1. Women and Heart Disease
Unequal Burden of Disease.
Patricia Davidson, MD.

3. Heart Disease Mortality Among
Women Per 100,000 Population
200
Native American
150 Hispanic
African American
100
Asian American
50 White
0

5. Atherosclerosis/ hardened
arteries:
 PREVENTABLE
BEGINS
 IN THE FETUS IF THE MOTHER HAS
HIGH CHOLESTEROL
 OR THE FIRST DECADE OF LIFE
 NOT A NATURAL PROCESS OF AGING

6. RISK FACTORS:
HOW DO THEY DIFFER?

7. Classification of Overweight
Based on Body Mass Index
 Overweight >20 BMI
 Obese >30 BMI
BMI= kg/m2 NHANES 111

8. Overweight Women
by Ethnicity
 African American 68.3%
 Asian 10.1%
 White 46.8%

11. Percent of Overweight Hispanic
Women
 Hispanic 33%
 Mexican 69.3%
 PuertoRican 40.2%
 New immigrant 25%

12. Diabetes
Prevalence Among Women
MIDDLE AGED OLDER
 Native Am. 21.8 31.8
 Mexican Am. 7.7 29.9
 African Am . 14.5 25.4
 White 8.5 14.5

13. Diabetes
 DM may explain the increased risk of CAD
in African American women.
 Insulin resistance contributes to the
development of CAD long before clinical
DM.
 Insulin resistance is more prevalent in
African American women.
NHANES 1

14. Diabetes
 African American women develop DM at a lower
BMI than other women.
 DM is increasing fastest in ethnic groups.
 80% of children diagnosed are obese. Screening
should begin by age 10.
NHANES 1

15. Exercise
PHYSICAL ACTIVITY of FEMALE
ADOLESCENTS ( %)
Vigorous moderate sports
Hispanic 45.2 27.6 27.3
Afr. Am. 41.2 26.4 34.9
White 56.7 16.8 47.1
MMWR 9/27/98

17. Percent of High School
Students Smoking
40
35
30 White W
25 White M
20 Af.Am W
15 Af.Am M
10 Hisp. W
Hisp. M
5
0
White Af.Am Hisp.
W W W

18. Racial and Gender Referral
Bias

21. Rates of Bypass Surgery (CABG)
Per 10,000 Medicare Patients:
 White men 40.4
 White women 16.2
 African American men 9.3
 African American women 6.4
JAMA 3/18/92

22. Variation in Use of Cardiac Procedures in
the Veterans Affairs Health System:
Effect of Race
 African American men after acute MI were
less likely to undergo the following
procedures:
 Cardiac cath 33%
 PTCA 42%
 CABG 54%
JAMA 4/20/94, NEMJ 1993, JACC 1994

23. Effect of Race and Sex on Physicians
Recommendations for Cardiac
Catheterization
 Study design: 720 physicians viewed video tapes
of actors presenting the same cardiac history and
all having positive stress tests.
 African American women were the least likely to
be referred for cardiac catheterization.
NEJM 2/25/99

24. Missed Diagnoses of Acute
Ischemia in the ER
 Risk of being sent home;
 Acute ischemia- 2 times higher among
African American patients.
 Acute MI- 4 times higher compared to
Caucasian patients.
NEJM 4/20/00

26. Lessons From Canada
Socioeconomic Status and Access to
Care
 In Ontario, despite Canada’s universal
health care system, socioeconomic status
had pronounced effects on access to
specialized cardiac services as well as on
mortality one year after acute myocardial
infarction.
NEMJ 10/18/99.

27. WHAT CAN WE DO?
RETURN TO OUR ROOTS.

28. SELF HELP GROUPS
 ENCOURAGE HEALTHY LIFE STYLES
 DISEMMINATE INFORMATION
 GIVE EMOTIONAL SUPPORT

29. TOPICS TO DISCUSS
DURING PANEL
QUESTIONS:
 HORMONE REPLACEMENT
 DIABETIC GOALS
 CHOLESTEROL GOALS, OPTIMAL
VERSUS NATIONAL GUIDELINES
 HYPERTENSION DRUG THERAPY
MYTHS BASED ON RACE

30. TOPICS TO DISCUSS
DURING PANEL
QUESTIONS:
 HORMONE REPLACEMENT
 DIABETIC GOALS
 CHOLESTEROL GOALS, OPTIMAL
VERSUS NATIONAL GUIDELINES
 HYPERTENSION DRUG THERAPY
MYTHS BASED ON RACE

31. FOOD FOR LIFE
 WHICH FOODS PROMOTE HEALTHY
ARTERIES
 WHICH FOODS PROMOTE DISEASE