Maintain BMI < 25 Diet and exercise essential Modify eating habits Incorporate exercise into daily routine Exercise to avoid muscle wasting with age
CARDIOVASCULAR MORTALITY WITH DIABETES 60 50 40 Diabetic Men Joslin Diabetic Women Joslin Nondiabetic Men Framingham Nondiabetic Women Framingham 30 20 10 0 0-3 4-7 8-11 12-15 16-19 20-23 Years of Follow-up Warram et al. Endocrinol Metab Clin N Am. 1997;26:165.
Diabetes Care LDL cholesterol < 100 mg/dl Blood pressure < 130/80 Good glucose control HgbA1c < 7%
American Heart Association Estrogen/Hormone Replacement Estrogen/Hormone Replacement Therapy not indicated for cardiovascular prevention Focus on proven therapies, including hypertension management, cholesterol reduction Decision to continue/stop HRT should be based on non-coronary benefits/risks and patient preference Consider stopping HRT while immobilized or hospitalized for acute CVD event
Barriers to Prevention 41% of underserved midlife women reported lack of restaurants with healthy food 50% reported lack of fresh produce sources 52% not enough affordable exercise places 42% not enough appropriate physical activity options that meet women s needs 47-53% unsafe conditions to exercise Jilcott et al. J Women s Health 2006;15569-83
Preventing Heart Disease Modify eating habits Increase whole grains, fruits, vegetables, fish Decrease total and saturated fat, processed foods Modify cardiovascular risk factors Smoking cessation Incorporate exercise into daily routine