• 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

Why “Tell A Friend”?

• 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!

Key Messages for Women

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.

• 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

Death After a Heart Attack

• Cholesterol profile numbers

• Blood pressure reading

• Blood sugar: blood test for diabetes

• BMI or Waist Circumference

Always Know Your Numbers!

• 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

Risk Factors for Heart Disease

• 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 are the Risk Factors?

• Age

• Gender

• Family History

What You Can Change

What You Can’t Change

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

• Previous heart attack or stroke

• Angina (chest pain or pressure due to blocked arteries)

• Circulation problems

• Diabetes

• Chronic kidney disease

Signs You’re at HIGH 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!

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

More Signs You’re at MODERATE RISK for Heart Disease

• “Optimal Risk”

• No major risk factors

• Healthy Diet

• Daily Exercise

• No Smoking

• Healthy weight (BMI 19-25)

Signs You’re at LOW RISK for Heart Disease

Tackling a Risk Factor: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

Recognizing High Blood Pressure

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

140-159 systolic or 90-99 diastolic

Stage 2 Hypertension

>160 systolic or >100 diastolic

Blood Pressure Treatment GoalsJNC-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.

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: Good Things Can Happen!

• 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

Lowering Your Blood Pressure: What Can You Do?

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

• 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

Lowering Your Cholesterol:What Can You Do?

Tackling a Risk Factor: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 haveALL of your risk factors treated:– Blood Pressure– Cholesterol– No Smoking!

Women and Diabetes

Know Your Numbers:Diabetes Guidelines*

Optimal fasting blood sugar level: <100 mg/dL

Impaired fasting glucose:Prediabetes

100-125 mg/dL

*American Diabetes Association Guidelines

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)

• 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!

Lowering Your Risk for Diabetes:What can you do?

Other Risk Factors

• 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

Smoking: The #1 Preventable Risk

• 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

Overweight and Obesity

• 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

Easy Ways to “Cut” and “Spend” Calories

• 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!

The Metabolic Syndrome

Risk Factors Add Up!

0

5

10

15

20

25

None Smoking Smoking + HighCholesterol

Smoking + HighCholesterol +

HTN

Rates per 1,000 Persons at Risk

Exercise helps:

• Lower blood pressure

• Prevent diabetes

• Lower LDL (bad cholesterol) and raise HDL (good cholesterol)

• Weight management

• Manage stress and depression

• Bone health

Exercise is Key!

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

What About Postmenopausal Hormone Therapy?

When Prevention Isn’t Enough:HAVING 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

How Do You Know:Symptoms of a Heart Attack

When Prevention Isn’t Enough:HAVING 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

How Do You Know:Symptoms of a Stroke

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

Key Take-Aways

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