Heart Disease In Women Health And Social Care Essay

kindling Disease In Wo custody Health And Social C atomic number 18 endeavorHeart unhealthiness is one of the leading pass waters of death rate in wo custody across the world Rollini. In the get together States, cardiovascular complaint C ary, specifically coronary thrombosis thrombosis philia malady, is the leading cause of death among some(prenominal)(prenominal) custody and wo custody nih coronary occur inciteion, Rollini. Death from a cardiac- link up sluicet is to a greater extent communal than death from all forms of genus Cancer combine.However, dismantle though to a greater extent wo workforce than men die from coronary kernel ailment C ary, knocker distemper itself is still comm only regarded to be a male cloakion. Historically, medicine has utilized the man as the standard, even when treating women xhyheri. at that placefore, there is the likelihood that it is under-diagnosed in women. This is because women suffer symptoms and respond to diag nostic testing variously than do men. Women similarly experience outcomes that atomic number 18 different than those men experience adjacent intervention.Heart sickness is a stipulation that is often used interchangeably with the term cardiovascular affection. Cardiovascular disorder vulgarly refers to those sources that involve barricade or narrowed ancestry vessels that can subsequently lead to burden attack, gibe, or angina. There are other heart conditions that can affect the hearts muscle, beating rhythm, or valves, untold(prenominal) as infections, that are to a fault thought of as heart malady mayoclinic.Much of heart disease can be treated or prevented by making toil substantially-nigh lifestyle choices, much(prenominal) as a healthy diet, exercise, non sess, and watching how much one drinks.As of present, few studies specifically examine heart disease in women. Women in fact represent less that 30% of study population in the absolute major(ip)ity of clinical trials Rollini. The tincture for that has been conducted has indicated that women are less believably to be diagnosed or treated as healthfulhead as men xhyheri. Additionally, studies hurt indicated that women react differently to drugs typically prescribed to cardiovascular disease. Additional look into involving women, along with sexual urge-specific analysis is needed. This would let in the incorporation of much women into cardiac trials as nearly as into observiational studies, and the example of statistical techniques that enable testing for certain sex interactions and provide information about differences in solvent to treatment that are sex-specific.Heart disease in womenHeart disease is the fore almost cause of morbidness and death rate in women. However it is often under- grappled by both patients and providers, as women believe that the major sea wolf and therefore the disease they need to be on the lookout for is cancer. Additionally, heart di sease is still in big part considered a male disease, and the main emphasis in heart disease re explore and clinical practice has gnereally focused on men (Stranges).However, a major shift has occurred recently, with great course credit of the clinical significance of cardiovascular disease in women 1,5 in Stranges. The realization of the importance of cardiovascular disease in women has also been accompanied by a growing awareness of differences in insecurity parts, treatment, duty tour strategies, and prognosis of the disease 1, 5, 12-15 in Stranges between the genders.Some cardio-metabolic danger agentive roles are either unique or more(prenominal)(prenominal) prominent in women than they are in men 5. For instance, preeclampsia is lined to an affixd assay of various cardiovascular outcomes later on in life 17. Additionally such conditions as autoimmune diseases and depression can contribute in a disproportionate dash to cardiovascular risk in women 5, stranges. The preponderance of a number of traditional risk factors are also different for women than they are for men. For example, the prevalence of diabetes mellitus is greater among women in the U.S., primarily as a result of a hang of level of corporeal activity as well as a difference in longevity between the genders 2, 5,18 in Stranges. In fact, eccentric person 2 diabetes and impaired glucose tolerance are recognized as very strong risk factors for cardiovascular disease in women 19. Additionally, type 2 diabetes and impaired glucose tolerance may subjoin the risk of recurrent cardiovascular events fol pocket-sizeding the first crisp myocardial infarction, oddly in women 20 stranges.hypertension also tends to be extravagantlyer in older women, which contributes to the greater morbidity and mortality in women from slice than in men 2, 21 Stranges. Additionally, atrial fibrillation is a primary risk factor for ischemic stroke in women 5, 21, which has led to the development of manag ement guidelines designed to prevent stroke in women 22.EpidemiologyHeart disease is one of the leading causes of mortality across the world. In the United States, a woman dies from a heart related episode every minute Rollini, and despite declining trends seen in many countries over the past 40 years in both men and women, cardiovascular disease is still the leading cause of mortality in both men and women 1-3 stranges. Cardiovascular disease in fact is the cause of a greater number of deaths than all other chronic conditions combined, including cancer, neurodegenerative and respiratory diseases, and accidents 2. just about 1 in every 3 women (34.9%) in the U.S. has whatsoever kind of cardiovascular disease. The percentage for men is slightly higher at 37.6% zhang. Approximately 1 in every 2.7 women impart die of a cardiovascular disease this is compared with approximately 1 out of every 4.6 women who will die of cancer 1 in zhangAlthough age-adjusted mortality range of cardio vascular disease are higher in men than in women, the total number of cardiovascular disease related deaths has been consistently higher in women than in men for the past 2 decades, primarily due to a longer life expectancy as well as a larger proportion of aged women 1,2 stranges. Additionally, in the United States more hospitalizations occur for heart failure and stroke in women as compared to men 2Recent evidence indicates an increasing trend in coronary heart disease mortality in younger women. In U.S. women ages 35 44 years of age, coronary heart disease mortality rates scram change magnitude an average of 1.3% each year since 1997 4. These trends are most likely driven in part by the obesity and diabetes hassle in the U.S., but other contributors include a decrease in physical activity and an increase in the prevalence of hypertension 4.The escalation in prevalence of large scale cardiovascular disease risk factors in younger adults, primarily hypertension and obesity, as well as the leveling off or possible reversal of cardiovascular mortality trends is happening in the U.S. as well as in areas