Health Care Facilitator Program at Lawrence Berkeley Laboratory

All-Employee Brown-BagFebruary 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

0

100

200

300

400

500

600

700

800

900

1900 10 20 30 40 50 60 70 80 90 00

Years

Dea

ths

in T

ho

usa

nd

s

CDC

2003 Cardiovascular Deaths

CDC/NCHS and NHLBI

2003 CVD vs Cancer Deaths

5 4

282338

3 4 15 50 9517 46 80

138

911

141 16780

555

0100

200300

400500600

700800

9001,000

<25 25-34 35-44 45-54 55-64 65-74 75-84 85+ Total

Dea

ths

in T

ho

usa

nd

s

CVD Cancer

CDC/NCHS and NHLBI

2003 Deaths from CVD vs Other Diseases

0

200,000

400,000

600,000

800,000

1,000,000

Alzheimer

COPD

Cancer

Other CVD

Stroke

Heart Disease

All Ages < 85

>85

CDC/NCHS and NHLBI

Cardiovascular, Breast and Lung Cancer Deaths

493,623

41,51467,542

0

100,000

200,000

300,000

400,000

500,000

600,000

Deaths

CVDBreast CancerLung Cancer

AHA FACTS 2002

2003 Leading Causes of Death - % total deaths

427

287

68 6035

484

268

66 45 39

0

100

200

300

400

500

A B C D E A B D F E

MalesFemales

A Total CVDB CancerC Accidents

D Chronic Lower Respiratory DiseasesE Diabetes MellitusF Alzheimer’s Disease

The Gender Difference in Cardiovascular Disease

There is a disparity in the incidenceincidence and deathdeath 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

400

420

440

460

480

500

520

79 80 85 90 95 00 03

Years

Dea

ths

in T

hous

ands

Males Females

CDC/NCHS and NHLBI

2002 Prevalence of Cardiovascular Cardiovascular DiseaseDisease

11.222.9

36.2

86.4

52.9

68.577.8

6.217.6

36.6

56.5

75.0

0102030405060708090

100

20-34 35-44 45-54 55-64 65-74 75+

Ages

Pe

rce

nt

of

Po

pu

lati

on

Males Females

NHANES: 2003

1999 - 2002 Prevalence of Coronary Heart Coronary Heart DiseaseDisease

0.01.4

3.0

16.8

0.31.6

3.6

11.611.5

6.3

10.3

0.20

5

10

15

20

20-34 35-44 45-54 55-64 65-74 75+

Ages

Per

cent

of P

opul

atio

n

Men Women

CDC/NCHS and NHLBI

1999- 2002Prevalence of StrokeStroke

1.1

3.1

6.6

11.5

0.41.2

12.0

0.3 0.82.1

3.0

6.3

0

2

4

6

8

10

12

14

20-34 35-44 45-54 55-64 65-74 75+

Ages

Per

cent

of P

opul

atio

n

Men Women

CDC / NCHS

1999 - 2002 Prevalence of Heart FailureHeart Failure

5.8 6.2

9.8

1.50.3 0.5

1.8 2.3

10.9

4.1

0.40.3

0

2

4

6

8

10

20-34 35-44 45-54 55-64 65-74 75+

Ages

Per

cen

t o

f P

op

ula

tio

n

Men Women

CDC/NCHS and NHLBI NHANES

2002 Prevalence of AnginaAngina

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Angina Angina Angina

NH W MaleNH W FemaleNH B MaleNH B FemaleH MaleH Female

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.

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

24.120.4

23.920.218.9

1517.811.3

33.437.3

0

10

20

30

40

Men WomenPe

rce

nt

of

Po

pu

lati

on

NH White NH Black

Hispanic Asian

American Indian or Alaska Native

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.

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)

11.121.3

34.1

5.8

55.5

74.0

46.6

60.969.2

18.1

34.0

83.4

0

20

40

60

80

100

20-34 35-44 45-54 55-64 65-74 75+

Ages

Per

cent

of P

opul

atio

n

Men Women

CDC/NCHS and NHLBI. NHANES 2002

Extent of Awareness, Treatment and Control of High Blood Pressure

62.9

48.6

29.8

55.4

29.8

49.8

34.9

17.3

70.3

01020304050607080

Awareness Treatment Controlled

Pe

rce

nt

of

Po

pu

lati

on

NH Whites NH Blacks Mexican Americans

Prevalence Trends for High Blood Pressure

28.4

40.4

26.7 27.825.6 22.9

37.5 38.2

26.9 25.027.5

43.4

01020

304050

NHWhite-

Only Men

NHWhite-Only

Women

NH Blackor AAMen

NH Blackor AA

Women

MexicanMen

MexicanWomenP

erce

nt

of

Po

pu

lati

on

1988-94 1999-02

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.

High Blood Pressure Facts

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

43.1 43.8

36.0

43.7

35.8 36.9 34.531.3

0.0

10.0

20.0

30.0

40.0

50.0

TotalPopulation

NH Whites NH Blacks MexicanAmericans

Pe

rce

nt

of

Po

pu

lati

on

Men Women

CDC/NCHS and NHLBI. NHANES 2002

1999 - 2002 HDL Cholesterol < 40 mg/dL

33.6 34.5

22.7

34.4

12.6 12.4 11.315.4

05

10152025303540

Total NH Whites NH Blacks MexicanAmericans

Pe

rce

nt

of

Po

pu

lati

on

Men Women

CDC/NCHS and NHLBI. NHANES 2002

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.

1999- 2002Diabetes

6.2

4.7

10.3

12.6

10.411.3

0

2

4

6

8

10

12

14

Men Women

Per

cent

of P

opul

atio

n

NH Whites NH Blacks Mexican Americans

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

45.7

25.6

42.4

27.026.4

34.237.5

25.0

34.428.3

44.8

31.5

36.3

22.2

28.7

38.7

26.330.9

38.334.1 31.1

18.4

32.5

20.4 23.8 21.6

33.939.6

24.031.8

05

101520253035404550

Per

cen

t o

f P

op

ula

tio

n

1994 2000 2004

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

12.2 12.8

20.6

28.1

34.0

15.710.7

16.8 17.1

26.0

0

10

20

30

40

Men Wom en

Per

cent

of P

opul

atio

n

1960-62 1971-74 1976-80 1988-94 1999-2002

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

62.9

27.949

77.2

28.2

69.4

30.7

57.2

27.3

73.1

38.4

71.7

0102030405060708090

NH Black Male NH Black Female NH White MaleNH White Female Hispanic Male Hipanic Female

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 - 2002Prevalence 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.

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 DayWear Red DayIn recognition of

Cardiovascular Disease in Cardiovascular Disease in WomenWomen