2017 Women’s Health Conference

Body & Soul: Discovering a Healthy U

California Lutheran UniversityThousand Oaks

Janki Shah, MDDirector, Northwest Valley Women’s Heart Health ProgramUCLA Health Thousand Oaks

Heart Health For Women

Janki Shah, MD

Cardiovascular disease mortality trends for males and females (United States: 1979–2013).

Dariush Mozaffarian et al. Circulation. 2016;133:e38-e360

Copyright © American Heart Association, Inc. All rights reserved.

PresenterPresentation NotesCardiovascular disease mortality trends for males and females (United States: 1979–2013). Cardiovascular disease excludes congenital cardiovascular defects (International Classification of Diseases, 10th Revision [ICD-10] codes I00–I99). The overall comparability for cardiovascular disease between the International Classification of Diseases, 9th Revision (1979–1998) and ICD-10 (1999–2013) is 0.9962. No comparability ratios were applied. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

2003 – Time magazine realizes that heart disease is a woman’s “biggest

worry…”

2016 –AHA releases the first scientific statement on myocardial infarction in

women

Heart Disease in Women• Heart disease is the #1 killer of women

•1 out of 3 women, killing approximately one woman every 80 seconds!

•It claims more lives than ALL cancers combined!

•90% of women have one or more risk factors for developing heart disease.

• 2 out of 3 women who die of heart disease have NO warning signs!

• A woman is more likely to die in the first year after a heart attack than a man is.

PresenterPresentation NotesAn estimated 43 million women in the U.S. are affected by cardiovascular disease.

UNDERDIAGNOSED and UNDERTREATED

vs

CHD: Statistics for U.S. Women

1 in 3CHD deaths

1 in 31breast cancer deaths

Why Should Women Have Cardiovascular Screenings?

• Women have easy-to-miss symptoms.

• Half of women who present with a heart attack NEVER had prior warning symptoms.

• More WOMEN than men who have sudden cardiac DEATH had no prior symptoms.

• Women with heart disease and strokes have a worse prognosis than men.

• Women are treated differently

• Gender Bias

PresenterPresentation NotesLess cholesterol screening, medication Less use of aspirin and other appropriate medications during a heart attack Less medical therapy for prevention of second eventFewer referrals to cardiac rehabilitationFewer implantable cardioverter-defibrillators compared to men with the same recognized indications

Women’s Symptoms are Easy to Miss

Risk factors for Heart Disease in Women

RISK FACTORS

• Smoking

• Diabetes

• High cholesterol

• High blood pressure

• Obesity/Overweight

• Physical inactivity

• Family history

• Depression

• Stress

•SEX-SPECIFIC RISK FACTORS

•Pre-term delivery

•Gestational hypertension

•Pre-eclampsia

•Gestational diabetes

•Auto-immune disease

•Breast cancer treatment

•Polycystic ovarian syndrome

•Functional hypothalamic amenorrhea

•Menopausal status and hormone use

Risk Factor: Smoking• Smoking:

• Causes plaque to form in blood vessels• Reduces HDL (“good”) cholesterol• Increases blood pressure• Increases heart arrhythmias

• Smokers who have a heart attack are more likely to die and die suddenly (within an hour)

• Puts women who smoke at a much higher risk of developing cardiovascular disease

Risk decreases after quitting• 1/3 in 2 years • Equal to a non-smoker in 10-14

years

Risk Factor: Obesity

• In the United States:• 34% of adults are overweight• 34% are obese• 6% are extremely obese

• ~30% increase in heart disease risk for each five-unit increase in body mass index (BMI)

Body mass index (BMI) = kg/m2

• Under weight: BMI 25• Obesity: BMI => 30• Morbid Obesity BMI>= 40

PresenterPresentation NotesAccording to the World Health Organization, worldwide obesity has doubled since 1980 with 1.5 billion adults considered obese in 2008

Body Weight and CHD Mortality Among Women

P for trend< 0.001

Relative Risk of CHD Mortality Compared to BMI < 19

PresenterPresentation NotesSLIDE INFORMATION SOURCE: Manson JE, et al. (1995). Body weight and mortality among women. New England Journal of Medicine, 333, 677-685.

