Cardiovascular Disease in Women
Risk Factors
• Smoking
• Hypertension
•
Elevated cholesterol
•
Overweight / obesity
•
Physical inactivity
• Diabetes
• Family history
• Age
Cardiovascular Disease in Women
Blood Pressure Classification
(Adults 18 and over)
Category Systolic Diastolic
Normal
Prehypertension
<120
120-139
Stage 1 Hypertension 140-159 and or or
<80
80-89
90-99
Stage 2 Hypertension >159 or >99
Source: National Heart, Lung, and Blood Institute 2003
Classification of Cholesterol Levels
Total Cholesterol
Under 200
200-239
240 and above
Desirable
Borderline High
High
LDL Cholesterol
Less than 100
100-129
130-159
160-189
Optimal
Near-optimal
Borderline High
High
190 and above Very High
*LDL in very-high-risk women with CHD should be < 70

Cardiovascular Disease in Women
Classification of Cholesterol Levels
HDL Cholesterol
Under 40 Low
Over 60
*Optimal HDL should be > 50 for women
High
Triglycerides
Under 150
150-199
200 and above
Optimal
Borderline high
High
Source: NIH: May 2001
Cardiovascular Disease in Women
Risk Factors
Overweight / obesity
•
62% of American women
≥ 20 years of age are overweight. 33% are obese
• Body Mass Index (BMI)
• 18.5 – 24.9 normal
• 25 – 29.9 overweight
• 30 or > obese
• Atypical chest, stomach or abdominal pain
• Nausea, vomiting, or dizziness
• Extreme fatigue, weakness, and sleeplessness
• Shortness of breath
• Unexplained anxiety
• Palpitations
• Cold sweat
• Paleness
• Severe indigestion
• Jaw, neck, or shoulder pain

Symptoms of a stroke that women may experience
• Non-traditional symptoms of pain
• Changes in consciousness or disorientation
• Non-neurologic symptoms
• Chest pain
• Shortness of breath
Cardiovascular Disease in Women
Prevention and Treatment
Lifestyle Changes
Heart Healthy Eating Plan
• Low in saturated fat and cholesterol and moderate in total fat
•
Limit saturated fat to < 10% calories (7% if possible) and trans fats to < 1%
• Limit salt and sodium < 2.3g/d ~ 1tsp
• If you drink alcoholic beverages, have no more than one per day
Lifestyle Changes
Maintain a healthy weight
• Balance calories taken in with those used up in physical activity
• Body Mass Index (BMI) should be < 25 kg/m 2 and waist circumference ≤ 35 inches

Cardiovascular Disease in Women
Prevention and Treatment
Lifestyle Changes
Be physically active -
EXERCISE!
30 minutes of moderateintensity cardio activity a day and 20 minutes of strength training 2-3 times per week
Cardiovascular Disease in Women
Prevention and Treatment
Lifestyle Changes
Be physically active -
EXERCISE!
If you need to loose weight or sustain weight loss a minimum of
60-90 minutes of moderate intensity physical activity on most and preferably all days of the week
Cardiovascular Disease in Women
Aspirin for prevention of heart disease
• High risk women
– ASA therapy 75-325 mg/day should be used unless contraindicated
• Other at-risk or healthy women
– Women ≥ 65 y.o. consider ASA therapy (81 mg/day or 100 mg every other day) if blood pressure is controlled and benefit for ischemic stroke and MI prevention is likely to outweigh risk of GI bleeding and hemorrhagic stroke
– In women < 65 y.o. when benefit for ischemic stroke prevention is likely to outweigh adverse effects of therapy

National Heart, Lung and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
Website: www.nhlbi.nih.gov
Additional Heart Health Websites:
 The Heart Truth: A National Awareness Campaign on Women and
Heart Disease: www.nhlbi.nih.gov/health/hearttruth

The Healthy Heart Handbook for Women: http://www.nhlbi.nih.gov/health/hearttruth/material/index.htm
 Act in time to Heart Attack Signs: www.nhlbi.nih.gov/actintime

American Heart Association: www.americanheart.org
 National Women’s Health Information Center, Office on Women’s
Health, U.S. Dept. of Health and Human Services: www.4woman.gov

Women Heart: The National Coalition for Women with Heart
Disease: www.womenheart.org

