State of the Heart: Building Science to Improve Women’s Cardiovascular Health

2006 ◽  
Vol 15 (6) ◽  
pp. 556-566 ◽  
Author(s):  
Anne G. Rosenfeld
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Cardiovascular Health ◽  
Signs And Symptoms ◽  
The United States ◽  
Cardiovascular Research ◽  
Obesity And Diabetes ◽  
Psychosocial Influences ◽  
State Of The Science ◽  
Provider Bias

Cardiovascular disease is the No. 1 killer of women in the United States, and marked disparities in cardiovascular health exist between women and men and among groups of women. Coronary heart disease is underdiagnosed, undertreated, and underresearched in women. Women with suspected heart disease are less likely than men to receive indicated diagnostic tests and procedures; sex-based biases in treatment of myocardial infarction persist; and women continue to be underrepresented in cardiovascular research. An accumulating body of literature points to 3 major explanations: sex-based physiology, provider bias, and psychosocial influences. Women’s acute and prodromal signs and symptoms of myocardial infarction have been described, yet women have difficulty recognizing and acting on these indications. Primary and secondary prevention of heart disease in women is imperative; although the science is lacking in several areas, existing evidence on diet, hormone therapy, aspirin, physical activity and obesity, and diabetes can serve as the basis for interventions. Potentially, large impacts could be made on women’s morbidity and mortality if current scientific knowledge were implemented. The state of the science of women and heart disease is reviewed, with a focus on those areas with the greatest potential to address the needs of women’s cardiovascular status. Key gaps in the science and remaining questions are presented as a research agenda for the coming decade.

Women and coronary disease: relationship between descriptors of signs and symptoms and diagnostic and treatment course

1998 ◽  
Vol 7 (3) ◽  
pp. 175-182 ◽  
Author(s):  
S Penque ◽  
M Halm ◽  
M Smith ◽  
J Deutsch ◽  
M Van Roekel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Chest Pain ◽  
Signs And Symptoms ◽  
The United States ◽  
Therapeutic Interventions ◽  
Initial Symptom ◽  
Men And Women ◽  
To Receive

BACKGROUND: Heart disease is the No. 1 killer among women in the United States. Differences in the clinical features of coronary heart disease among men and women have been reported, along with various approaches to the diagnostic workup and therapeutic interventions. PURPOSE: To explore the relationship between descriptors of signs and symptoms of coronary heart disease and follow-up care and to investigate any differences between male and female patients. METHODS: Structured interviews with patients and chart audits were used to assess initial signs and symptoms, associated cardiac-related signs and symptoms, and the diagnostic tests and interventions used for treatment. The sample consisted of 98 patients (51 women and 47 men) who were admitted with a medical diagnosis of myocardial infarction. RESULTS: Chest pain was the most common sign or symptom reported by both men and women. The 4 most common associated signs and symptoms were identical in men and women: fatigue, rest pain, shortness of breath, and weakness. However, significantly more women than men reported loss of appetite, paroxysmal nocturnal dyspnea, and back pain. Women were also less likely than men to have angiography and to receive i.v. nitroglycerin, heparin, and thrombolytic agents as part of acute management of myocardial infarction. CONCLUSION: Chest pain remains the initial symptom of acute myocardial infarction in both men and women. However, women may experience some different associated signs and symptoms than do men. Despite these similarities, men still are more likely than women to have angiography and to receive a number of therapies.

scholarly journals Bending the Curve in Cardiovascular Disease Mortality

Circulation ◽  
2021 ◽  
Vol 143 (8) ◽  
pp. 837-851
Author(s):  
David Calvin Goff ◽  
Sadiya Sana Khan ◽  
Donald Lloyd-Jones ◽  
Donna K. Arnett ◽  
Mercedes R. Carnethon ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Health ◽  
Research Policy ◽  
The United States ◽  
Observational Research ◽  
Cardiovascular Disease Mortality ◽  
Obesity And Diabetes ◽  
Disease Mortality

More than 40 years after the 1978 Bethesda Conference on the Declining Mortality from Coronary Heart Disease provided the scientific community with a blueprint for systematic analysis to understand declining rates of coronary heart disease, there are indications the decline has ended or even reversed despite advances in our knowledge about the condition and treatment. Recent data show a more complex situation, with mortality rates for overall cardiovascular disease, including coronary heart disease and stroke, decelerating, whereas those for heart failure are increasing. To mark the 40th anniversary of the Bethesda Conference, the National Heart, Lung, and Blood Institute and the American Heart Association cosponsored the “Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40” symposium. The objective was to examine the immediate and long-term outcomes of the 1978 conference and understand the current environment. Symposium themes included trends and future projections in cardiovascular disease (in the United States and internationally), the evolving obesity and diabetes epidemics, and harnessing emerging and innovative opportunities to preserve and promote cardiovascular health and prevent cardiovascular disease. In addition, participant-led discussion explored the challenges and barriers in promoting cardiovascular health across the lifespan and established a potential framework for observational research and interventions that would begin in early childhood (or ideally in utero). This report summarizes the relevant research, policy, and practice opportunities discussed at the symposium.