The participants in this part of the Nurses Health Study were 115,195 women free of diagnosed cardiovascular disease and cancer in 1976, who were followed until 1992 (1). This graph demonstrates mortality among non-smoking women at various BMI levels.The lowest mortality was seen in women who weighed at least 15% less than the U.S. average, and among those whose weight had been stable since early adulthood (1).

Low Risk* Diet is Associated with Lower Risk of Heart Attack in Women

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Diet Score by Quintile* Consumption of vegetables, fruit, whole grains, fish, legumes

1 = little consumption / 5 = high consumption

RelativeRisk of

MI*

*Adjusted for other

cardiovascular risk factors

PresenterPresentation NotesSLIDE INFORMATION SOURCE: Akesson A, et al. (2007). Combined effect of low-risk dietary and lifestyle behaviors in primary prevention of myocardial infarction in women. Archives of Internal Medicine, 167, 2122-2127.

In this population-based prospective cohort study of 24,444 postmenopausal women in Sweden, after 6.2 years of follow-up, a low-risk diet characterized by a high intake of vegetables, fruit, whole grains, fish, and legumes, as well as moderate alcohol consumption, physical activity, maintaining a healthy weight, and not smoking were associated with lower risk of myocardial infarction. A combination of all healthy behaviors was predicted to prevent 77% of myocardial infarctions in the study population. In this study, only 5% of women had all healthy behaviors (1).

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AHA recommendations for a Healthy Diet• 5 cups of fruits/vegetable per day

• Not canned, not frozen fruits with added sugars, not fruit drinks

• 3.5 ounces or more whole grains a day• Whole wheat flour, bulgur, oatmeal, whole cornmeal, brown rice

• 2-3 servings of fish/week• Preferably oily fish – have omega 3 fatty acids• Salmon, mackerel, trout, herring

• Under 450 calories added sugar/week• Avoid processed sugars and syrups, soft drinks, sugar-sweetened beverages

• Less than 1500 mg sodium/day

Why Exercise ?• Helps in weight loss.• Increases HDL (good cholesterol)• Decreases blood pressure.• How?

• Goal 150 minutes of moderate or 75 minutes vigorous exercise a week (or equivalent combination)

• Aerobic exercises (brisk walking, jogging, swimming) at least 5 times a week lasting 30 minutes.

• Target heart rate: 50-75 percent of your maximum heart rate.

Risk Reduction for CHD Associated with Exercise

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RelativeRisk

Walking

Any Physical Exercise

Quintile Group for Activity (MET - hr/wk)

PresenterPresentation NotesSLIDE INFORMATION SOURCE: Manson JE, et al. (1999). A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. New England Journal of Medicine, 341, 650-658.

Research has shown that, after controlling for other factors that affect heart disease risk, women who walk the equivalent of three or more hours per week have a risk of coronary events that is 35% lower than women who walk infrequently (1) .

Risk Factor: DiabetesCoronary Artery Disease Mortality in Women with Diabetes

Mortality Rate per 1,000

The risk of coronary heart disease was > 6-fold that of women without diabetes!

PresenterPresentation Notes SLIDE INFORMATION SOURCES:

Krolewski AS, et al. (1991). Evolving natural history of coronary artery disease in diabetes mellitus. American Journal of Medicine, 90, 56S-61S.National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). (2002).. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation, 106, 3143–3421.

This graph represents results from a study of 116,000 subjects, aged 30-55, who were followed for 8 years (1).

The risk of nonfatal and fatal CHD was > 6-fold that of women without diabetes (1).Risks for all forms of CVD are elevated in women with type 1 and type 2 diabetes (2).Women with diabetes with CHD are more likely to die than women without diabetes with CHD (2).