Evidence-based Guidelines for Cardiovascular Disease Prevention in
Women: 2007 Update in Circulation (Journal of the American Heart
Association) http://circ.ahajournals.org

Associated with:
 Coronary artery disease
 Hypertension
 Stroke
 Type-II diabetes
 Cancer (endometrial, breast, colon)
 Gallbladder disease
 Sleep apnea
 Osteoarthritis
 Increased health care cost
 Reduced quality of life
 Increased risk for premature death
Related to:
 Cardiovascular disease
 Alzheimer’s disease
 Cancer (colorectal, breast, prostate, and others)
 Kidney disease
 Lupus
 Arthritis
 Psoriasis
How to reduce inflammation:
 Exercise 30 to 60 minutes most days to improve circulation and loose weight
 Quick smoking – ease burden on arteries
 Adopt the Mediterranean diet – vegetable, fish, nuts, olive oil, etc.
 Try to get at least 6 hours of sleep a night (7.5 hours ideal for many people)
 Reduce stress – major cause of inflammation – through relaxing activities through medication and yoga

 192,000 cases of breast cancer diagnosed each year
 13.2% of women will develop breast cancer in their lifetime
 For women with the BRCA1 and BRCA2 gene mutations the risk of developing breast cancer rises to 36% to 85% o Most breast cancers are not due to BRCA1 or BRCA2 gene mutations o Accounts for less than 10% of breast cancers
Prevention of breast cancer:
 According to the American Cancer Society, women should limit their alcohol use, exercise regularly, maintain a healthy weight to decrease the risk of developing breast cancer
 If possible avoid hormone therapy after menopause
 Regular screening mammogram every one to two years depending on your age or breast cancer risk
 If you have a strong family history of breast cancer, talk to your physician about genetic testing

 Wheezing or shortness of breath
 Chronic cough or chest pain
 Frequent fevers or infections
 Difficulty swallowing
 Swollen lymph nodes-neck, axilla, groin
 Excessive bruising or bleeding that doesn’t stop
 Weakness and fatigue
 Bloating or abdominal weight gain- “My jeans don’t fit” syndrome (comes on fairly suddenly and continues on and off over a long period of time)
 Feeling full and unable to eat- more than 13 times over the period of a month
 Pelvic or abdominal pain
 Rectal bleeding or blood in stool
 Unexplained weight loss
 Upset stomach or stomach ache
 Red, sore or swollen breast
 Nipple changes
 Unusual heavy or painful periods or bleeding between periods
 Swelling or facial features- small cell lung tumors commonly block blood vessels in the chest, preventing blood from flowing freely from the head and face
 Sore or skin lump that doesn’t heal, becomes crusty or bleeds easily
 Changes in nails- clubbing
 Pain in the back or lower right side

Important for:
 Calcium and phosphorous absorption
 Helps prevent osteoporosis and other metabolic bone diseases
 Cancer prevention (colon, breast, ovarian)
 Immune system function
 Brain function
 Heart disease prevention
 Diabetes prevention
 Possible role in multiple sclerosis, lupus, and irritable bowel syndrome
Obtained from 3 sources:
 Sunlight o Exposure three times per week for 15 minutes, no sunscreen
 Food o Fish high in oil content
 Salmon
 Herring
 Mackerel
 Oysters
 Sardines
 Shrimp o Some cereals, juices, and milk fortified with vitamin D
 Supplements o Vitamin D3 (cholecalciferol)
 Stronger and more active than D2
 1000 IU/day
 2000 IU/day is recommended for those at high risk for Vitamin D deficiency:
Vitamin D Deficiency o Obesity o Osteoporosis o Limited sun exposure o Medications that reduce nutrient absorption in the GI tract.
 Very common – 50% of women over 55 are deficient o Test to determine concentration of vitamin D in the blood
25 – hydroxy vitamin D (normal range 30-74 ng/ml)

 Stay physically active o Dancing, tennis, bicycling
 Stay mentally active o Reading, crossword puzzles
 Maintain a social network o Support system of family and friends o Stay socially connected and interact with people
 Treat early symptoms of depression o If you start to withdraw socially and loose interest in things that once brought you pleasure, see a physician or counselor promptly. Depression can begin to rob you of your memories
 Avoid head injury o Take steps to prevent falls
 Keep taking your medications
 Get enough sleep o Short term memory improves when you get plenty of sleep
(6-7 hours / night)
 Eat right o Whole grains and fatty fish are linked to production of high density lipoprotein which are associated with the preservation of memory

