Why “Tell A Friend”?
• It is important for women to talk to their nurse or
doctor about the health of their heart and blood
vessels
• It is important for women to talk to their nurse or
doctor about symptoms of heart problems
• Women need to tell other women about heart health
and important risk factors
Key Messages for Women
• Heart disease is the #1 cause of death in women
• Stroke is the #5 cause of death in women
• Know the symptoms of heart attack and stroke,
and seek medical attention promptly
• Prevention is important for everyone!
CVD & Other Causes of Death
More than 1 in 4 women will die of heart disease
1 in 30 women will die of breast cancer
Women are Getting the Message
What is the leading cause of death in women?
We know the answer: Heart Disease!
• In 1997, only 30% (less than 1 out of 3) women
knew the right answer.
• In 2012, 57% of women knew the right answer.
*However, in 2012, only 36% Hispanic and Black women
were aware. 45% women ages 25-60 did not know
heart disease is their #1 killer.
Death After a Heart Attack
• Women are more likely to die in the first year
following a heart attack than men the same age
– 1 of 4 men will die in the first year
– More than 1 of 3 women will die in the first year
• We don’t know all the reasons for this difference
• The government requires that heart disease researchers:
– include women as research subjects
– report how men and women
respond to treatments
Always Know Your Numbers!
• Cholesterol profile numbers
• Blood pressure reading
• Blood sugar: blood test for diabetes
• BMI or Waist Circumference
Risk Factors for Heart Disease
• Guidelines put women in 1 of 3 classes:
– Low Risk
– Moderate Risk
– High Risk
• The same things that increase risk for a heart attack
can increase the risk for a stroke
• Ask your nurse or doctor to help you make a plan to
lower your risk level
What are the Risk Factors?
What You Can Change
• Physical Activity
• Life Stress
• High Blood Pressure
• Obesity
• Diabetes
• High Cholesterol & Triglycerides
• Smoking
• Unhealthy Diet (HIGH in saturated fat
& calories; LOW in fresh fruit, veggies,
whole grains & fish)
What You
Can’t Change
• Age
• Gender
• Family History
Small Changes Can Make
a Difference Long Term
• Study of 90,000 women (ages 27-44) from 1991-2011
reduced their risk for HD over 90% over 20 years.
• 6 Healthy Lifestyle Habits
– Not smoking
– Exercising at least 2.5 hours a week
– Maintaining a normal weight
– Eating a healthy diet
– Watching 7 or less hours of TV a week
– Limiting alcohol to no more than
1 drink a day
Signs You’re at
HIGH RISK for Heart Disease
• Previous heart attack or stroke
• Angina (chest pain or pressure due to blocked
arteries)
• Circulation problems
• Diabetes
• Chronic kidney disease
Signs You’re at MODERATE
RISK for Heart Disease
• One or more of the following risk factors:
– High cholesterol
– Smoking
– High blood pressure
– Family history of heart disease or stroke at a
young age (<50 for men; <60 for women)
• Metabolic Syndrome-a cluster of risk factors that
often occur together-more about this later!
More Signs You’re at MODERATE
RISK for Heart Disease
• Rheumatoid arthritis or Lupus
• A history of high blood pressure in pregnancy,
diabetes in pregnancy or preeclampsia
• If you can only exercise for a short time during a
treadmill test performed by your nurse or doctor
Signs You’re at LOW RISK
for Heart Disease
• “Optimal Risk”
• No major risk factors
• Healthy Diet
• Daily Exercise
• No Smoking
• Healthy weight (BMI 19-25)
Tackling a Risk Factor:
HIGH BLOOD
PRESSURE
Recognizing High Blood Pressure
• High blood pressure is very common as women
get older
• Even women who had good blood pressure all their
lives are at risk for high blood pressure as they age
• High blood pressure is called the “silent killer”
because it doesn’t have any symptoms
Blood Pressure Recommendations
You May Be Familiar With
Optimal
<120 systolic and <80 diastolic
Pre-Hypertension 120-139 systolic or 80-89 diastolic
Stage 1
Hypertension
Stage 2
Hypertension
140-159 systolic or 90-99 diastolic
>160 systolic or >100 diastolic
Blood Pressure Treatment Goals
JNC-7
• Treat to BP <140/90 mmHg.
