lucy and the iceman: epidemiology of ischemic heart disease

Heat Centre Nursing Education Day 2016

Lucy and the Iceman: Epidemiology of Ischemic Heart Disease

Karin H Humphries, DScUBC-Heart and Stroke Foundation Professor in Women’s Cardiovascular Health

Objectives

1. Describe the incidence, prevalence and mortality of IHD in BC/Canada

2. Describe differences in IHD pathophysiology between women and men

3. Describe differences in management of IHD between women and for men

Incidence, Prevalence, Mortality of IHD

Ischemic Heart Disease in Canada

Ishemic Heart Disease in Canada

AMI Hospitalization Rates -BC

J of Women’s Health, 2013; Vol 23, pg1-8

Sex Differences in AMI Hospitalization Rates,

by Age and Year

IHD Death in Canada

IHD Death by Province

IHD Death by Country

Rotterdam Study-Incidence by Type

Sex Differences in Pathophysiology of IHD?

Coronary Microvascular Dysfunction

Camici GB et al. Nature Reviews Cardiology 2015;12:48–62

Mechanisms of Myocardial Ischemia

Curr Atheroscler Rep

(2015) 17: 34

Admission Diagnosis

STEMI with age in women

with age in men

Diagnosis - cTn

Clinical Chemistry 2013;59(7):1099-1107

Proportion with Type1 MI

Single Assay 50 ng/L Single Assay 26 ng/L34 ng/L Men

16 ng/L Women

Shah ASV et al BMJ 2015;350:g7873

Sex Differences in Management?

Impact on Treatment/Outcomes

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Shah ASV et al BMJ 2015;350:g7873

Impact on Treatment/Outcomes

ACS and Pre-Hospital Delay

Age Group Men Women

< 65 years 160 (84 - 365) 180 (95 - 420) < 0.05

65-74 years 180 (93 - 392) 195 (100 - 435) < 0.05

75-84 years 180 (95 - 392) 191 (100 - 442) < 0.05

> 85 years 177 (90 - 275) 190 (93 - 450) < 0.05

p = 0.17 p < 0.001

Use of medications by sex and age groupreference: men <65 years

Use of 3+ medications by sex, age, period

HORIZONS-AMI Trial

Yu et al. Catheter Cardiovasc Interv 2015; 85:359–368

Summary

• Important differences exist between women and men in clinical

presentation, and response to treatment for ischemic heart disease

• Behavioural causes of sex-related differences may be more important

than biological factors

• A traditional diagnostic strategies, focusing on coronary obstruction,

and using a single cTn cut-point are likely to be inadequate in women

• Additional testing aimed at determining endothelial coronary

dysfunction may be useful to risk-stratify women with chest pain and

minimal or no obstructive coronary artery disease

Thank You

lucy and the iceman: epidemiology of ischemic heart disease

Health & Medicine