Cardiovascular Disease in Georgia Women

D. Stephen Goggans, M.D., M.P.H.

District Health Director – East Central

District

Georgia Department of Public Health

Senate Study Committee on Women's Adequate Healthcare

October 6, 2015

Cardiovascular Disease in Georgia

• Cardiovascular Disease (CVD) includes:

– Heart Attacks and Angina, Heart Failure

– Stroke and Transient Ischemic Attacks

– Peripheral/Aortic Artery Disease

• Cardiovascular Disease in Georgia

CVD is the leading cause of death, and the

leading cause of death for women

29 women die each day from CVD

including 11 from heart disease, 6 from stroke

Source: BRFSS 2013

Key CVD Risk Factors in Women

• Age over 55 years

• Family history of early

CVD

• Abnormal lipids**

• Diabetes mellitus**

• Smoking**

• High Blood Pressure

• Obesity

• Prediction

• Primary prevention

• Secondary prevention

(lipids, blood

pressure, smoking)

1Age-Adjusted to the 2000 Standard Million.

Cardiovascular = ICD10 I00-I78 (ICD9 390-434, 436-448)

Sources: Centers for Disease Control & Prevention, CDC WONDER, http://wonder.cdc.gov/

Online Analytical Statistical Information System (OASIS). Georgia Department of Public Health, Office of Health Indicators for Planning (OHIP). http://oasis.state.ga.us/

DPH Chronic Disease Prevention Section Works to

Support the Creation of Healthier Communities

through Collective Impact Approaches

Community

Public Health

System

Clinical

Success Factors

1. Partnerships

2. Shared Goals

3.Communication

OBESITY

Obesity in Georgia • 66% of adults are either

overweight or obese

73% males

59% females

• Obesity increases risk of

death from CHD by a

factor of 4

• Independent as well as

associated with other

factors

Geographic Trends in Obesity, Georgia

1993-1996 2004-2006 2000-2003 1997-1999

Percent of obese adults:

< 10% 10-14% 15%-19% 20-24% 25-29% 30%+

Source: Georgia BRFSS

2007-2009

County Health Rankings (RWJ)

Health Outcomes Health Factors

www.countyhealthrankings.org

Childhood Obesity Prevention Priority

• Participation in the Georgia

Shape Initiative – 29 additional schools have been selected for

the Shape Schools Grantee Program

– Growing Fit Curriculum used to train over 29

early care education centers in evidence-

based nutrition and physical activity policies.

100 more planned for this year.

– 3 Health Districts were selected to

implement strategies to promote nutrition

and physical activity through policy,

systems and environmental change in

schools, early childhood education centers

and worksites. Funded Health Districts include

South (Valdosta), Southeast (Waycross) and

Coastal (Savannah).

DIABETES

Diabetes Mellitus (DM) in Georgia

• Diabetes is an extremely

powerful risk factor

• “CHD Equivalent”

• Diabetes prevalence is

increasing

• In women, DM brings a

higher risk of CHD than

in men

Diabetes Prevalence Trend 2004-2013

Diabetes Interventions in Georgia

• Diabetes Prevention Program

– Intensive program focused on lifestyle changes – weight loss,

diet changes and exercise – to prevent development of DM

in at-risk individuals

• Diabetes Self-Management Education (DSME)

– Increase the number of accredited DSME sites in the state,

including via teleheath

• Diabetes Screening and Nurse Protocol

TOBACCO

Tobacco Use in Georgia Women 2011-2013

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

21.4 20.2 18.5

14.0 14.3 12.8

0

5

10

15

20

25

2011 2012 2013

Perc

en

t (

%)

White Females Black Females

Smoking

• Associated with HALF of CHD events in

women

• Risk occurs with even minimal use (2.4X

chance of event for 1 ½ cigarettes/day)

• Risk drops off quickly with quitting

– Mostly gone in 2-3yrs

Tobacco Use in Georgia

Interventions

• Establish comprehensive smoke free policies

• Promote cessation and assist tobacco users to quit

– Making cessation services fully accessible to tobacco users

• Prevent initiation of tobacco use

• Fund hard hitting mass-media campaigns

2012-2013 Georgia

Tobacco Quitline Evaluation

7 month follow-up survey

826 people

74% long term tobacco users

– 2/3 used pharmacotherapies; associated with 6 month quit rates

– 78 percent only used GTQL services; 91 percent were satisfied with

GTQL

– Among those who did not quit, less tobacco dependence

Duration without Tobacco Percent of Respondents

24 hours or longer 41 percent

7 days or longer 37 percent

30 days or longer 31 percent

OTHER RISK FACTORS

Other Risk Factors

Hypertension (HTN)

• Extremely common

• High blood pressure is a

stronger risk for CHD in

women than men

• HTN is a particularly

strong risk for stroke

• Treatment regimens use

the same medications

Abnormal Lipids

• Women have more risk

from “good” (HDL)

cholesterol being low

• Lipoprotein (a) and Tri-

glycerides have more

impact

• Differences affect testing;

Treatment regimens use

the same medications

Cardio Metabolic Syndrome Priority Area

Georgia. Working on Health.

• Goal is to reduce the burden of obesity, heart disease, and diabetes in Georgia’s workforce

• Target is to reduce hospitalizations for Type 2 diabetes and hypertension by 25% by 2019

• Multiple, evidence-based interventions at different levels in selected geographical locations— – Home

– Schools

– Worksite

– Clinical • Diabetes Self-Management

Education

• Team based care for hypertension

– Community

Contact Information:

East Central Health District

1916 North Leg Road

Augusta, GA 30909

Online: www.ecphd.com

Georgia Department of Public Health

2 Peachtree Street, NW, 16th Floor

Atlanta, Georgia 30303

Email: Chronic.Disease@dph.ga.gov

DPH online: www.dph.ga.gov

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