Wake Cv Cardiovascular Disease In Women

Front 1

Why is CV dz important in women?

Back 1

- Leading cause of mortality in adult women

- Higher mortality in women since 1984

Major cause of disability:
- 36% of women 55-64
- 55% of women over the age of 75

Front 2

When do women catch up with men in terms of CVD?

Back 2

in the 40-59 year old age bracket

Front 3

True or False: men have first MI ~10 years before women have their first MI.

Back 3

True --> Age at first MI older than men (~10 years)

Front 4

True or False: men generally have more risk factors for CAD, including DM, HTN, and dyslipidemia

Back 4

False --> In contrast to men, women have more risk factors for CAD, including DM, HTN, dyslipidemia

Front 5

True or False: women are just as likely to have ST segment elevation MI as men, but clinicians are less likely to recognize it

Back 5

False --> Women less likely to have ST segment elevation, and have higher prevalence of “silent MI”

Front 6

What are some “atypical” ways that women may present with MI?

Back 6

Women have atypical pattern for angina such as:
- neck/jaw pain,
- dyspnea, or
- fatigue

Front 7

Gender Differences in MI:
Evaluation and Outcomes

Back 7

- Women less likely to undergo cardiac workup when presenting with chest pain

- Non-invasive studies have decreased sensitivity and specificity in women (perhaps due to breast tissue and ECG lead placement)

- Higher in-hospital and 30-day mortality

- Worse long-term mortality (likely due to older age and more comorbidities)

Front 8

Traditional CHD Risk Factors

Back 8

Hypertension (>140/90) (Risk Factor 4)
Diabetes mellitus (Risk Factor 3)
Dyslipidemia (Risk Factor 1)
- LDL > 130
- HDL < 50
Smoking (Risk Factor 2)
Age
- Men > 45
- Women > 55
Family history of early MI
- Male < 55
- Female < 65

Front 9

Novel CHD Risk Factors

Back 9

1. C-reactive protein
2. Obesity
3. Hypertriglyceridemia
4. Sedentary lifestyle
5. Impaired glucose tolerance

Front 10

What is the best way to determine obesity in women?

Back 10

waist to hip ratio is better than BMI (b/c it is an indicator of abdominal obesity)

Front 11

If you have CHD or CHD risk equivalents (10 year risk>20%), then what is your LDL-C Goal and when do you treat with medicine?

Back 11

LDL- C Goal (mg/dL):
<100
(clinically at <70)

LDL-C Level for Drug Therapy (mg/dL):
>=130
(100-129: drug optional)

Front 12

If you have 2+ CHD risk factors (10 year risk=<20%), then what is your LDL-C Goal and when do you treat with medicine?

Back 12

LDL- C Goal (mg/dL):
<130
(clinically at <100)

LDL-C Level for Drug Therapy (mg/dL):
10 year risk <10%: >= 160

Front 13

If you have 0-1 CHD risk factors then what is your LDL-C Goal and when do you treat with medicine?

Back 13

LDL- C Goal (mg/dL): <160

LDL-C Level for Drug Therapy (mg/dL):
>=190
(160-189: LDL-lowering drug optional)

Front 14

CRP as a risk factor for CHD

Back 14

- Sensitive serum marker that is elevated in general inflammatory conditions
- Proposed as an independent risk factor for the development of future CHD events
- Elevated in conditions such as MI, diabetes, HTN, obesity, smoking, advanced age and oral HRT use
- Statin therapy reduces CRP and may modulate CHD risk by reducing inflammation

Front 15

Estrogen modifies several of the key processes in the development of CHD
(list them)

Back 15

- lipid levels
- aterial vasodilation
- clot formation/breakdown

Front 16

Estrogen and Endothelial Function

Back 16

1. Stimulate the local synthesis of Nitric Oxide
2. Vasodilation
3. Increases Plasma renin activity
4. Inhibits ACE activity
5. Protects LDL from oxidation
6. Increases the regrowth of endothelial cells

Front 17

Estrogen: Effects on coagulation

Back 17

- Many procoagulant effects
- Increases Prothrombin
- Decreases antithrombin III
- Contributes to increased venous thromboembolic events

Front 18

Heart and Estrogen/Progestin Replacement Study (HERS) Results

Back 18

- Showed no significant difference in CAD outcomes
- Increase in CAD events in HRT gp at year 1
- Fewer CAD events at years 4 and 5
- Favorable lipid profiles in HRT group

Front 19

Women’s Health Initiative (WHI) Results

Back 19

- Increase in invasive breast CA without CAD benefit
- Increased stroke and PE
- Additional estrogen alone arm (n=10,739) also failed to show CAD benefit with increased risk of stroke

Front 20

What can be done to lower risk of CAD in women?

Back 20

- Modify Risk Factors
- Smoking Cessation
- Proper Diet and Weight Control
- Exercise
- Earlier detection of risk factors may help prevent CHD
- Increase awareness of CHD in women

Front 21

How do you determine a 10 year risk score for CHD?

Back 21

Use the Framingham study, which bases the prediction on:
- age
- total cholesterol
- HDL-C
- Systolic BP
- Smoking Status

Front 22

Which gender is more obese?

Back 22

Women at all ages

Front 23

Gender Differences in Risk Factors for CVD

Back 23

Greater risk for women:
DM
High Triglycerides
Smoking in middle-aged women

- CRP levels are higher in women
- Physical Activity is more prevalent in women

Front 24

Do estrogen and progesterone play a role in vasculature?

Back 24

Estrogen and Progesterone Receptors which are present on vasculature endothelium have a direct effect on vasomotor tone