# Presentation: 261784

## Cardiovascular Disease in WomenModule I:Epidemiology

## Module I: Epidemiology 

**Statistics on Women and Cardiovascular Disease**
**Comparisons to Men**
**Age Differences Among Women**
**Racial and Ethnic Group Differences**

**Notes:**
GRAPHIC SOURCE:  Heart Disease and Stroke Statistics-2004 Update, American Heart Association.

This slide from the American Heart Association show mortality trends by gender.  While mortality in males has been steadily declining over the past 15-20 years, cardiovascular mortality for women has remained flat or increased slightly(1).

(1) Heart Disease and Stroke Statistics-2004 Update, American Heart Association. 

## Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sex                    NHANES III: 1988-94   

***Source:******	******CDC/NCHS © AHA , 2004***

**Note:****	****These data include CHD, CHF, stroke and hypertension.**

**Notes:**
GRAPHIC SOURCE:  Heart Disease and Stroke Statistics-2004 Update, American Heart Association.

Cardiovascular diseases are more prevalent in younger men.  By the age of 65, however, the prevalence of cardiovascular disease begins to be higher in women (1).

(1) Heart Disease and Stroke Statistics-2004 Update, American Heart Association.

**Notes:**
GRAPHIC SOURCE:  Heart Disease and Stroke Statistics- 2004 Update, American Heart Association.

Cardiovascular disease far outnumbers other major killers, claiming more lives than the next seven causes combined (1). 

It affects women of all ages.  As an example, over 10,000 women under age 45 suffer myocardial infarction every year (2) .

Although over 40% of women die of cardiovascular disease, more than half of women identify cancer (breast cancer or cancer in general) as their greatest health risk (3) .  

(1) Heart Disease and Stroke Statistics- 2004 Update, American Heart Association, page 2.
(2) Heart Disease and Stroke Statistics- 2004 Update, American Heart Association, page 6.
(3)  Mosca L, et al.  Tracking Women’s Awareness of Heart Disease. Circulation. 2004;109:573-579.

## Acute MI Mortality by Age & Gender 

**Notes:**
SLIDE INFORMATION SOURCE:  Vaccarino V. et al.  Sex-based differences in early mortality after myocardial infarction.  National registry of myocardial infarction 2 participants.  N Engl J Med 1999; 341(4): 217-225.

Based on national registry data including 155,565 women and 229,313 men enrolled between June 1994 and January 1998, , overall in-hospital mortality during hospitalization for myocardial infarction is 16.7% for women, compared to 11.5% for men(1)

Among persons less than 50 years of age, the rate of mortality for women is twice the rate of mortality for men (1).  

 In contrast, for persons over the age of 74 years, there is no statistically significant difference in mortality rates between women and men(1).

(1) Vaccarino V. et al.  Sex-based differences in early mortality after myocardial infarction.  National registry of myocardial infarction 2 participants.  N Engl J Med 1999; 341(4): 217-225.

## Congestive Heart Failure: Gender Differences

**Compared to men, women with heart failure are:**
**Older**
**More likely to have hypertension**
**More likely to have diabetes**
**More likely to have diastolic dysfunction **
**Knowledge of diastolic dysfunction prognosis and treatment is limited **
**Trials of congestive heart failure treatments have included mainly men**

***Stromberg & Martensson, Eur J Cardiovasc Nursing 2003***

**Notes:**
Slide Information Source:  Stromberg A and Martensson J. Gender differences in patients with heart failure. Eur J Cardiovasc Nuars, 2003. 2(1):7-18.

**Notes:**
Put Slide from Standardized Set Here

## Leading Causes of Death for White Males and Females                                      United States: 2001

***Source:******	******CDC/NCHS  © AHA 2004***

**Notes:**
GRAPHIC SOURCE:  Heart Disease and Stroke Statistics-2004 Update, American Heart Association. 

For white Americans, cardiovascular disease is the biggest killer of both men and women(1).

(1) Heart Disease and Stroke Statistics-2004 Update, American Heart Association . 

## Leading Causes of Death for Black or African-American Males and Females                                 United States: 2001

***Source:******	******CDC/NCHS © AHA 2004***

**Notes:**
GRAPHIC SOURCE:  Heart Disease and Stroke Statistics-2004 Update, American Heart Association . 

For persons identifying as Black or African-American, cardiovascular disease is the biggest killer of both men and women(1).
African American women are at highest risk of death from heart disease among all racial, ethnic, and gender groups (1).
African American women  have higher rates of many risk factors for heart disease, including obesity, physical inactivity, metabolic syndrome, diabetes, and hypertension than white women (1)
Among women of various racial and ethnic groups, African American women are less aware that smoking, high cholesterol, and family history increase their risk of cardiovascular disease (2)

(1) Heart Disease and Stroke Statistics- 2004 Update, American Heart Association.
Mosca L, et al.  Tracking Women’s Awareness of Heart Disease. Circulation. 2004;109:573-579.

## Age-Adjusted Death Rates for Coronary Heart Disease, Stroke, and Lung and Breast Cancer for White and Black Females                                      United States: 2001

***Source:******	******CDC/NCHS © AHA***

**Notes:**
GRAPHIC SOURCE:  Heart Disease and Stroke Statistics-2004 Update, American Heart Association . 

Women identifying as Black or African-American are more likely to suffer from coronary heart disease or stroke than white women(1).
African American women are at highest risk of death from heart disease among all racial, ethnic, and gender groups (1).
African American women  have higher rates of many risk factors for heart disease, including obesity, physical inactivity, metabolic syndrome, diabetes, and hypertension than white women (1)
Among women of various racial and ethnic groups, African American women are less aware that smoking, high cholesterol, and family history increase their risk of cardiovascular disease (2)

(1) Heart Disease and Stroke Statistics- 2004 Update, American Heart Association.
Mosca L, et al.  Tracking Women’s Awareness of Heart Disease. Circulation. 2004;109:573-579.

