Heart Disease in Women

1
Heart Disease in Women
2
WOMEN AND HEART DISEASE

• Myocardial infarction, stroke and other
  cardiovascular disease have killed more women
  than men in the United States eacy year since
  1984
• In 1995, 455,000 men vs. 505,000 women died from
  cardiovascular disease

American Heart Association
3
Leading causes of death in women1995 Statistics
Death in Thousands
1998 AHA Heart and Stroke Statistics
4
WOMEN AND HEART DISEASE

• Disease of the heart and blood vessels kill more
  American women than the next 16 causes of death
  combined, including all types of cancer

American Heart Association
5
Prevalence of CVD by Age and Sex
Percent of Population
NHANES III 1988-1991
6
WOMEN AND HEART DISEASE

• 53 of non-Hispanic white women older than 20
  have borderline-high or high cholesterol
• over 27 of non-Hispanic black women have high
  blood pressure
• lt 60 of all women know that loss of estrogen is
  a significant risk factor

American Heart Association
7
Accuracy of Tests for DiagnosingCoronary Artery
Disease in Women

• Number of
• Test studies women
  sensitivity specificity
• Stress Echo 3 296 0.86 0.79
• Thallium Stress 5 842 0.78 0.64
• Exercise ECG 20 3,874 0.61 0.69

Dr. Rita Redberg - AHA 1998
8
HRT usage and Osteoporosis
of Women Age 40 Using HRT
Familiarity with role of HRT and osteoporosis
1993 New York Womens Health Survey
9
HERS Study

• Heart and Estrogen / progestin Replacement Study
  (HERS)
• 2,763 women with coronary-heart disease (CHD),
  average age of 67
• Hormone vs placeboaverage duration of study -
  4.1 years

JAMA 1998280605-613,650-652
10
HERS Study

• Placebo HRT
• (n1,383) (n1,380)
• First Year
• MI 29 (2) 42 (3)
• Death 11 17
• End of study
• MI / death 176 172

JAMA 1998280605-613,650-652
11
HERS Study

• Risk for CAD among subjects on HRT
• year one ? 52
• years 2-3 ? 13
• years 4-5 ? 23

JAMA 1998280605-613,650-652
12
HERS StudyKey Points

• Greatest risk occurs during first year of
  combination treatment
• HRT should not be started specifically to prevent
  MIs
• Those who already had CHD had increased chance of
  events

JAMA 1998280605-613,650-652
13
References

• Heart and Estrogen / progestin replacement
  StudyJ Am Med Assoc 1998280605-613, 60-652