What is the largest killer of women (In the US)?
How do women's expectations of illness compare?
Improving, but still skewed. Breast cancer incidence overstated.
Give some examples of how physicians' perceptions can reduce quality of CVD care in women.
How do women's own perceptions contribute to this?
Women are less likely to be referred for testing or surgery, are less likely to receive medication, and are referred later.
Women are more likely to delay seeking care, may have been misinformed about their symptoms, and may not recognize the atypical signs.
Try to recall some of the 9 major risk factors for MI found in the INTERHEART study.
High waist-hip ratio
Low physcial activity
Low/no alcohol use
How can stress contribute to heart disease?
Stress (eg marital) increases CAD risk. Cynicism worsens outcomes, optimism & stress reduction improves it.
Also, Takotsubo cardiomyopathy.
What interventions are not indicated for the prevention of CVD in women?
(I'm not talking about pregnancy contraindications, that'll be later)
Estrogen replacement therapy
Folic acid supplements
Aspirin (this is contradicted later)
What is Framingham risk?
What are some problems with it?
Framingham risk is a 10-year risk calculation for CVD.
May lull patients & physicians into false sense of security. Lifetime risk is more relevant.
What characteristics feature in women at high risk for CVD?
There's quite a few; emphasis on the women-specific ones.
CAD, CVD, PAD, AAA, ESRD, DM, Framingham risk >10%, smoking, hypertension, elevated lipids, obesity, poor diet, inactivity, family history, metabolic syndrome, poor exercise capacity, atherosclerosis, collagen vascular disease.
Pre-eclampsia, gestational diabetes or hypertension
Besides gestational diabetes, hypertension, and eclampsia, what are some other signs in pregnancy that imply future CVD risk?
Decreased EF, stenotic valvular lesions, heart failure, pulmonary HTN.
How does PCOS affect a woman's risk for CVD?
What about timing of menarche/menopause?
Elevated; screen for MBS, hyperlipidemia, etc.
Early menarche/menopause increases CVD risk.
Two major lifestyle modifications to reduce CVD risk include smoking cessation and increasing physical activity. Try to recall some of the specific guidelines.
Smoking: Stop smoking, avoid environmental smoke, pursue nicotine replacement pharmacotherapy and counseling as needed.
Exercise: 150min moderate / 75min vigorous per week. More benefit with more exercise, more needed for weight loss. Wt training 2/wk. Goal: Waist size <35in, BMI <25.
When is cardiac rehab indicated?
Following recent coronary event, angina, stroke, PAD, or in heart failure with decreased ejection fraction.
How do treatment indications for hypertension in women differ from that of men?
Not much; still give thiazides, as well as ACE-Is/ARBs/beta-blockers in high risk cases.
Exception: No ACE-Is/ARBs in pregnant or potentially pregnant women.
How does statin use and treatment goals differ in women from men?
Higher goal HDL (50 rather than 40)
Contraindicated in pregnancy (stop 3 months prior)
What anticoagulants are indicated as preventive treatments in women?
Aspirin (for CHD, DM, stroke, and maybe stroke <65yrs)
Thienopyridines if aspirin is poorly tolerated.
Warfarin for women with a-fib but NOT IF CHILDBEARING
Dabigatran (alternative for some patients)
When is beta-blocker use indicated?
Following MI/ACS. Long-term if LV function is lost, or with ongoing CAD/vascular disease.
What anti-hypertensives are safe for pregnancy?
Describe the presentation of stress-induced cardiomyopathy.
Presents likek a STEMI but with normal coronaries. Must be diagnosed by exclusion of other possibilities. Preceded by stressful event.
More common in women than men.
Women die (more/less) often than men from CVD, perhaps because their presentation is ____. They are more likely to develop ____ cardiomyopathy. Their unique risk factors include ____. Drugs such as ____ should be avoided in pregnancy.
Women die more often than men from CVD, perhaps because their presentation is more atypical. They are more likely to develop Takotsubo/stress-induced cardiomyopathy. Their unique risk factors include PCOS, Pre-eclampsia, and gestational diabetes. Drugs such as ACE-I/ARBs and statins should be avoided in pregnancy.