Women and Heart Disease Women and Heart Disease

Unequal Burden of DiseaseUnequal Burden of Disease..

Patricia Davidson, MD.

Heart Disease Mortality Among Heart Disease Mortality Among WomenWomen Per 100,000 PopulationPer 100,000 Population

0

50

100

150

200Native AmericanHispanicAfrican American Asian American White

Atherosclerosis/ hardened Atherosclerosis/ hardened arteries:arteries:

PREVENTABLE

BEGINS IN THE FETUS IF THE MOTHER HAS

HIGH CHOLESTEROL OR THE FIRST DECADE OF LIFE NOT A NATURAL PROCESS OF AGING

RISK FACTORS:RISK FACTORS:

HOW DO THEY DIFFER?

Classification of Overweight Classification of Overweight Based on Body Mass IndexBased on Body Mass Index

Overweight >20 BMI Obese >30 BMI

BMI= kg/m2 NHANES 111

Overweight WomenOverweight Womenby Ethnicityby Ethnicity

African American 68.3%

Asian 10.1%

White 46.8%

Percent of Overweight Hispanic Percent of Overweight Hispanic WomenWomen

Hispanic 33%

Mexican 69.3%

Puerto Rican 40.2%

New immigrant 25%

DiabetesDiabetesPrevalence Among WomenPrevalence Among Women

MIDDLE AGED OLDER

Native Am. 21.8 31.8 Mexican Am. 7.7 29.9 African Am . 14.5 25.4 White 8.5 14.5

DiabetesDiabetes

DM may explain the increased risk of CAD in African American women.

Insulin resistance contributes to the development of CAD long before clinical DM.

Insulin resistance is more prevalent in African American women.

NHANES 1

DiabetesDiabetes

African American women develop DM at a lower BMI than other women.

DM is increasing fastest in ethnic groups.

80% of children diagnosed are obese. Screening should begin by age 10.

NHANES 1

ExerciseExercise

PHYSICAL ACTIVITY of FEMALE ADOLESCENTS ( %)

Vigorous moderate sports

Hispanic 45.2 27.6 27.3

Afr. Am. 41.2 26.4 34.9

White 56.7 16.8 47.1 MMWR 9/27/98

Percent of High School Percent of High School StudentsStudents SmokingSmoking

0

5

10

15

20

25

30

35

40

WhiteW

Af.AmW

Hisp.W

White W

White M

Af.Am W

Af.Am M

Hisp. W

Hisp. M

Racial and Gender Referral Racial and Gender Referral BiasBias

Rates of Bypass Surgery (CABG)Rates of Bypass Surgery (CABG)

Per 10,000 Medicare Patients:

White men 40.4 White women 16.2 African American men 9.3 African American women 6.4

JAMA 3/18/92

Variation in Use of Cardiac Procedures in Variation in Use of Cardiac Procedures in thethe Veterans Affairs Health System:Veterans Affairs Health System:

Effect of RaceEffect of Race

African American men after acute MI were less likely to undergo the following procedures:

Cardiac cath 33% PTCA 42% CABG 54%

JAMA 4/20/94, NEMJ 1993, JACC 1994

Effect of Race and Sex on Physicians Effect of Race and Sex on Physicians Recommendations for Cardiac Recommendations for Cardiac

CatheterizationCatheterization

Study design: 720 physicians viewed video tapes of actors presenting the same cardiac history and all having positive stress tests.

African American women were the least likely to be referred for cardiac catheterization.

NEJM 2/25/99

Missed Diagnoses of Acute Missed Diagnoses of Acute Ischemia in the ERIschemia in the ER

Risk of being sent home; Acute ischemia- 2 times higher among

African American patients. Acute MI- 4 times higher compared to

Caucasian patients. NEJM 4/20/00

Lessons From CanadaLessons From CanadaSocioeconomic Status and AccessSocioeconomic Status and Access to to

CareCare

In Ontario, despite Canada’s universal health care system, socioeconomic status had pronounced effects on access to specialized cardiac services as well as on mortality one year after acute myocardial infarction.

NEMJ 10/18/99.

WHAT CAN WE DO?WHAT CAN WE DO?

RETURN TO OUR ROOTS.

SELF HELP GROUPSSELF HELP GROUPS

ENCOURAGE HEALTHY LIFE STYLES DISEMMINATE INFORMATION GIVE EMOTIONAL SUPPORT

TOPICS TO DISCUSS TOPICS TO DISCUSS DURING PANEL DURING PANEL

QUESTIONS:QUESTIONS: HORMONE REPLACEMENT DIABETIC GOALS CHOLESTEROL GOALS, OPTIMAL

VERSUS NATIONAL GUIDELINES HYPERTENSION DRUG THERAPY

MYTHS BASED ON RACE

TOPICS TO DISCUSS TOPICS TO DISCUSS DURING PANEL DURING PANEL

QUESTIONS:QUESTIONS:

HORMONE REPLACEMENT DIABETIC GOALS CHOLESTEROL GOALS, OPTIMAL

VERSUS NATIONAL GUIDELINES HYPERTENSION DRUG THERAPY

MYTHS BASED ON RACE

FOOD FOR LIFEFOOD FOR LIFE

WHICH FOODS PROMOTE HEALTHY ARTERIES

WHICH FOODS PROMOTE DISEASE