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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 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
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
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.