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14 Cards in this Set
- Front
- Back
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Coronary artery disease: women's cause of death
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Leading cause of death in women
More women then men 2/3 sudden cardiac death occurred in women with no prior symptoms Death rate in african american women = 69% higher Death rate of CAD between women 35-54 years old is increasing |
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Disparities between men and women epidemiology and disease outcomes
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Women and men with CHD present with different symptoms and have different outcomes
Women develop clinical manifestations of CHD about 10 years later than men Disparities are compounded by women of racial and ethnic minorities having poorer outcomes than Caucasian women |
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Women's CAD symptoms
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Dyspnea
Nausea/vomitting Indigestion Dizziness/fainting Fatigue Sweating Area/shoulder pain |
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Strategies to assess, modify and prevent a woman's risk of heart disease
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Traditional risk scores underestimate CHD risk in women (e.g. Framingham Risk Score)
Some diagnostic tests less accurate in women than men (e.g. treadmill) -Sensitivity and specificity in women 31% to 71% and 66% to 86%, respectively. -Sensitivity and specificity in men 68% and 77%, respectively |
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Framingham risk score
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Age
Gender TC (total cholesterol) HDL Smoker Systolic blood pressure Currently on any medication to treat high blood pressure? Crude estimate, works better in men than women |
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Heart disease prevention in women: lifestyle interventions
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Class I
-Cigarette smoking -Physical activity -Dietary intake -Weight maintenance/reduction Class II -Omega-3 fatty acids |
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Metabolic syndrome
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IMPORTANT FOR TEST
Must have 3 of 5 criteria in women Waist circumference >35 inches Fasting triglycerides >150 mg/dl HDL cholesterol <50 mg/dl Hypertension (systolic blood pressure >130 mmHg, diastolic blood pressure >85 mmHg or use of antihypertensive drug therapy Fasting glucose measurement > 100 mg/dl |
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Heart disease prevention in women: medical intervention
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Blood pressure
-Optimal blood pressure is <120/80 -Begin medications (to include a thiazide diuretic at >140/90 and >130/80 with kidney disease or diabetes mellitus Lipid and lipoprotein levels -Optimal is LDL <100 and HDL >50, TG <150 Diabetes mellitus -Goal is to have HbA1C 7% |
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Aspirin and women's CAD prevention
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Women under 65 should not take ASA for primary prevention
Low dose ASA did not prevent first myocardial infarctions or reduce death* 17% lower risk of stroke Greatest benefit in women 65 and older |
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Estrogen and women's CAD prevention
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Observational studies suggested that hormone replacement therapy (HRT) in postmenopausal women was associated with a 40% to 50% reduction in risk of CAD
Heart Estrogen Replacement Study (HERS) cast doubt(Estrogen + Progestin) -stopped early Women’s Health Initiative (WHI) funded by NIH to address role of Estrogen +Progestin as well as Estrogen alone -24% higher risk of CAD among women in the E + P study compared to women taking placebo -81% increased risk of CAD in the 1st year after starting E + P -Estrogen Alone trial stopped early due to increased risk of stroke -No overall protection against cardiac death or MI -Study flawed, average age 63 Recommendation is women don't take estrogen or estrogen and progestin to reduce CAD |
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Evaluation of symptoms in women
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Sensitivity and specificity of exercise treadmill testing (ETT) reduced in women as compared with men
-Estrogen modulates ST segment on EKG -Still recommended to start with treadmill Optimal test identifies myocardial ischemia – even for women with non-obstructive CAD. These tests include imaging of the heart. Always recommended that women have imaging |
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Diagnostic accuracy of exercise treadmill test in women
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Altered prevalence of disease1,2
Reduced predictive accuracy in younger women2 Potential factors affecting diagnostic accuracy1: - Hormonal influences - Reduced functional capacity - Resting ST-T wave abnormalities |
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CAD pathophysiology in women
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Cholesterol plaque may not build up into major blockages
Coronary microvascular syndrome - plaque accumulates in very small arteries of the heart resulting in ischemia Approximately 50% of women referred for evaluation of ischemia do not have obstructive coronary disease -Prognosis for these women is intermediate for future adverse cardiac events and persistent symptoms Physicians should no longer ignore nonobstructive coronary angiograms in women Physicians should not call an abnormal perfusion test with nonobstructive coronary artery disease a false positive |
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Women's heart failure type
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Prevalence of HF in men and women is similar
Women have diastolic dysfunction as the cause of their HF more often than men. -EF preserved |
