CC 4 - Gender & Racial Disparities in Cardiovascular Disease Flashcards
What group of patients is underdiagnosed and undertreated for CV disease?
Women
Since which year has heart disease become the #1 killer of American women? What happened that year?
1908
First time that the US came out with statistics like this one
Fraction of americans considered overweight or obese today?
1/3
Which group of patients has the highest incidence of deaths related to CVD among all racial, ethnic, and gender groups?
African American women
For what ethnicities is CVD the leading cause of death?
- AAs
- Latinos
- Asian Americans
- Pacific Islanders
- American Indians
- Caucasians
= ALL ethnic groups
What are some cheap prevention measures of CVD?
- Weight loss
- Exercise
- BP drugs
- Cholesterol drugs
- Aspirin
Compare the rates of preventable hospitalizations between whites and blacks.
Blacks have double the rate
How much do preventable hospitalizations cost each year?
$7 B
List the 4 leading causes of women’s death in 2006.
- Coronary heart disease
- Stroke
- Lung cancer
- Breast cancer
List the 4 ethnicities of women that died from coronary heart disease from highest to lowest. 2006
- AA
- White
- Hispanic
- Asian
List the 4 ethnicities of women that died from stroke from highest to lowest. 2006
- AA
- White
- Asian
- Hispanic
List the 4 ethnicities of women that died from lung cancer from highest to lowest. 2006
- White
- AA
- Asian
- Hispanic
List the 4 ethnicities of women that died from breast cancer from highest to lowest. 2006
- AA
- White
- Hispanic
- Asian
How many women died from heart disease in 2007 in the US? How does this compare to women who died from the other leading causes of death?
Close to 500,000 = 1/min
More women died from CVD than from the next 8 causes of death COMBINED: cancer, chronic lower respiratory disease, Alzheimer’s, accidents.
In what age group of women is the rate of heart disease increasing? Why?
Women aged 35 to 54, probably because of obesity epidemic
Do more women die than heart disease than men?
YUP
Since when do more women die from CVD than men?
1984
Are there certain age groups in which women die more from breast cancer than CVD?
NOPE, all age groups die more from CVD
Incidence of death from CVD in women?
1 in 2
Incidence of death from breast cancer in women?
1 in 10
Do women who die from a heart attack usually have previous symptoms?
NOPE, 2/3rds of them do not
How more likely are women to die within the first few weeks after suffering a heart attack compared to men?
Twice as likely
How more likely are women to die following heart bypass surgery compared to men?
2 to 3 times more likely
What % of men and women who die from a heart attack had previous symptoms?
50%
When do women present with symptoms of CVD compared to men? What could this explain?
10 years later (mid 60s)
Could explain why more women are dying and why they do not do well after heart attacks or by pass surgeries (other comorbidities)
Do more men or women have strokes each year? How many more?
Women: 55,000 more
% of stroke deaths occurring in women?
60%
How will the mortality of women due to strokes compare to that of men in 2050?
Mortality in women will be 30% higher
Why are more women dying from stroke than men?
Women live longer => as you live longer you become more hypertensive => higher stroke incidence
What is the #1 risk factor for strokes?
HT
What race has highest prevalence of diabetes?
AAs: 60% more common for them
How many more AAs die from strokes than white americans?
4x more
In what ethnic group do docs have the LEAST success in controlling BP?
Mexican-Americans
Describe BP in AAs compared to whites.
AAs develop high BP earlier in life and have much higher BPs than white Americans.
Are symptoms of myocardial infarction the same in men and women?
NOPE, male pattern angina pectoris does not often occur in women
Women may present with typical and atypical symptoms (shortness of breath, abdominal pains, indigestion, fatigue, dizziness)
What are the typical symptoms of myocardial infarction?
- Crushing chest pain traveling down the left arm
2. Nausea
What do the atypical MI symptoms seen in women lead to?
Delays in treatment because the symptoms are vague and associated with other medical conditions => poorer outcomes
What are 4 reasons why gender differences exist with CVD?
- Most of the research has been done on men
- Physiological differences between men and women leading up to a heart attack
- Symptoms are different
- Problem of awareness and perception
How does the anatomy, physiology and pathology of women and CVD differ from men?
- Anatomy: smaller heart arteries
- Physiology: estrogen has a protective effect
- Less likely to have total blockage of coronary arteries; may have plaque erosion rather than plaque rupture
How do CVD plaques differ in men and women? How does this affect diagnosis?
- Men: more localized in discrete areas
2. Women: diffuse plaques => angiogram could be easily misinterpreted as normal
What are the 7 risk factors of CVD?
- Cholesterol level
- BP
- Diabetes
- Smoking
- Age
- Physical inactivity
- Father had stroke before age of 45/Mother had stroke before age of 55
Are there differences between risk factors for CVD between men and women?
YES
- Cholesterol level: more common in older women than men
- BP: pregnancy and some brith control pills can increase risk of high BP
- Diabetes: increases CVD risk in women up to 7x (only 3x in men)
- Smoking: combination with birth control pills increases risk
- Age: women experience symptoms 10 years later
- Physical inactivity: osteoporosis and other age-related conditions may limit ability to exercise
What are 7 interventions for CVD that women receive less than men?
- Cholesterol screening
- Lipid-lowering therapies
- Use of heparin, beta-blockers, ACE inhibitors and aspirin during myocardial infarction
- Less life-saving clot-buster drugs after myocardial infarction
- Less antiplatelet therapy for secondary prevention
- Fewer referrals to cardiac rehab
- Fewer implantable cardioverter-defibrillators
Are men or women more likely to receive a “do not resuscitate” order?
Women
Other than difference in symptoms, what else can make diagnosis of CVD in women harder?
Some diagnostic tests, like the exercise stress test, is less accurate in women
How does denial by women play a role in their diagnosis and treatment for CVP?
Women are less likely to seek rapid and appropriate care when their symptoms start which causes significant delays in treatment:
- They show up an hour later to ER compared to men
- They are less likely to complain of heart attack symptoms
- They will continue activities when feeling ill
What has been done to try and correct the gender and minorities disparities seen in disease?
NIH Revitalization Act of 1993:
- NIH ensures that women an minorities are included in all human subject research
- Phase III clinical trials inclusion of women and minorities in numbers adequate to allow for valid analyses of differences in intervention effect
- Cost is not allowed as an acceptable answer reason for excluding these groups
- NIH initiates programs and support for outreach efforts to recruit and retain women and minorities and their subpopulations as volunteers in clinical studies
What could be a good reason for not including as many women as men in a research study?
Prevalence of disease in women is not as high as in men
What has been done to try and correct the gender and minorities disparities seen in CVD?
- Coalition to Reduce Racial and Ethnic Disparities in CVD Outcomes (CREDO) of the American College of Cardiology
- Get with the Guidelines Initiative of the American Heart Association (because if doctors followed guidelines without any consideration for gender/ethnicity we would not have these issues)
- Close The Gap Initiative of Boston Scientific: to educate physicians (PCPs and OBs) to diagnose and treat
What is the #1 reason why ER physicians get sued in the US?
Missing heart attacks
