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Men & Women:
Differences in Heart Disease
Suzanne Sims, M.D., M.P.P.
LifeConnections Health Center
Physician
February 18, 2010
Summary of Topics
Heart Disease Statistics
Risk factors for heart disease, including by gender
A couple of interesting studies on salt and exercise
Screening tests and preventative treatments available at LCHC
Mechanism and symptoms of a heart attack
Emergency procedures at work
The Statistics
Heart Disease is the #1 killer in women– 500,000 deaths in the U.S. per year
– More women die of heart disease than men
Heart Disease is the #1 killer in men
(In East Asian-American men, heart disease is second to cancer)
– 1 in every 4 deaths
– 50% who died suddenly had no previous symptoms
– South Asians have a 4x higher risk for heart disease
Risk Factors in Both Genders
Age– Men > 45 (younger in South Asians)
– Women > 55
High blood pressure– 135/85 is the cutoff, the lower the
better
– Can be made worse by salt intake
High cholesterol– Elevated LDL
– Decreased HDL cholesterol (more important risk in women than men)
– Fixing them can halt or reverse heart disease
How does salt increase blood pressure?
Ouabain
– Secreted by the adrenal
gland
– Regulates sodium and
calcium in the smooth
muscles of the arteries
– Causes increased artery
smooth muscle contraction
– Oversecreted when you
each to much salt
Before you reach for the salt…
Typical American consumes about 3400mg
salt/day
“Reduced sodium” means the product is down
25% from the original version
“No added salt” doesn’t mean salt free
Salt can increase the reactivity of platelets
(clotting cells) even without hypertension
Potassium in fresh fruits and vegetables helps to
balance the effect of sodium
Risk Factors in Both Genders
Age– Men > 45
– Women > 55
High blood pressure– Common in women >55
– Can be made worse by salt intake
High cholesterol– Elevated LDL
– Decreased HDL cholesterol (more important risk in women than men)
– Fixing these levels can halt or reverse heart disease
Risk Factors in Both Genders
Family history
– Especially if family member <60 yo
– Especially if family member was a sister or brother
Smoking– Includes long term exposure to second hand smoke
– Damages artery walls and increases risk of blood clots
– Accounts for the majority of heart attacks in women <45 yo
Alcohol use– Binge drinking in the past year (3 or more drinks
within a 2 hour period) increases the risk of death after a heart attack
– Excessive drinking causes increased blood pressure, increased triglycerides
Risk Factors in Both Genders
Obesity
– BMI >= 30
– More common in postmenopausal women than in men the same age
Metabolic Syndrome (At least 3 of 5 of the following)
– Abdominal obesity» Waist > 35 inches in women
» Waist> 40 inches in men
– Triglycerides >150
– HDL» <50 in women
» <40 in men
– Fasting glucose>=110
– Blood pressure >= 130/85
Risk Factors in Both Genders
Physical Inactivity– More common in postmenopausal
women than in men the same age (Women tend to be caregivers-don’t prioritize regular exercise)
Stress– Increases mortality, lipids, inflammation,
obesity, risk of metabolic syndrome
– 2.67-fold increase in risk for a heart attack
Use of stimulant drugs– Cocaine
– Amphetamines
Recent study on sedentary lifestyleOwen, et al in Circulation, January 12, 2010
8800 people in Australia tracked for an
average of 6 years
Participants averaged 30-45 minutes of
exercise/day
Average age 50
Study measured number of hours of TV
watching/day and related it to mortality
Recent study on sedentary lifestyleOwen, et al in Circulation, January 12, 2010
Those who reported watching
TV for more than 4 hours a day:
– 46% more likely to die of any cause
– 80% more likely to die of cardiovascular
disease
– Compared to those watching <2 hours/day
– Even if exercising regularly
– Even when adjusting for age, gender, waist
circumference
– There was also an increased risk for
watching >=2hours/day (13% and 19%
increase respectively)
Physiological results of being sedentary
After a few hours of inactivity, Lpa
which pulls fat from the blood, shuts
down
After just one day of inactivity, levels
of HDL can fall by as much as 20%
Consider standing up while working on
the computer which causes muscle
contraction, get up and walk around,
fold laundry while watching TV, don’t
use the remote to change channels
Risk Factors in Both Genders
Physical Inactivity– More common in postmenopausal
women than in men the same age (Women tend to be caregivers-don’t prioritize regular exercise)
Stress– Increases mortality, lipids, inflammation,
obesity, risk of metabolic syndrome
– 2.67-fold increase in risk for a heart attack
Use of stimulant drugs– Cocaine
– Amphetamines
Additional Risk Factors in Men
Low vitamin D
– Goal blood level should be 30ng/ml or higher
Low testosterone (maybe)
Additional Risk Factors in Women