## African Americans

- African American women are at highest risk for death from heart disease among all race, ethnic, and gender groups
- African Americans with established CHD are at high risk for cardiac death
- The risk of death and morbidity from CHD attributable to HTN is higher in African Americans

**Notes:**

SLIDE INFORMATION SOURCE:  Heart Disease and Stroke Statistics- 2004 Update, American Heart Association; Mosca L, et al.  Evidence-based guidelines for cardiovascular disease prevention in women.  Circulation 2004; 109:672-693.; Third Report of the National Cholesterol Education Program (NCEP) Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), NIH, NHLBI, 2002.
African American women  have higher rates of many risk factors for heart disease, including obesity, physical inactivity, metabolic syndrome, diabetes, and hypertension than white women (1)

Among women of various racial and ethnic groups, African American women are less aware that smoking, high cholesterol, and family history increase their risk of cardiovascular disease (2)

(1) Heart Disease and Stroke Statistics- 2004 Update, American Heart Association.
Mosca L, et al.  Tracking Women’s Awareness of Heart Disease. Circulation. 2004;109:573-579.

## Leading Causes of Death for Hispanic or Latino Males and Females                     United States: 2001

***Source:******	******CDC/NCHS © AHA 2004***

**Notes:**
GRAPHIC SOURCE:  Heart Disease and Stroke Statistics-2004 Update, American Heart Association. 

Cardiovascular disease is the leading killer of persons identifying as Hispanic or Latino(1)
Latinas have higher rates of many risk factors for heart disease, including obesity, physical inactivity, metabolic syndrome, diabetes, and hypertension than white women (1)

(1) Heart Disease and Stroke Statistics- 2004 Update, American Heart Association.

## Latinas

- Latinas have higher rates of many risk factors for heart disease, including obesity, physical inactivity, metabolic syndrome, diabetes, and hypertension than white women
- It is estimated that over 50% of Latinas born in the year 2000 will develop diabetes.  CHD is the leading cause of death in diabetics.

**Notes:**
SLIDE INFORMATION SOURCES:  Heart Disease and Stroke Statistics- 2004 Update, American Heart Association., Narayan et al., “Lifetime Risk for Diabetes Mellitus in the United States” JAMA 2003. 290:  1884-1890. 

## Leading Causes of Death for Asian/Pacific Islander Males and Females  	 United States: 2001

- A   Dis. of the Heart, & StrokeB   CancerC   Accidents

- D	Chronic Lower Resp. Dis.                           E	Influenza and Pneumonia                               F	Diabetes Mellitus

***Source:******	******CDC/NCHS © AHA, 2004***

**Notes:**
GRAPHIC SOURCE:  Heart Disease and Stroke Statistics-2004 Update, American Heart Association. 

Cardiovascular disease is the leading killer of persons identifying as Asian/Pacific Islander(1)
Persons identified as “Asian/Pacific Islander” may belong to racial and ethnic groups at high risk of cardiovascular disease, such as South Asian Americans, or low risk of cardiovascular disease, such as Japanese Americans. More specific data are not available (1).

(1) Heart Disease and Stroke Statistics-2004 Update, American Heart Association 

## Asian Americans and Pacific Islanders

- There is limited information on the prevention and treatment of heart disease in Asian Americans and Pacific Islanders
- South Asians have been reported to have a high prevalence of heart disease at young ages, in part because of a high prevalence of metabolic syndrome

**Notes:**
SLIDE INFORMATION SOURCE:  Third Report of the National Cholesterol Education Program (NCEP) Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), NIH, NHLBI, 2002.

## Leading Causes of Death for American Indian/Alaska Native Males and Females                                           United States: 2001

***Source:******	******CDC/NCHS.***

**Notes:**
GRAPHIC SOURCE:  Heart Disease and Stroke Statistics-2004 Update, American Heart Association. 

Cardiovascular disease is the leading killer of persons identifying as American Indian or Alaska Native(1)

(1) Heart Disease and Stroke Statistics-2004 Update, American Heart Association 

## American Indians

- Cardiovascular disease rates vary among American Indian communities
- Unlike other ethnic groups, the incidence of CHD is increasing among American Indians

**Notes:**
SLIDE INFORMATION SOURCE:  Third Report of the National Cholesterol Education Program (NCEP) Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), NIH, NHLBI, 2002.

## Summary

**CVD claims more lives than next seven cause of death combined**
- Cardiovascular disease is the leading cause of death for African Americans, Latinos, Asian Americans, Pacific Islanders, and American Indians

**Notes:**
SLIDE INFORMATION SOURCE: Heart Disease and Stroke Statistics- 2004 Update, American Heart Association.

## Summary

**Mortality from CVD has decreased for men in the past 20 years, but has not changed for women**
- Over 10,000 women under age 45 suffer an acute myocardial infarction every year

**Notes:**
SLIDE INFORMATION SOURCE: Heart Disease and Stroke Statistics- 2004 Update, American Heart Association.