Risk Factors for Osteoporotic Fractures
Non-modifiable
• Personal history of fracture as an adult
• History of fracture in first-degree relative
• Caucasian or Asian race
• Small skeletal frame
• Advanced age
• Female sex
• Dementia
• Poor health / frailty
Risk Factors for Osteoporotic Fractures
Potentially modifiable
• Current cigarette smoking
• Low body weight (<127 lbs)
• Estrogen deficiency
– Early menopause (<age 45) or bilateral ovariectomy
– Prolonged premenopausal amenorrhea (>1 yr)
Risk Factors for Osteoporotic Fractures
Potentially modifiable (cont.)
• Low calcium intake (lifelong)
• Alcoholism
• Impaired eyesight despite adequate correction
• Recurrent falls
• Inadequate physical activity
• Poor health / frailty

Defining Osteoporosis by BMD
(World Health Organization Classification)
Normal BMD is within 1 SD of a “young normal” adult (T-score above -1)
Low Bone Mass BMD is between 1 and 2.5 SD below that
(Osteopenia) of a “young normal” adult (T-score between -1 and -2.5)
Osteoporosis BMD is 2.5 SD or more below that of a
“young normal” adult (T-score at or below
-2.5)
Bisphosphonate Drugs Available in the
United States
Pamidronate (Aredia) Parenteral
Reclast)
Clodronate (Bonefos)
Etidronate (Didronel)
Alendronate (Fosamax and
Fosamax plus D)
Risedronate (Actonel)
Ibandronate (Boniva)
Tiludronate (Skelid)
Parenteral
Oral
Oral
Oral
Oral and Parenteral
Oral
Bone Health Recommendations
Adequate intake of dietary calcium and vitamin D
Calcium
Vitamin D
3
At least 1200 mg/day recommended for adults 50 and over
Supplementation (800-1000 IU daily) recommended for adults
50 and over


National Osteoporosis Foundation – www.nof.org

International Osteoporosis Foundation – www.osteofound.org
 National Institutes of Health Bone Disease Center – www.osteo.org
 Doctor’s guide: Osteoporosis – www.pslgroup.com/osteoporosis.htm

HEALTH TESTS AND EXAMS FOR WOMEN
*
EXAM OR TEST
General Checkup
HOW OFTEN
Ideally, every year
Blood Pressure and Weight Every year at annual checkup
Blood sugar Every 3 yrs starting at age
45; earlier if you have diabetes risk factors, i.e. family hx., being overweight, high cholesterol
Cholesterol Test or blood pressure
Every 5 yrs. starting at age 20. Start earlier or have it checked more often if you have a family hx. of heart disease or other risk factors for heart disease
Vaccinations Tetanus-diphtheria (Td) booster every
10 yrs.
All adults need a 1 time dose of Tdap (a combo of whooping cough, tetanus and diphtheria vaccines)
Annual flu shot, esp. if > 50 or have any chronic conditions.
Pneumonia and H1N1 flu vaccines as advised by your physician.
Human papillomavirus vaccine (HPV) one series (ages 9-26)
Breast Exams/ Mammogram Do a monthly self-exam and have a yearly clinical exam by physician or nurse. Starting at age 40, have a mammogram every 1-2 years and beginning at age 50, yearly. (maybe starting at a younger age if you are at an increased risk for breast cancer, as per you physician)

Pelvic Exam/ Pap Smear Under 30, get these annually. If you’re over 30 and have gone for 3 years with normal results, you may be able to get a
Pap every 2-3 yrs.
Colonoscopy Unless you have a family hx. of colon cancer or symptoms, you can wait until age 50. Talk to your doctor about how often you should get them.
Bone Density Test Get screened at least once starting at age
65, but if you have risk factors for osteoporosis, your doctor may suggest that you be tested earlier and more often.
* This is not meant to be an all inclusive list; mainly germane to material
presented in lecture. Follow your physician’s advise for tests and exams.