• Treat to BP <130/80 mmHg in patients with diabetes
or chronic kidney disease.
• Majority of patients will require two medications to
reach goal.
Lowering Your Blood Pressure:
Good Things Can Happen!
When you lower your blood pressure,
you lower your risk of:
– Stroke by 40%
– Heart Attack by 25%
– Heart Failure by 50%
Lowering Your Blood Pressure:
What Can You Do?
• Make healthy habits
– Take a 30 minute
walk everyday
– Avoid being overweight
– Lower salt in your diet
– Follow a heart-healthy
diet (low fat, lots of fruits/
veggies and 2-3 servings of low
fat dairy products every day)
– Limit alcohol to
one drink per day
• Take the right medicines
– There are many good
and safe medicines
– Most people will
need more than one
Tackling a Risk Factor:
HIGH CHOLESTEROL
Cholesterol (Lipid) Recommendations
You May Be Familiar With
Total Cholesterol Goal:
<200 mg/dL
“Bad Cholesterol” LDL Goal:
(Low Density Lipoprotein Cholesterol)
<100 mg/dL
“Good Cholesterol” HDL Goal:
(High Density Lipoprotein Cholesterol)
>50 mg/dL
Triglycerides Goal:
<150 mg/dL
Newer Cholesterol
Recommendations (2013)
Who should be taking cholesterol medication?
1. If you have had a heart attack or a stroke
2. If you have diabetes (Type 1 or 2) and are
40-75 years old
3. If your LDL-C is higher than 190 mg/dl
4. If your estimated 10 year risk of developing
a heart attack is greater than 7.5 % and
you are 40-75 years old
Lowering Your Cholesterol:
What Can You Do?
• Main Target of Treatment = LDL Cholesterol
• Healthy behaviors are important!
• If you already have heart disease or diabetes, or if
your cholesterol level or risk is high, you might need
medicine to lower your cholesterol
Note: Women who are pregnant, nursing, or who
may become pregnant should not be prescribed
cholesterol-lowering medications
Tackling a Risk Factor:
DIABETES
Women and Diabetes
Type 2 diabetes increased 50% in the last 10 years
• A woman with diabetes has 5x the risk of heart
disease than a woman without diabetes
• Women with diabetes get heart disease at a younger
age
• If you have diabetes, it is important to have
ALL of your risk factors treated:
– Blood Pressure
– Cholesterol
– No Smoking!
Know Your Numbers:
Diabetes Guidelines*
Optimal fasting blood sugar level:
<100 mg/dL
Impaired fasting glucose:
Prediabetes
100-125 mg/dL
You have diabetes if:
Your fasting blood sugar is 126 or more (and tests at
that level or higher on a second reading on a different
day)
*American Diabetes Association Guidelines
Lowering Your Risk for Diabetes:
What can you do?
• Research shows that diabetes can be prevented,
or at least postponed by improving diet, losing
weight, and increasing physical activity
• People at risk for diabetes who follow a diet and
exercise can decrease their risk of developing
diabetes by more than 50%
– This has been proven in a trial where the people
lost an average of less than 10 pounds.
• Small steps make a BIG difference!
Other Risk Factors
Smoking: The #1 Preventable Risk
• Women who smoke have 2-6 times the risk of sudden
cardiac death than non-smokers
• That risk is even higher for heavy smokers
• Second-hand smoke increases health risks, too
• Health benefits begin as soon as you quit!
• Talk to your nurse or doctor about how to stop:
– Quitting is difficult
– Nicotine replacement or medications may be helpful
– Get Support: Call 1-800-Quit Now
or visit www.SmokeFree.gov
Overweight and Obesity
• A growing problem in the United States
• Being overweight increases risk of:
– High blood pressure
– Cholesterol abnormalities
– Diabetes
• Exercise recommendations to lose weight:
– 60-90 minutes of moderate-intensity activity everyday
• All women should reduce saturated fat intake
to less than 7% of calories
Easy Ways to “Cut”
and “Spend” Calories
• Choose fat free milk instead of whole milk
• Park far away, so you can walk
• When eating out, share an entrée or save half
for the next day
• Portion Control: Fill up half of your plate with veggies
or salad, smaller amounts of carbs and low fat protein
• Wear a pedometer to count your steps – then increase
your steps gradually (2,000 steps = 1 mile)
• Walk to a co-worker’s desk
instead of emailing
The Metabolic Syndrome
• Certain risk factors tend to “go together” and increase
your risk for getting diabetes or heart disease:
– Overweight, especially when carried around the waist
– High blood pressure
– Cholesterol abnormalities (low HDL or high
triglycerides)
– Elevated blood glucose
• People with these risk factors need to be treated very
aggressively for heart disease prevention
• Heart healthy habits are key!
