heart disease prevention and management in women ... afshan hameed, md, facog, facc associate...

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  • Heart Disease Prevention and Management in

    Women

    Heart Disease Prevention and Management in

    Women

    AFSHAN HAMEED, MD, FACOG, FACC Associate Clinical ProfessorAssociate Clinical Professor

    Maternal Fetal Medicine and Cardiology Maternal Fetal Medicine and Cardiology University of California, IrvineUniversity of California, Irvine

    Scripps Scripps MercMerc y Hospitaly Hospital January 22January 22,, 20132013

  • Prevalence of CVD Prevention and Management

    of CVD 

    ACC/AHA guidelines for prevention

    of CVD in women 2011 update 

    Pregnancy related cardiac mortality • CMQCC/PAMR Report 2011

    Gender Differences

    Key points

    Presenter Presentation Notes We will review prevalence of CVD. I will share with you the recent guidelines update from ACC/AHA on prevention of CVD in women. Will review the latest on pregnancy related mortality data in California along with the gender differences

  • Cardiovascular DiseaseCardiovascular Disease Leading cause of death

    among women 

    > 500,000 women/yr 

    6 X breast cancer

    Presenter Presentation Notes CVD remains the leading cause of death amongst women.

  • CVD is the Leading Cause of Death in Women

    CVD Accounts for More Deaths Than the Next “7” Leading Causes of Death In Women!

    CVD is the Leading Cause of Death in CVD is the Leading Cause of Death in Women Women

    CVD Accounts for More Deaths Than the Next CVD Accounts for More Deaths Than the Next ““77”” Leading Causes Leading Causes of Death In Women!of Death In Women!

    Adapted from Thom T et al. Circulation 2006;113:e85–e151.

    Actual Cause of Death of U.S. Women (2003) CVD Cancer COPD Alzheimer’s Diabetes

    D ea

    th s,

    th ou

    sa nd

    s

    500

    400

    300

    200

    100

    0

    600

    38,74845,05865,672

    267,902

    483,842

    Presenter Presentation Notes Cardiovascular disease (CVD) is by far the leading cause of mortality in U.S. women, responsible for more deaths than the next “7” leading causes of death in women combined (cancer, COPD, Alzheimer’s, diabetes, and accidents).1 2. Mosca L, Ferris A, Fabunmi R, et al. Tracking women's awareness of heart disease: an American Heart Association national study. Circulation. 2004;109:573–579.

  • Cardiovascular disease in womenCardiovascular disease in women 

    CVD still causes more deaths in women than cancer, chronic lung disease, Alzheimer's, and trauma combined

    5

  • All Age Groups ………All Age Groups ……… Young women 

    Cardiac risk factors 

    Metabolic syndrome

    Older women 

    Prevention & treatment

    Pregnant 

    Diagnosed/undiagnosed cardiac disease

    Presenter Presentation Notes We as OB/GYNs are privileged to interact with women at various stages of their lives. There are opportunities for improvement starting early years of life

  • Maternal Mortality Rate, California and United States; 1991-2008

    SOURCE: State of California, Department of Public Health, California Birth and Death Statistical Master Files, 1991-2008. Maternal mortality for California (deaths ≤

    42 days postpartum) was calculated using ICD-9 cause of death classification (codes 630-638, 640-648, 650-676) for 1991-1998 and ICD-10 cause of death classification (codes A34, O00-O95,O98-O99) for 1999-2008. United States data and HP2010

    Objective were calculated using the same methods. The break in the trend line represents the change from ICD-9 to ICD-10. U.S. data is available through 2007 only. Produced by California Department of Public Health, Maternal, Child and Adolescent Health Division, February,

    2011.

    Presenter Presentation Notes Updated 4.27.11 TALKING POINTS:

  • THE CALIFORNIA PREGNANCY-ASSOCIATED

    MORTALITY REVIEW (CA-PAMR)

    Report from 2002-2003 Maternal Death Reviews

    THE CALIFORNIA PREGNANCY-ASSOCIATED

    MORTALITY REVIEW (CA-PAMR)

    Report from 2002-2003 Maternal Death Reviews

    This project was supported by federal Title V block grant funds received from the California Department of Public

    Health; Center for Family Health; Maternal, Child and Adolescent Health Division

    Presenter Presentation Notes Updated 4.27.11

    ACKNOWLEDGEMENTS The California Pregnancy-Associated Mortality Review (CA-PAMR) requires the work and support of many people who deserve acknowledgement. Dr. Susann Steinberg, former Chief, and Dr. Shabbir Ahmad, Acting Chief of the California Department of Public Health (CDPH); Maternal, Child and Adolescent Health Division provided early leadership to sound the alarm and to act to address the rising rates of maternal deaths.

