pdnational black women healthproject
TRANSCRIPT
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Women and Heart Disease Women and Heart Disease
Unequal Burden of DiseaseUnequal Burden of Disease..
Patricia Davidson, MD.
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Heart Disease Mortality Among Heart Disease Mortality Among WomenWomen Per 100,000 PopulationPer 100,000 Population
0
50
100
150
200Native AmericanHispanicAfrican American Asian American White
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Atherosclerosis/ hardened Atherosclerosis/ hardened arteries:arteries:
PREVENTABLE
BEGINS IN THE FETUS IF THE MOTHER HAS
HIGH CHOLESTEROL OR THE FIRST DECADE OF LIFE NOT A NATURAL PROCESS OF AGING
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RISK FACTORS:RISK FACTORS:
HOW DO THEY DIFFER?
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Classification of Overweight Classification of Overweight Based on Body Mass IndexBased on Body Mass Index
Overweight >20 BMI Obese >30 BMI
BMI= kg/m2 NHANES 111
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Overweight WomenOverweight Womenby Ethnicityby Ethnicity
African American 68.3%
Asian 10.1%
White 46.8%
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Percent of Overweight Hispanic Percent of Overweight Hispanic WomenWomen
Hispanic 33%
Mexican 69.3%
Puerto Rican 40.2%
New immigrant 25%
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DiabetesDiabetesPrevalence Among WomenPrevalence Among Women
MIDDLE AGED OLDER
Native Am. 21.8 31.8 Mexican Am. 7.7 29.9 African Am . 14.5 25.4 White 8.5 14.5
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DiabetesDiabetes
DM may explain the increased risk of CAD in African American women.
Insulin resistance contributes to the development of CAD long before clinical DM.
Insulin resistance is more prevalent in African American women.
NHANES 1
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DiabetesDiabetes
African American women develop DM at a lower BMI than other women.
DM is increasing fastest in ethnic groups.
80% of children diagnosed are obese. Screening should begin by age 10.
NHANES 1
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ExerciseExercise
PHYSICAL ACTIVITY of FEMALE ADOLESCENTS ( %)
Vigorous moderate sports
Hispanic 45.2 27.6 27.3
Afr. Am. 41.2 26.4 34.9
White 56.7 16.8 47.1 MMWR 9/27/98
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Percent of High School Percent of High School StudentsStudents SmokingSmoking
0
5
10
15
20
25
30
35
40
WhiteW
Af.AmW
Hisp.W
White W
White M
Af.Am W
Af.Am M
Hisp. W
Hisp. M
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Racial and Gender Referral Racial and Gender Referral BiasBias
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Rates of Bypass Surgery (CABG)Rates of Bypass Surgery (CABG)
Per 10,000 Medicare Patients:
White men 40.4 White women 16.2 African American men 9.3 African American women 6.4
JAMA 3/18/92
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Variation in Use of Cardiac Procedures in Variation in Use of Cardiac Procedures in thethe Veterans Affairs Health System:Veterans Affairs Health System:
Effect of RaceEffect of Race
African American men after acute MI were less likely to undergo the following procedures:
Cardiac cath 33% PTCA 42% CABG 54%
JAMA 4/20/94, NEMJ 1993, JACC 1994
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Effect of Race and Sex on Physicians Effect of Race and Sex on Physicians Recommendations for Cardiac Recommendations for Cardiac
CatheterizationCatheterization
Study design: 720 physicians viewed video tapes of actors presenting the same cardiac history and all having positive stress tests.
African American women were the least likely to be referred for cardiac catheterization.
NEJM 2/25/99
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Missed Diagnoses of Acute Missed Diagnoses of Acute Ischemia in the ERIschemia in the ER
Risk of being sent home; Acute ischemia- 2 times higher among
African American patients. Acute MI- 4 times higher compared to
Caucasian patients. NEJM 4/20/00
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Lessons From CanadaLessons From CanadaSocioeconomic Status and AccessSocioeconomic Status and Access to to
CareCare
In Ontario, despite Canada’s universal health care system, socioeconomic status had pronounced effects on access to specialized cardiac services as well as on mortality one year after acute myocardial infarction.
NEMJ 10/18/99.
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WHAT CAN WE DO?WHAT CAN WE DO?
RETURN TO OUR ROOTS.
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SELF HELP GROUPSSELF HELP GROUPS
ENCOURAGE HEALTHY LIFE STYLES DISEMMINATE INFORMATION GIVE EMOTIONAL SUPPORT
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TOPICS TO DISCUSS TOPICS TO DISCUSS DURING PANEL DURING PANEL
QUESTIONS:QUESTIONS: HORMONE REPLACEMENT DIABETIC GOALS CHOLESTEROL GOALS, OPTIMAL
VERSUS NATIONAL GUIDELINES HYPERTENSION DRUG THERAPY
MYTHS BASED ON RACE
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TOPICS TO DISCUSS TOPICS TO DISCUSS DURING PANEL DURING PANEL
QUESTIONS:QUESTIONS:
HORMONE REPLACEMENT DIABETIC GOALS CHOLESTEROL GOALS, OPTIMAL
VERSUS NATIONAL GUIDELINES HYPERTENSION DRUG THERAPY
MYTHS BASED ON RACE
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FOOD FOR LIFEFOOD FOR LIFE
WHICH FOODS PROMOTE HEALTHY ARTERIES
WHICH FOODS PROMOTE DISEASE
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