# Presentation: 633301

## Health Care Facilitator Program at Lawrence Berkeley Laboratory 

**All-Employee Brown-Bag**
**February 1, 2006**
**Perseverance Hall Conference Room**

## Cardiovascular Disease – An Equal Opportunity?

**Facts, Figures and Statistics**

**Cathy Luginbill, RN, MS, CNS**
**Cardiac Rehabilitation **
**Alta Bates Summit Medical Center**** **

## The Problem

**Cardiovascular Disease is the leading cause of death in the United States. **
**1 in 3 Americans have some form of Cardiovascular Disease.**

## 1900 - 2003 Deaths from Cardiovascular Disease 

- CDC

**Notes:**
71 million Americans have one or more kinds of Cardiovascular disease.

## 2003 Cardiovascular Deaths

- CDC/NCHS and NHLBI

**Notes:**
HF – heart failure

## 2003 CVD vs Cancer Deaths

- CDC/NCHS and NHLBI

## 2003 Deaths from CVD vs Other Diseases

- All Ages

- < 85

- >85

- CDC/NCHS and NHLBI

**Notes:**
COPD – Chronic Obstructive Pulmonary Disease

## Cardiovascular, Breast and Lung Cancer Deaths

- AHA FACTS 2002

## 2003 Leading Causes of Death - % total deaths

**A Total CVD**
**B Cancer**
**C Accidents**

**D Chronic Lower Respiratory Diseases**
**E Diabetes Mellitus**
**F Alzheimer’s Disease**

## The Gender Difference in Cardiovascular Disease

**There is a disparity in the ****incidence**** and ****death**** due to CVD between genders.**
**Slightly lower incidence of CVD  in  women but they have a higher % CVD death rate. **

## 1979 to 2003 Gender Differences in Deaths from CVD

- CDC/NCHS and NHLBI

## 2002 Prevalence of Cardiovascular Disease

- NHANES: 2003

## 1999 - 2002 Prevalence of Coronary Heart Disease

- CDC/NCHS and NHLBI

## 1999- 2002Prevalence of Stroke

- CDC / NCHS

## 1999 - 2002 Prevalence of Heart Failure

- CDC/NCHS and NHLBI NHANES

## 2002 Prevalence of Angina 

**Notes:**
NH W – Non-Hispanic White
NH B – Non-Hispanic Black
H - Hispanic

## Anginal Presentation

**Men**
**Mid-chest - 60%**
**Neck/Jaw/Throat-50%**
**Dizziness 30 %**
**Arm / shoulder pain-25%**
**Shortness of breath - 20%**
**Nausea/vomiting**
**Unusual fatigue**
**Sweating**
**Arm/shoulder/hand**

**Women**
**Shortness of breath - 50%**
**Nausea / vomiting - 35%**
**Mid-chest pain - 30%**
**Abdominal / mid-back **
**Neck / Jaw /Throat- 25%**
**Dizziness - 20%**
**Unusual fatigue**
**Sweating**
**Left arm / hand**
**Arm / shoulder pain**
**Impending doom**

## Gender Disparity of Care

**43%  women vs 38 % men die of CVD annually    (~ 500,000 vs 440,000).**
**38% women vs 25% men will die within 1 year of their first heart attack.**
**35% of women vs 18% of men who have a heart attack will have another one in 6 years.**
**335,000 people a year die of CHD from sudden death. **
**About half of all deaths from CHD — more than 930 Americans each day.**

**Notes:**
CVD – cardiovascular disease
CHD – coronary heart disease

## Gender Disparity of Care

**46% of women vs  22% of men heart attack survivors will be disabled w/in 1 year.**
**Women are 2x more likely to die after cardiac bypass.**
**Women are less likely to receive Beta Blockers, Ace Inhibitors, ASA, Statins after a heart attack.**
**Women are less likely to be admitted from the ER for cardiac problems.**
**Women are less likely to undergo testing for CVD, including Stress tests, EKGs and blood work.**

## Gender Disparity of Care

**Though more women than men die of heart disease each year, women receive:**
**33% fewer angioplasties and stents**
**28% implanted defibrillators **
**36% fewer open heart operations**
**Fewer heart transplants**

## Risk Factors 

**Non-Modifiable**
**Age (> 65 not as important)**
**Ethnic background**
**Family history (< 60)**
**Gender (at birth)**

**Modifiable**
**Smoking**
**Hypertension**
**Unhealthy lipids**
**Diabetes **
**Sedentary lifestyle**
**Overweight / Obesity**
**Depression**

## Smoking 

- MMWR, Vol. 54, (44); Nov. 11, 2005, CDC/NCHS

## Smoking - Intervention

**37% of Caucasian women stated they received any MD counseling to quit smoking.**
**50% of Caucasian men stated they received any MD counseling to quit smoking. **
**All women and minorities of both genders received less MD counseling to quit smoking.**
**Women and minorities received less medication to help quit smoking.**

- Silagy C,, *et al*.. *BMJ* 1992;**305**:871-874

## People who were heavier, older, in poorer health, and minority were less likely to receive cessation counseling. 

Having insurance and a regular source of care were also associated with a greater likelihood of being counseled.