Typical and atypical clinical signs and symptoms of myocardial infarction and delayed seeking of professional care among blacks

1997 ◽  
Vol 6 (1) ◽  
pp. 7-13 ◽  
Author(s):  
HO Lee
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
The United States ◽  
United States Department ◽  
Manual Search ◽  
Black Patients ◽  
Definitive Therapy ◽  
Clinical Signs And Symptoms

BACKGROUND: Despite the fact that the effectiveness of thrombolytic therapy for acute myocardial infarction is inversely related to the time between the onset of signs and symptoms and definitive therapy, long delays in seeking treatment have been reported consistently. A variety of reasons for the delays have been suggested. Because such delays are associated with longer hospital stays and higher mortality and morbidity, interventions that reduce delays are especially important. PURPOSE: To examine research on patients with myocardial infarction who delay seeking professional treatment and the factors related to the delay, and to review studies indicating that black patients have premonitory clinical signs and symptoms of myocardial infarction and changes in the structure and function of the cardiovascular system that are different from those in whites. METHODS: Studies were reviewed by using MEDLINE and by doing a manual search of relevant research journals in cardiovascular, nursing, and behavioral medicine published since 1970. Data published by the United States Department of Health and Human Services and the Agency for Health Care Policy and Research were also reviewed. RESULTS: Although the lengths of the delays have varied considerably, blacks have generally experienced longer delays than whites between acute onset of signs and symptoms of myocardial infarction and arrival at the emergency department. Studies show that black patients have a lower incidence of classic chest pain or discomfort but an increased incidence of dyspnea, whereas white patients are much more likely to complain of chest pain. CONCLUSION: Culturally sensitive public education about typical and atypical premonitory clinical signs and symptoms of myocardial infarction and the significance of early treatment of myocardial infarction in blacks is needed.

Atypical Kawasaki Disease with Aortic Aneurysm

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 885-888 ◽  
Author(s):  
Charles E. Canter ◽  
Richard J. Bower ◽  
Arnold W. Strauss
Keyword(s):  
Myocardial Infarction ◽  
Kawasaki Disease ◽  
Aortic Aneurysm ◽  
Unusual Case ◽  
Febrile Illness ◽  
Signs And Symptoms ◽  
The United States ◽  
Abdominal Aortic ◽  
Atypical Kawasaki Disease ◽  
Arterial Aneurysms

Kawasaki disease (mucocutaneous lymph node syndrome), initially described in Japan, is now being seen with increasing frequency in the United States.1 The diagnosis is based on the typical constellation of signs and symptoms.1,2 Mortality is 1% to 2%, and significant morbidity results from aneurysmal formation in midsize arteries, especially the coronary arteries, which may result in rupture or myocardial infarction. We report an unusual case of Kawasaki disease. The initial febrile illness was an atypical presentation. A large abdominal aortic aneurysm developed, which subsequently was resected. Seven months after the febrile illness an asymptomatic myocardial infarction secondary to bilateral coronary arterial aneurysms was documented.

