Ischemic Heart Disease and Women

One of the many amazing (and distinguished) cardiologist I am fortunate to know is Dr. Noel Bairey Merz. Read more about her here. She and her colleagues in their 2009 article (see here) posit that the female presentation of disease may be due, in part to ischemia presenting differently in women (as compared to men)

In a rudimentary perspective, ischemia is often viewed as obstruction (due to atheromatous plaques and sticky platelets.)

 As the diameter of the vessel becomes more compromised and when demand for blood flow goes up (e.g. exercise), the mismatch of needed blood to tissues and that delivered results in pressure, pain or symptoms.
The clogged vessel approach may be true for some people (men and women) but it does not explain why women (with cardiovascular risks and normal catheterizations) respond better to treatment similar to those with obstructive disease.
The endothelial response of illness in ischemia, may be in part a reason why women, vs men experience a)no symptoms (yet have disease); b) 'different' symptoms - fast heart rate, GI upset, profound fatigue and c) die at higher numbers than their male counterparts.
So here again, we have the opportunity that sex and gender medicine can present inroads to the pathophysiology of ischemic heart disease that is accurate for both women and men - but we are still early in the game. Read more in the article link above and search the blog for other useful resources and stats.

For the latest guidelines check out Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update overseen by Lori Mosca, MD, MPH, PhD and Professor of Medicine and Preventive Cardiology at Columbia.

Two of our Drexel Heart Health Medicine experts contributed to this - Dr Katherine Sherif Associate Professor of Medicine and Director of the Center for Women's Health and Dr Ellie Kelepouris, Professor of Medicine, Section Chief of Nephrology and Vice Chair for Medical Education




Check out more info at : http://whepducom.blogspot.com/2010/08/heart-health-and-women.html
http://whepducom.blogspot.com/2011/08/female-pattern-of-heart-disease.html
http://whepducom.blogspot.com/2012/02/assessing-risk-and-still-promoting-hope.html

The Female Pattern of Heart Disease

Welcome back! Some day, heart disease will not be the biggest killer of people in the U.S. And someday, despite higher risks in men - similar or fewer (rather than more) women will die of heart related deaths.
For this year, I'm trying something a bit different - but I will rely on your feedback to continue with it.
There exists a different way to show material called Prezi. I'm using this as a resource session / lecture review reinforcer to help you 'at a glance' review our time together.

So, here is the link http://prezi.com/hiu-zxeatihs/sex-gender-and-cardiac-disease/
Check it out and let me know if it is useful - these are pretty labor intensive so I need to know if  they are value added or not.

Heart Health and Women

Cardiac disease is an excellent example of sex/ gender health disparities. Cardiac disease is not unique in women - it is the number one killer of men and women in the US. Women fear dying of breast cancer, but die most of heart disease. So, how is it a disparity? Since 1984, more women have died of heart disease as compared to men (even though it occurs in men and usually ten years earlier!)

DIFFERENT EMPHASIS ON RISK FACTORS - The heart story does not focus on different risk factors - rather different importance in risk factors. For example, the ten year - or 'female advantage' in heart disease is lost if a women is a Diabetic. It's lost if she's a smoker. It's also gone when menses stops (surgically or naturally.)
DIFFERENT WAYS IT CAN PRESENT - Heart related diseases can present differently in women. Yes, women can have the 'classic' findings of obstructive heart disease as men - exertional chest pressure that radiates down the arm and is relieved with rest. But they can have other findings that may be viewed as atypical - yet are typical for women: unexplained fast heart beat (tachycardia); nausea; unexplained fatigue; inability to do housework or typical tasks (esp seen in elderly women) and even more alarming, 1 in 4 women may not have any complaints at all! Thus, we need to screen EVERYONE for heart risk (high, medium and low) and evaluate appropriately.
DIFFERENT THRESHOLDS TO PREVENT AND TREAT - Although, heart health awareness are creating change, women still have lower rates of screening for lipids and heart health as compared to their male counterparts. A well known study created vignettes of 'classic' cardiac symptoms and changed the ethnicity (white versus black) and gender. The scripts were exactly the same. Physicians most likely recommended cardiac catheterization to men over women patients. Another 2007 study found that physicians still intervene less with women and heart disease.
SO WHAT SHOULD WE DO? - Collectively and personally, we all need to be more aware of heart health risk factors - for clinicians as well as for patients be they children, men or women. Getting into the risk assessment habit (high, medium, low and optimal) for everyone helps overcome the selective focus of missing half of the population.

A Sampling of Great Web Resources
 Our webpage (Women's Health Education Program)
 Women’s Health Initiative
 DHHS Office of Women’s Health
 Food information planning site Mypyramid.gov Want to know how many calories you eat? What's in the food that you love? Check this site out.
 Society for Women’s Health Research
 The Heart Truth: Resources for health professionals (videos of patients; patient cases and slides)
 NHBLI: National Heart Blood Lung Institute (great resources on heart health)
 Video on taking a heart health history and the role of gender and ethnicity in heart health risk
– Gender and Ethnic Medicine Cardiac Disease and Women

Reports
– IOM Report Sex Matters 2001 Evidence based report highlighting the difference that sex/gender makes in health.
– Heart Disease and Stroke Statistics-2010 Update, American Heart Association. A ton of great graphs and info here.
– HRSA Women's Databook - each years data book has useful health information on various topics.
Other
 -Sentinel article on heart health and women  Evidence-based guidelines for cardiovascular disease prevention in women L Mosca, LJ Appel, EJ Benjamin, K Berra, N … - Circulation, 2004
-CDC BMI Online Calculator