Risk Factors Add Up!
Rates per 1,000 Persons at Risk
25
20
15
10
5
0
None
Smoking
Smoking + High Smoking + High
Cholesterol
Cholesterol +
HTN
Exercise is Key!
Exercise helps:
• Lower blood pressure
• Prevent diabetes
• Lower LDL (bad cholesterol) and
raise HDL (good cholesterol)
• Weight management
• Manage stress and depression
• Bone health
What About Postmenopausal
Hormone Therapy?
Postmenopausal Hormone Therapy (HT) is
NOT recommended to prevent heart disease.
•Research trials have failed to demonstrate that
HT lowers risk.
•It may increase stroke
•Women should focus on the things we know
really work to improve heart health
•Hormone therapy may still be used to treat
menopause symptoms – talk to your
nurse or doctor
When Prevention
Isn’t Enough:
HAVING A
HEART ATTACK
How Do You Know:
Symptoms of a Heart Attack
• Uncomfortable pressure, fullness, burning or
squeezing sensation in the chest
• Pain in your chest, neck, arms, or back
• Unusual shortness of breath
• Nausea, vomiting, dizziness, sweating
• Unusual fatigue
• Feeling of doom – a sense that something really
bad is happening, or about to happen
How Do You Know:
Symptoms of a Heart Attack
• You may not have all symptoms
• Symptoms are different for everyone
• It may not be as dramatic as on TV or movies
• You know your body – trust your instincts!
• Immediate treatment that can limit the amount of
heart muscle damage is crucial
SYMPTOMS REQUIRE IMMEDIATE ACTION!
CALL 9-1-1
When Prevention
Isn’t Enough:
HAVING A STROKE
How Do You Know:
Symptoms of a Stroke
• Sudden numbness or weakness in your face, arm, or
leg – especially on one side of your body
• Sudden confusion, trouble speaking or
understanding
• Sudden trouble seeing in one eye, or both
• Sudden trouble walking, dizziness, loss of balance or
coordination
• Sudden, severe headache with no known cause
How Do You Know:
Symptoms of a Stroke
• A stroke is a brain attack
• Emergency treatment that can limit the amount of
brain damage must be started quickly
• It is usually not the person experiencing the stroke
that calls 9-1-1
• Make your family aware of the symptoms
SYMPTOMS REQUIRE IMMEDIATE ACTION!
CALL 9-1-1
Key Take-Aways
Key Take-Aways
• Know the symptoms of heart attack and stroke
• Know your risk factors for heart disease
• Work with your nurse or doctor to reduce your risk:
– Avoid tobacco products and second-hand smoke
– Have your blood pressure and cholesterol profiles
measured (and blood sugar if at risk for diabetes)
– Follow their advice to manage risks with healthy
behavior changes and medicine, if needed
– Eat a heart healthy diet – low in “bad” fat and salt
– Exercise – walking for 30 minutes
each day is perfect
Key Take-Aways
SPREAD THE WORD:
TELL A FRIEND, NEIGHBOR,
SISTER OR CO-WORKER
Online Resources
• National Heart Lung and Blood Institute: www.nhlbi.nih.gov
(information about cholesterol and blood pressure)
• Heart Truth Campaign: www.nhlbi.nih.gov/health/hearttruth/
• American Heart Association (AHA): www.heart.org
• AHA Go Red for Women: www.goredforwomen.org
• WomenHeart: National Coalition for Women with
Heart Disease: www.womenheart.org
• Preventive Cardiovascular Nurses Association:
www.pcna.net