scholarly journals Life"s simple 7 and the risk of stroke in Finnish men: a prospective cohort study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Isiozor ◽  
SK Kunutsor ◽  
A Voutilainen ◽  
S Kurl ◽  
J Kauhanen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischaemic Stroke ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Cox Regression ◽  
Smoking Status ◽  
Population Based ◽  
P Value ◽  
Cardiovascular Research ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): North Savo Regional Fund and Finnish Foundation for Cardiovascular Research Background Population-wide preventive measures constitute important approaches toward reducing stroke risk and its associated burden. We sought to examine the association between American Heart Association’s (AHA) Life’s Simple7 (LS7) score and the risk of stroke in men. Methods The study is based on the prospective population-based Kuopio Ischaemic Heart Disease cohort comprising men (42-60 years) without pre-existing history of stroke at baseline. LS7 was computed from AHA’s cardiovascular health metrics for 2520 men and includes data on diet, physical activity, body mass index, smoking status, blood pressures, total cholesterol and blood glucose. Participants were classified into three LS7 groups based on the number of ideal metrics: inadequate (0–2), average (3–4) and optimal (5–7). Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LS7 scores for total and ischaemic stroke. Results During a median follow-up of 26years, 428 total and 362 ischaemic incident stroke events were recorded. The risk of both stroke outcomes decreased continuously with increasing LS7 scores across the range 2 to 6. Men with optimal LS7 had 48% (HR: 0.52; 95%CI: 0.32–0.86) lower risk of total stroke when compared with those with inadequate LS7. The association was similar for the risk of ischaemic stroke, with 50% (HR: 0.50; 95%CI: 0.29–0.87) lower risk among men with an optimal LS7 compared with those with inadequate LS7. Conclusion LS7 was strongly, inversely and linearly associated with risk of total and ischaemic strokes among a middle-aged male Caucasian population. Life’s Simple 7 and the risk of stroke Total Stroke Ischaemic Stroke LS7 score 0-2† (inadequate) 3-4 (average) 5-7 (optimal) 0-2† (inadequate) 3-4 (average) 5-7 (optimal) n/N 224/1109 187/1273 17/138 192/1109 156/1273 14/138 Model 1 HR (95%CI) 1 0.65 (0.53 - 0.79) 0.49 (0.30 - 0.81) 1 0.63 (0.51 - 0.78) 0.47 (0.27 - 0.82) p value* <0.001 0.005 <0.001 0.007 Model 2 HR (95%CI) 1 0,69 (0.56 - 0.84) 0.52 (0.32 - 0.86) 1 0.67 (0.54 - 0.84) 0.50 (0.29 - 0.87) p value* <0.001 0.01 <0.001 0.014 n/N, number of events/Total; HR, hazard ratio; CI, Confidence interval *p-values for the HRs <0.05 are considered statistically significant †Reference category Model 1: adjusted for age, alcohol consumption and socioeconomic status Model 2: Model 1 plus history of coronary heart disease and history of type 2 diabetes mellitus

Abstract 140: Women of Color: Where Race/Ethnicity, Sex/Gender, Culture and History Affect Cardiovascular Health and Disparities

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Claudette E Brooks ◽  
Amy Mistretta ◽  
Maggie Brewinski-Isaacs ◽  
Leah Miller ◽  
Terri L Cornelison ◽  
...  
Keyword(s):  
Health Disparities ◽  
Heart Disease ◽  
Health Status ◽  
Cause Of Death ◽  
Women Of Color ◽  
Cardiovascular Health ◽  
The United States ◽  
The Us ◽  
Race Ethnicity ◽  
Hispanic White

The United States is in the midst of a historic demographic shift in its population that will have multiple societal impacts including healthcare issues. In 2043 it is predicted that the majority of the US population will be persons of color (“racial and ethnic minorities”). This new majority will be 53.4% of the nation by 2050. Of the 49 million uninsured in the US in 2011, 55% were persons of color who were only 33% of the population. Women of color are projected to increase in number from 57 million in 2010 to 107 million in 2050, from 36 percent to 53 percent of the total US female population. The Women of Color Health Data Book, 4th edition, consists of US Government sourced, population-based health and disease data disaggregated by sex/gender and race/ethnicity with relevant discussions of the roles of historical, cultural and socio-geo-demographic factors in the health status of women of color. The impending hurdles facing the US and the globe in access, outcomes, and health disparities are underscored including those in cardiovascular diseases. Cardiovascular disease remains the leading cause of death for women in the US, even though sub-populations of women may have different prevalence rates for major risk factors for heart disease and stroke_i.e., diabetes, hypertension, high cholesterol, obesity, lack of exercise, and smoking. Cerebrovascular diseases (strokes), with a similar risk factor profile to heart disease, continue to be the third leading cause of death of black, Hispanic, and Asian or Pacific Islander females, the fourth for Non-Hispanic white females and the fifth for males overall. Age -adjusted death rates for stroke were still highest among black women. Despite the decline in both heart disease and stroke mortality overall and that Non-Hispanic white women are at significant risk, the majority of women of color continue to be disparately burdened with these two preventable causes of death and debilitating morbidity. This year, 2015, the US Census Bureau projects that black females will have the shortest life expectancy at birth in the nation. Understanding the underlying varied cultural dynamics and other factors that affect health status and influence differences seen across and among populations of women is critical to address prevailing cardiovascular health disparities and inform the design and implementation of interventions to improve outcomes within an increasingly diverse population.

Ischemic Heart Disease

2016 ◽  
pp. 83-102
Author(s):  
Nandan S. Anavekar
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Cardiac Disease ◽  
The United States ◽  
Ischemic Heart ◽  
Coronary Syndrome ◽  
Acute Mi ◽  
St Elevation ◽  
New Treatments

Ischemic heart disease is cardiac disease that results in diminished myocardial blood supply and its attendant clinicopathologic manifestations. It may be clinically silent or present with syndromes categorized as stable angina, unstable angina, non–ST-elevation acute coronary syndrome, ST-elevation myocardial infarction (MI), or sudden death. Ischemic heart disease causes nearly 800,000 deaths annually. Notably, about a third of deaths annually in the United States are due to MI. Primary prevention and new treatments have led to a substantial decrease in death from acute MI since 1970.

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