Postmenopausal
Having had ovaries surgically removed
Use of older generation, high estrogen birth control pills, especially if also smoking
Complicated pregnancy (Pregnancy induced HTN, DM, low birth weight)-possible, but very low, risk of heart attack during the pregnancy
Screening Tests Available at
LifeConnections Health Center
Fasting lipid panel
Fasting glucose
Vitamin D level
Obtaining your family history
Obtaining your history of tobacco,
alcohol, and drug use
Obtaining your diet & exercise history
Referral for outside exercise
treadmill test if symptomatic
Preventative treatments before a heart attack occurs
Condition Management at the health center can help you achieve the following:
– Eat a diet low in saturated fat, trans fat, and cholesterol and moderate in total fat
– Limit salt and sodium
– If you drink alcoholic beverages, have no more than one a day (2 in men)
– Stop smoking
Health Coach at LifeConnections can help you achieve the following:
– Lose weight
Trainer at the Fitness Center can help you achieve the following:
– Get at least 30-45 minutes of moderate exercise most days of the week
Additional preventative treatments
EAP at LCHC can help you:– Address stress, anxiety, depression
A doctor at LCHC can prescribe the following:– Blood pressure medication
– Cholesterol medication
– Blood sugar medication
– Aspirin » For men only, to prevent heart attack
» After a heart attack, both genders should take it
How does a heart attack occur
Plaque
Inflammation
Pressure
Clot
Vessels get more narrow the further downstream
When tributary of stream blocked, that area of the heart does not receive oxygen and nutrients and is injured or dies
Damage and possibility of plaque rupture
Unstable Plaque = Vulnerable Plaque
21Heart Center Online , http://www.heartcenteronline.com
How does a heart attack occur
Plaque
Inflammation
Pressure
Clot
Vessels get more narrow the further downstream
When tributary of stream blocked, that area of the heart does not receive oxygen and nutrients and is injured or dies
Damage and possibility of plaque rupture
23Texas Heart Institute Heart Information Center , www.vp.org
How does a heart attack occur
Plaque
Inflammation
Pressure
Clot
Vessels get more narrow the further downstream
When tributary of stream blocked, that area of the heart does not receive oxygen and nutrients and is injured or dies
Damage and possibility of plaque rupture
When should I worry?
Chest pain (angina)
– Heavy, pressure, aching, burning, fullness,
squeezing, discomfort
– Can radiate to left arm, neck, jaw, back
– Can be mistaken for heartburn
Shortness of Breath* at rest or with minimal activity
Palpitations (skipped beats)
Rapid heart rate even though not exercising
Weakness*
Dizziness*
Nausea
Sweating*
Symptoms last for 30 minutes or more and are not
relieved by rest, medication
Emergency Procedures at Work
Call Safety and Security (within 5 minutes if possible) who will activate the Emergency Response Team and call 911
Don’t drive yourself to the hospital– Paramedics can start treating you before you
arrive to the hospital
– You could die while driving
– You could kill someone else when you die while driving
Don’t be embarrassed of a false alarm
Summary
Everyone is at risk for heart disease
Heart disease is mostly preventable
Eat a healthy diet
Exercise, exercise, exercise
Treat your genetic risk factors
All of us at the LifeConnections Health Center are here to help
Questions?
Free Blood Pressure Screening Event
at LifeConnections Health Center
Tuesday, February 23rd
11 am – 3 pm
No appointment necessary
Cisco employees and their families,
and contractors welcome
Sponsored by Kaiser Permanente and Plus One
References
Women and the Risk Factors of Heart Disease Some risk factors affect women differently from men By Richard N. Fogoros, M.D., About.com Guide, Created: November 30, 2009
Symptoms of Heart Disease, WebMD.com
www.americanheart.org
Men and Heart Disease Fact Sheet www.cdc.gov
“A Salty Tale: Why We Need a Diet Less Rich in Sodium”, Melinda Beck,WSJ, April 21, 2009
Salt Wars - Is Salt Restriction Necessary? A new spin on an old problem By Richard N. Fogoros, M.D., About.com Guide, Updated: November 30, 2009
SCIENTISTS UNCOVER HOW EXCESS SALT LEADS TO HYPERTENSION http://www.umm.edu/news/releases/salt_hypertension.htm
References 2
Suppression of skeletal muscle lipoprotein lipase activity
during physical inactivity: a molecular reason to maintain daily
low-intensity activity, Lionel Bey and Marc T Hamilton, Physiol.
2003 September 1; 551(Pt 2): 673–682.
Heart Attack Risk Factors www.mayoclinic.com
Low Vitamin D Ups Heart Risk in Men Kelli Miller Stacy
WebMD Health News
The Toll Stress Takes on the Body
www.southasianheartcenter.org
Women's Heart Attack Symptoms Different from Men's:
Symptoms may appear up to a month before attack By
Robert Longley, About.com Guide
