女性心脏病

HeartDiseaseInWomen2005GreatWallMeetingBeijing V roniqueL Roger MD MPHProfessorofMedicineMayoClinicCollegeofMedicine Outline ThegrowingburdenofheartdiseaseinwomenMortalityPrevalence IncidenceOutcomeExplanationsfordisparitiesActionplan CardiovascularDeaths US 2004HeartandStrokeStatisticalUpdate CDC NCHS AHA CP1138028 9 Deaths 000s 1979 Years 1982 1986 1990 1994 1998 2001 Females CoronaryDiseasePrevalenceNHANESIII1988 94 CDC NCHSandAHA Incidenceratex100 000 CP1145262 1 MIIncidence AnnalsofIntMed 2002 CHDIncidence CP1079700 1 1988vs1979 MI40years60years80yearsMI SCD40years60years80yearsAnyCHD40years60years80years 1998vs1988 Women Men ArcieroAJM2004 CP1099138 11 May2003 DeathWithinFirstMonthPost MI OlmstedCounty1979 1998 CP1053938 6 AnnalsofIntMed 2002 Overall Men Women 75 75 1979 83 1984 88 1989 93 1994 98 SexandMIMortality CP1165215 5 NRMI Vaccarino NEJM 1999 Hospitalmortality Overall 302520151050 Burdenofheartdiseaseinwomen CHDismoreprevalentinolderwomenIncidenceofallCHDdeclinedamongmenandyoungerpersons NOTinwomenBurdenofCHDdisplacedtowardswomen whohaveworstoutcomes Why Why AwarenessRiskfactors Atypical symptomsTreatment 2003AHASurvey 13 U S womenthinkheartdiseaseistheirgreatesthealththreat51 believeitiscancer CP1021901 2 Misperception Missedopportunitiesforprevention PerceivedLeadingCauseofDeathinWomen CP1165215 2 AHASurvey Mosca Circulation 2004 Breastcancer Cancer any Heartdisease Unsure White CauseofDeathinWomen AHAStatisticalUpdate 2004 Deaths thousands Heartdisease Cancer COPD Influenza Diabetes Other Cerebro vasculardisease BreastCancer CP992570 6 CP1110520 1 CP1110520 2 Ifawomandoesn tthinkshecanhaveheartdisease notesDr GeorgeSopkooftheNHLBI she snotgoingtointerprethersymptomsasheartdisease evenifhersymptomsarethesameasaman s Why AwarenessRiskfactors Atypical symptomsTreatment SmokingRatesandRiskofMIinWomen CP1165215 14 WHO MONICA 32populations 21countriesMahonen TobaccoControl 2004 35 39 Non fatalMIPopulation RR 5 3 CI3 2 8 7 Attributablerisk 55 40 44 45 49 50 54 55 59 60 64 Age IncreasingobesityBMI 30 Flegaletal JAMA 2002 CP1043203 17 DiabetesandCVRiskinWomen NursesHealthStudy ArchIntMed 2001 RRofCVdeath n 120 000womenage30 55 20 yrF U CP1138028 2 50 ofpatientswithCHDhavenoidentifiable conventionalriskfactors Smoking DM BP cholesterol Myth Reality Greenlandetal JAMA2003 Chic HeartAssoc MRFIT Framingham BeforeCHDevent exposureto 1RFin87 100 ofcases Khotetal JAMA2003 14clinicaltrials GUSTO PURSUIT BeforeCHDevent exposureto 1RFin80 90 ofcases 90 ofwomen 45yearsoldwithMIhad 1riskfactorand80 werecurrentsmokers Stampferetal NEJM2000 Womenwhoactually Don tsmokeEatahealthydietExercise 30min dayArenotoverweightUsealcoholmoderately CP1021901 2 Stampferetal NEJM2000 CVeventspreventedifALLwomen DidnotsmokeAteahealthydietExercised 30min dayBMI 25Usedalcoholmoderately CP1021901 2 Summary TheadoptionofWesternlifestyleandthegrowingprevalenceofriskfactorswillleadtosimilartrendsinallcountries Why AwarenessRiskfactors Atypical symptomsTreatment Womenvsmenreportingchestpainasasymptomofacutecoronaryischemia infarction Milneretal AmJCardiol 1999 CP949761 10 PrecipitantsofAngina Frequency Rest Sleep Activity P 0 006 Mentalstress Pepineetal AJC 1994 CP981765 5 SymptomsofAcuteCHDinPatientsWithoutChestPain Milneretal AmJCardiol 1999 CP926094 1 DyspneaNauseaIndigestionDizzinessFatigueSweatingArm VomitingFaintingshoulder pain Why AwarenessRiskfactors Atypical symptomsTreatment CP1021901 10 Womenwhosedoctordiscussedheartdiseaseprevention 2003AHASurveyMosca Circulation2005 MD ssystematicallyunderestimateCVDriskandinwomenvs men CP1141913 3 JAMA 2001 SexDisparitiesinMITreatmentUSNationaldata CP1074357 7 35 835ptswithNSTEMI 41 womenWomen DM HTN age CADevents EarlyASA heparin GPIIb IIIa ACE I Revascularizations CABG 41 DischargeASA blocker ACE I statins Death MI CHF Blomkains JACC2004CRUSADENSTEMIdatabase MIs 83 85 82 84 86 87 88 89 90 91 92 93 94 95 96 97 98 Year CP1099138 2 Witt etal JACC2004 44 988 96 SecondarypreventionafterMIinourpractice1821personswithMI participation55 Summaryoftreatmentdifferences Ineverycircumstance sexdisparitiesintreatmenthavebeendocumentedWomenarelesslikelytogetaggressivetreatmentthanmenThesedisparitiesidentifyopportunitiesforimprovement ACTIONPLAN Mosca Circulation 2004 109 672 693 CP1170099 24 CVDPreventionWomen sGuidelineResources FraminghamCHDriskscoreADA diabetes JNCVII HTN DASH HTN