heart disease

Cardiovascular disease outnumbers the next 16 causes of death, including all cancers, in women combined. Approximately 520,000 women die from every year. In fact, research has shown that first cardiac events in women are often fatal, with nearly 250,000 women dying of a MI each year. Since 1980, mortality from cardiovascular disease has declined significantly in men and increased substantially in women. Regardless of the mechanism or approach, women, in general, do appear to benefit from directed cardiovascular disease interventions. However, statistics show that economically disadvantaged women tend to have fewer opportunities to develop positive health attitudes, behaviors, and favorable health outcomes, presumably because of long-standing social and contextual influences.

The focus of this study was to determine the knowledge of heart disease among women in an urban population. Despite recent increased media attention and public education programs, only a small percentage of women were able to correctly identify the leading cause of death and greatest health issue facing women. The population surveyed reflects a high-risk population for poor cardiovascular outcomes.

Race has already been shown to be a significant predictor variable in whether or not patients presented for treatment within the first hour after the onset of cardiac symptoms. African Americans had significantly delayed presentations as compared to non-Hispanic whites (3.25 hours vs. 2.0 median hours). In addition, the age-adjusted cardiovascular disease mortality rate for African-American women is 69% higher than that of Caucasian women.

Only half of the women surveyed were able to correctly identify at least three of the top five risk factors for development of heart disease. This points to a potential failure in our disease prevention approach, as 92% of surveyed women indicated regular physician contact outside of the emergency department.

Cigarette smoking, a risk factor that only half of the women surveyed correctly identified, is known to be the leading preventable cause of cardiovascular disease in women. Smoking cessation is associated with a significant reduction in risk of all-cause mortality among patients with cardiovascular disease.
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Despite studies that have shown that diabetes is a greater predictor of cardiovascular disease in women than for men, only 20% of survey participants recognized diabetes as a risk factor for heart disease.

It appears that a number of participants were unable to comprehend commonly understood causal relationships associated with risk factors for heart disease. Although the majority could correctly select hypercholesteremia as a risk factor, only 36% appeared to identify the relationship between a high-fat diet and hypercholesteremia.

Studies have shown that presentation of cardiovascular disease differs between men and women. Women are more likely to exhibit atypical signs and symptoms of MI, such as dizziness, nausea, and gastrointestinal upset. An atypical presentation can be responsible for delayed diagnosis and treatment. While the majority of surveyed women correctly identified the more traditional symptoms associated with MI of chest pain and shortness of breath, less than one-third of all surveyed women were familiar with the more atypical symptoms associated with MI. In a high-risk population, such as the partici¬pants in this study, unfamiliarity can be costly in terms of increased morbidity and mortality.
This study is unique in that the majority of participants were premenopausal African-American women, a group recently identified as having a two-to-threefold greater rate of coronary artery disease than premenopausal Caucasian women. In addition, the average age group in this study is ideal for risk modification intervention. viagra soft

Limitations

This study was performed as a convenience sample over relatively brief time intervals and represented a small percent of potentially eligible participants. Approximately 10% of surveyed women were excluded from data analysis secondary to questionnaires that were incorrect or incomplete, which may suggest an even deeper problem with this subgroup. Continuous data collection over a longer period of time would decrease the likelihood of selection bias and increase the external validity of this study. In addition, this study was conducted at a single institution. To confirm and generalize the results, a multicenter study is needed.

CONCLUSION

During the past 25 years, advances in technologic and pharmacologic interventions have markedly decreased the morbidity and mortality of cardiovascular disease in men. Prior to 1985, women were rarely included in clinical trials because of concern about reproductive effects and the perception that results from men could be applied to women. While there has been an increase in awareness of the equal incidence of heart disease between men and women, the female gender has not seen the same decrease in incidence of poor outcomes from cardiac disease. Despite increased media attention, up to 87% of surveyed women did not know that cardiovascular disease is the leading cause of death for women. Given the prevalence of heart disease and the importance of risk modification, the data gathered from this study demonstrates deficiencies in the knowledge urban women have regarding cardiovascular disease. As mortality rates for heart disease in women continue to climb, the role of a patient advocate needs to extend beyond just symptomatic treatment and encompass preventive measures as well.
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Because cardiovascular risk can be modified by early intervention, it is vitally important to re-examine the approach to women concerning heart disease, focusing on urban populations who historically tend to have worse outcomes.