Risk Factor: Hypertension• Know Your Numbers: Classification of Blood Pressure

PresenterPresentation NotesBlood pressure is another risk factor with new guidelines. An optimal or ideal blood pressure is now considered < 120 on the top number (systolic blood pressure) over

Prevalence of high blood pressure in adults ≥20 years of age by age and sex (National Health and Nutrition Examination Survey: 2007–2010)

High blood pressure is very common as we get older

PresenterPresentation NotesPrevalence of high blood pressure in adults ≥20 years of age by age and sex (National Health and Nutrition Examination Survey: 2007–2010). Hypertension is defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, if the subject said “yes” to taking antihypertensive medication, or if the subject was told on 2 occasions that he or she had hypertension. Source: National Center for Health Statistics and National Heart, Lung, and Blood Institute.

Lifestyle Modifications to Reduce BPLifestyle Factor Recommendation Reduction in SBP (mmHg)

Weight reduction Maintain BMI 18.5-24.9 5-20 per 10 kg wt loss

DietDiet rich in fruits/veggies, low fat dairy, reduced saturated and total fat

8-14

Sodium Restriction

Benefits of Lowering Your Blood Pressure

• When you lower your blood pressure, you lower your risk of:

• Stroke by 40%• Heart Attack by 25%• Heart Failure by 50%

PresenterPresentation NotesKeeping blood pressure in the recommended range is important not only for heart disease prevention but also for stroke prevention. High blood pressure is a major factor in the development of congestive heart failure, a serious problem for women.

Cholesterol- Know Your numbers!

25

Stress and Heart Disease

New England Journal of Medicine

Cardiac Deaths and Fear: The Northridge earthquake

January 1994

January 1992

Day of the earthquake

January 1993

Numberof

Cardiac Deaths

January 1991

Numberof

Cardiac Deaths

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1998 World Cup Soccer Match

1 day afterDay of match 2 days after4 days after

3 days after

Increase in Heart Attacks in England after English soccer team loses to Argentina

British Medical Journal 2002;325:1439

PresenterPresentation NotesInsert video called “soccermatch edited m4V here

How to Reduce Stress• Diet: Increase antioxidants, limit stimulants/processed

foods

• Exercise: Cardiovascular and weight-bearing

• Mindfulness: Yoga/meditation/tai chi

• Counseling: target psychosocial triggers

Who Should Get a Cardiovascular Screening?

American College of Cardiology CLASS 1 recommendation:A global risk score should be obtained in ALL asymptomatic women

CALL TO ACTION!

• Schedule a heart screening • Advanced testing may reveal an increased risk of heart

disease and stroke, allowing for earlier detection and prevention!

• Follow The AHA’s Life Simple 7 program!

PresenterPresentation Notes, so detailed history taking, comprehensive physical examination, and possibly more advanced testing may be necessary to help reduce your risk

Life’s Simple 7

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Dr. Janki ShahUCLA Health Thousand Oaks100 Moody Court, Suite 200Thousand Oaks, CA 91360

Questions?

Thank you!

Slide Number 1Slide Number 2Heart Health For WomenSlide Number 4Slide Number 5Slide Number 6Slide Number 7Heart Disease in WomenCHD: Statistics for U.S. WomenWhy Should Women Have Cardiovascular Screenings? Women’s Symptoms are Easy to MissRisk factors for Heart Disease in WomenRisk Factor: SmokingRisk Factor: ObesityBody Weight and CHD Mortality Among WomenLow Risk* Diet is Associated with Lower Risk of Heart Attack in WomenAHA recommendations for a Healthy DietWhy Exercise ?Risk Reduction for CHD Associated with ExerciseRisk Factor: Diabetes�Coronary Artery Disease Mortality in Women with DiabetesRisk Factor: HypertensionPrevalence of high blood pressure in adults ≥20 years of age by age and sex �(National Health and Nutrition Examination Survey: 2007–2010)Lifestyle Modifications to Reduce BPBenefits of Lowering Your Blood PressureCholesterol- Know Your numbers!Stress and Heart DiseaseCardiac Deaths and Fear: The Northridge earthquakeIncrease in Heart Attacks in England after English soccer team loses to ArgentinaHow to Reduce StressWho Should Get a Cardiovascular Screening?CALL TO ACTION!Life’s Simple 7Questions?��Thank you!