3/17/2016

1

STEPHEN G. SWANSON, MD, FACOG

“NEW UNDERSTANDING”

RECOGNITION, PREVENTION,

DIAGNOSIS, AND TREATMENT

WOMEN AND HEART DISEASE

#1 Cause of Death in Women Over 40

22. 9 percent of All Deaths in Women

Only 1 in 5 Women Believe Heart

Disease is

THEIR GREATEST RISK

3/17/2016

2

3/17/2016

3

3/17/2016

4

1. OBS TETRICAL C OMPL ICATIONS

A. GESTATIONAL HYPERTENSION

B. PRE-EC L AMPSIA

C. GESTATIONAL DIABETES

D. PRE-TERM LABOR

E. PERS IS TENT “BABY WEIGHT” POS T 3-12 MONTHS

Risk Factors Specific to Women

2 . I N F E R T I L I T Y - A N O V U L A T I O N - I R R E G U L A R P E R I O D S

A . P O L Y C Y S T I C O V A R Y S Y N D R O M E

B . O B E S I T Y — E L E V A T E D S E R U M I N S U L I N L E V E L S

C . M E T A B O L I C S Y N D R O M E

3/17/2016

5

3/17/2016

6

3. V ALVUL AR HEART DISEASE—

DISC OVERED IN PREGNANCY

4. BREAST C ANC ER

A. CHEST RADIATION

B. CHEMOTHERAPY

3/17/2016

7

UNIQUE WOMEN’S CARDIAC PROBLEMS

SPONTANEOUS CORONARY ARTERY DISSECTION

(SCAD)

3/17/2016

8

TAKOTS U BO—

STRESS INDUCED CARDIOMYOPATHY

(CM)

3/17/2016

9

MICROVASCULAR DISEASE

(MVD)

HEART FAILURE WITH PRESERVED EJECTION

FRACTION

3/17/2016

10

PERIPARTUMCARDIOMYOPATHY

3/17/2016

11

VALVULAR HEART DISEASE

AND PREGNANCY

ACUTE CORONARY SYNDROME

MINOCA

3/17/2016

12

DIAGNOSTIC STUDIES AVAILABLE

3/17/2016

13

MenopauseHormone Replacement

Heart Disease

3/17/2016

14

Why Consider HormoneReplacement Therapy?

North American Menopause Society—NAMS

25 Years of Excellent Research

3/17/2016

15

3/17/2016

16

OR DOES IT?

3/17/2016

17

3/17/2016

18

Conclusion:

1. Hormone Replacement Therapy Improves Quality of Life Issues.2. Most Benefits Up to Age 60

? May be Up to Age 703. Significant Improvement in Osteoporosis4. Assists in Management of Weight gainWith Visceral Weight5. Improves Postmenopausal ↑ in LDL and

Lipoproteins6. No Significant Increases in Incidence of Breast Cancer. NOT CAUSATIVE.7. Replace Estrogen Transdermal and Does Not

↑ Most Clotting Problems

Risks and Benefits Should Be Carefully Evaluated for Each Patient and Based Upon Their Entire Medical Condition