**Having insurance and a regular source of care were also associated with a greater likelihood of being counseled.**

- Kansas Heart Institute  June 2002

## Smoking

**When a woman quits smoking by the age of 39, she will add 3 years to her life.**
**When a man quits smoking by the age of 39, he will add 5 years to his life.**
**Smoking - greater negative affect on HDL in women than in men.**
**Smoking - greater influence in developing heart disease in women than in men.**

- Njolstad I., et al. Circ. 1996; 93:450-456.

## 1999 - 2002 High Blood Pressure (Hypertension - HTN)

- CDC/NCHS and NHLBI. NHANES 2002

## Extent of Awareness, Treatment and Control of High Blood Pressure

## Prevalence Trends for High Blood Pressure

## Leading cause of stroke in men and women. 

Women - more severe symptoms than men with similar BPs over same amount of time. 

HTN is 2x-3x more common in women taking oral contraceptives, esp. those who are older and obese, than women not taking them.

HTN kills more women than men.

HTN leads to heart failure more often in women than men.

**Women - more severe symptoms than men with similar BPs over same amount of time. **
**HTN is 2x-3x more common in women taking oral contraceptives, esp. those who are older and obese, than women not taking them.**
**HTN kills more women than men.**
**HTN leads to heart failure more often in women than men.**

**High Blood Pressure Facts**

## 1999 - 2002 LDL Cholesterol of 130 mg/dL or Higher

- CDC/NCHS and NHLBI. NHANES 2002

## 1999 - 2002 HDL Cholesterol < 40 mg/dL

- CDC/NCHS and NHLBI. NHANES 2002

## HPS - Statin vs Placebo in High Risk Patients

**HPS - Statin vs Placebo in High Risk Patients**

## Lipid Therapy 

**Women are less likely to be told they have unhealthy lipids.**
**Women are less likely to receive lipid lowering medication.**
**Lower HDL in men is more atherogenic than in women.**
**Women are less likely to continue with their medication if cost is an issue.**

- Berra, Kathy, MSN, ANP.Journal of Cardiovascular Nursing. 14(2):59-78, January 2000.

## Women are less likely to have their doctors renew their medication once their lipid profile is acceptable. 

Women’s lipid profile improved greater than men’s with the same amount of exercise and no change in diet.

**Women’s lipid profile improved greater than men’s with the same amount of exercise and no change in diet.**

## 1999- 2002Diabetes

- CDC/NCHS and NHLBI. NHANES 2002

## 1995 Diabetes and Heart Disease

## Diabetes Facts

**75% to 80% diabetics will die from CVD.**
**Diabetic women are 5-7 times more likely to die of CVD than diabetic men.**
**Diabetic women have a 3x higher risk of dying from a heart attack than non-diabetic women.**

## 1994 - 2004 Leisure-Time Physical Inactivity

- MMWR, Vol. 54, No. 39, Oct. 7, 2005, CDC. BRFSS: 1994, 2000, 2004

## Physical Inactivity

**38 % of heart disease deaths in women are associated with physical inactivity.**
**35% for men.**
**1989 estimate that physical inactivity cost the nation $5.7 billion due to hospitalizations and other related health care costs.**

## 1960 - 2002 Obesity

- NHES, 1960-62; NHANES, 1971-74, 1976-80, 1988-94 and 1999-2002

- Obesity is defined as having a BMI of 30.0 or greater.

## Prevalence of Overweight / Obesity

## Obesity Facts

**Obesity**** ****is an independent predictor of coronary**** ****atherosclerosis.**
**Overweight (24 BMI) women had a 50% increase in risk of nonfatal or fatal coronary heart**** ****disease, **
**Overweight (26-28) men had a 72% increased risk.**

- Manson JE., et al. *N Engl J Med.* 1995;333:677-685.

## Obesity Facts

**Risk of death from heart disease was 43% higher for “low risk” obese people. **
**In “moderate-risk” group, the risk of death from heart disease was 2.1 times higher for obese people.**
**Risk of hospitalization for “low risk” obese people were 4.2 times greater than “normal weight” low risk people. **

- Deepak Bhatt, M.D. JAMA, Jan. 11, 2006.

## 1998 - 2002Prevalence of Depression 

**Annually **
**12% women are diagnosed with depression**
**7% men are diagnosed with depression**
**6.5% (6.7 million) women have major depression (1998)**
**3.3% (3.2 million) men have major depression (1998)**

## Depression

**Depressed women:**
**73%  more likely to develop heart disease than non-depressed women.**
**50% increase in death after a heart attack.**
**2x more likely to have metabolic syndrome.**
**	**
**Depressed men:**
**71% more likely to develop heart disease  than non-depressed men.**
**240% increase in death from heart disease.**
**No any increase in metabolic syndrome.**

- AHA June 2005

## Women and Depression

**50% more likely to have high blood pressure. **
**60% more likely to have a history of stroke or angina.**
**Women with risk factors for CAD, such as smoking, obesity, sedentary, HTN, and diabetes, had a 20%-50% higher risk of having depression.**

**Notes:**
CAD – Coronary Artery Disease

## Summation

**CVD kills more Americans than all other diseases combined.**
**Women receive fewer therapies and risk factor counseling than men.**
**Survival for both men and women would increase with risk factor intervention. **
**Education of medical community and the general public is needed to reduce the incidence of morbidity and death from cardiovascular disease.**

## Thank you!

**February 3 is American Heart Association – **_**Wear Red Day**_
**In recognition of **
_**Cardiovascular Disease in Women**_