    Their requests for action were supported by leadership in the Department of Public Health: Catherine Camacho, Deputy Director of the Center for Family Health; Dr. Kevin Reilly, Chief Deputy Director of Policy and Programs; Dr. Mark Horton, former CDPH Director; and Kim Belshé, former Secretary of the California Health and Human Services Agency.

    We sadly acknowledge the women who died during or after their pregnancies, the families who love and miss them, and the clinicians who cared for them. Each maternal death in this report represents a woman whose life ended early.

    This report seeks to honor the memories of these women by improving the experience of expectant mothers everywhere.

  • Maternal MortalityMaternal Mortality African American Women 

    4 x likely to die (only 6% of all births)

    Leading cause of death is cardiomyopathy

    Hispanic Women 

    Hispanic women have the largest number of pregnancy-related deaths (account for 51% of all births)

    Preeclampsia/eclampsia leading clinical cause of death

  • Preventable DeathsPreventable Deaths Chance to alter outcomes 

    38% of all cases were found to have good or strong chance to alter the outcome • Health care professional factors (97%) • Facility factors (75%) • Patient factors (75%)

  • CA-PAMR Major Findings CA-PAMR Major Findings • Increased incidence of pregnancy-

    related deaths in California for 2002- 2003

    • Cardiac disease, especially cardiomyopathy, is the leading cause of pregnancy-related deaths in California

    Presenter Presentation Notes Updated 4.27.11

    Elaborations of bullet points: The emergence of cardiomyopathy as a leading cause of pregnancy-related death should prompt public health efforts to help childbearing women optimize their health before and during pregnancy. This includes appropriate screening, follow-up, and monitoring for underlying conditions, such as heart disease.

    One example of translation of CA-PAMR data into action is the Obstetric Hemorrhage Toolkit developed by CMQCC (http://www.cmqcc.org/ob_hemorrhage). Using Title V funds provided by CDPH MCAH, the Toolkit and associated Learning Collaborative target improvement in the recognition and response to obstetric hemorrhage in California.

  • 3 million women age 18-44 in the US have cardiac

    disease ~ 1-2% of pregnant women

    3 million women age 18-44 in the US have cardiac

    disease ~ 1-2% of pregnant women

  • 13

    Presenter Presentation Notes Disease of heart arteries, this process starts very early in life, in teenage years, from the 20’s-30;s there is deposit of fat or plaque in the artery walls. Later in life as this plaque builds it can rupture causing a heart attack.

  • PDAY study: US Adults 30-34 years of age

    14

    Presenter Presentation Notes Here is more evidence of how early it starts. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Autopsies, death due to trauma, MVA, homicide, or suicide. This study showed that among US adults 30-34 years of age, 19% of male and 8% of females have an LAD stenosis that is 40% or greater. Most of us would not have guessed that 1 in 5 males and 1 in 10 women the ages of 30-34 has around a 50% diameter lesion in his LAD…Atherosclerosis starts early in life.

  • Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sex

    NHANES: 1999-2002

    Prevalence of Cardiovascular Diseases in Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and SexAmericans Age 20 and Older by Age and Sex

    NHANES: 1999NHANES: 1999--20022002

    Source: CDC/NCHS and NHLBI. These data include coronary heart disease, congestive heart failure, stroke and hypertension.

    11.2 22.9

    36.2

    86.4

    52.9 68.5

    77.8

    6.2 17.6

    36.6

    56.5

    75.0

    0 10 20 30 40 50 60 70 80 90

    100

    20-34 35-44 45-54 55-64 65-74 75+

    Ages

    Pe rc

    en t o

    f P op

    ul at

    io n

    Males Females

    Presenter Presentation Notes IF you look at the most recent data closely…you see that women now “catch up” with men in terms of the prevalence of CVD by the 4th decade.

  • PREVENTION AND MANAGEMENT OF CARDIOVASCULAR

    DISEASE

    PREVENTION AND MANAGEMENT OF CARDIOVASCULAR

    DISEASE

  • Evaluation of CVD RiskEvaluation of CVD Risk