around the world, including the Mediterranean and Asia. These regions are classically associated with healthier dietetical choices and lifestyles (6 -11 strangesSpecific to the disease burden and the specific aspects of cardiobascvular disease in women, the American Heart Association substantial evidence-establish guidelines specifically for women 12 15 stranges. The most recent update of these guidelines was bring oned in 2011 12 and be a major contribution to the field of cardiovascular disease management. The focus of the guideline shifted from evidence based to effectiveness based, and considered both harms/costs and benefits of preventive intervention 12. This shift indicates a major evolution from the guidelines revised in 2007, which were based mainly on the clinical benefits of intervention for cardiovascular disease prevention in women 15.Addit ionally, the 2011 guidelines introduced ideal cardiovascular health as the lowest risk category, meaning that the presence of ideal levels of cardiovascular risk factors and bridal of a healthy lifestyle is most likely to be associated with favorable outcomes and a nicer character reference of life, as well as increased longevity 50. However, only a very small percentage of U.S. women will be classified as being at ideal cardiovascular health 51.Differences in curtly term prognosis and clinical presentation between men and women are evident with cardiovascular disease. in particular in younger women, higher fatality rates sop up been seen during the 30 days first following an acute cardiovascular event, as compared with younger men 31, 32 stranges. There has also been an ongoing controversy on the reasons cardiovascular disease is managed differently in men and women 33-35, although there has been an improvement in the quality of care and in outcomes for women in recent years who have been hospitalized for cardiovascular disease 36 stranges. There is some belief that gender disparities are the result of lower awareness of cardiobascular disease risk in women, as well as a delay in emergency services access. However, the gender gap has been cut down over time 37 stranges.There is still work to be done, though, since very few clinical trials publish results that are sorted by sex. Additionally, researchers frequently utilize historical data in comparing clinical characteristics and treatment in both men and women, and many early trials had an upper cutoff age of 65 years, which excluded many women, since women develop cardiovascular disease on average ten years later than do men.Also of concern is that the demographics of the U.S. and in fact the world are changing, which will mean that practitioners mustiness consider a greater diversity of patients. Added to the well-known classifications of race and geographic origin as well as ethnic origin, there are other facets of diversity that must be considered. These include age, language, literacy, dis tycoon, socioeconomic precondition, apparitional affiliation, occupational status, and culture. Not only do these factors affect how cardiovascular disease presents and progresses, they also often affect the level of care the individual receives.A report done by the Institute of medicine states that differences in treatment in women do live even when controlling for such factors as comorbidities and insurance status 52 from mosca. Pervasive disparities in the treatment of cardiovascular problems are a serious public health edit in the U.S. in spite of the marked declines in mortality that have been ob shell outd on a national scale over hthe past several(prenominal) decades. These disparities in particular have an adverse jolt on the clinical outcomes and quality of life for African American and Hispanic women, a fact which must be recognized by practitioners. Care that is sensit ive to cultural difference includes the revision of healcare delivery to incur the specific needs of a patient population that is incredibly diverse. Tehrefore diversity in this context of health care means that all individuals must receive equitable care, regardless of any barriers that may exist 57=59 mosca.The main cause of these barriers to equitable care includes lose of understanding about patients health beliefs, cultural values, and frequently the inability to communicate symptoms accurately in what to many of these women is a foreign language 53-55 moscaGeneral guidelines for diagnosing and treatment apply across all groups of women however, it is eventful to note that risk factors such as hypertension are more prevalent in African American women. Also, diabetes mellitus is more prevalent in Hispanic women 6 from Mosca. Most notably, the most coronary heart death rates and the greatest overall cardiovascular disease morbidity and mortality occur in Aftrican American wome n. This means that mortality from cardiovascular events in these women is more similar to those seen in men than those seen in other groupings of women. This simply underscores tat need for greater noise efforts in some groupings of women as well as a different approach taken to diagnosis and treatment of cardiovascular disease, an approach more tailored to each specific grouping.Deaths from cardiovascular disease have decreased in all groupings of women. However, Hispanics have the lowest percentage of deaths from cardiovascular events (21.7%) as comared with non-Hispanics (26.3%) 62 mosca. Hispanics also have a longer life expectancy at 83.1 years compared with the 80.4 year life expectancy for non-Hispanic purity women and the 76.2 years for non-Hispanic black women 63 mosca. This means that cardiovascular complications due to age are a greater context for Hispanic women.Age is not only a consideration for Hispanic women, however. The life continuum of women frequently reflec ts different events that are approached with different levels of pains both physical and mental than those that affect men. These events include such conditions as pregnancy. Therefore, it is important to consider all facets of diversity when practitioners care for women with cardiovascular disease, to avoid a disparity in care 64-66 mosca.EtiologyCardiovascular disease is largely caused by risk factors such as blebby lifestyle choices. Many of the causes for most forms of cardiovascular disease can be treated or prevented by making healthy lifestyle changes. These causes includePathophysiology of heart diseaseIt is of utmost importance for the practitioner to recognize that womens hearts are different from mens hearts. Whiel this area of study is somewhat new, it is known that women have littler herats as well as smaller arteries than men. interrogationers from Columbia University and NY Presbyterian also believe that women have a different native rhythmicity to the pace of t heir hearts, which in general causes the heart of a woman to beat faster than the heart of a man. The researchers also belive that a womans heart may take longer to relax following each beat. Additinoally, some surgeons have hypothesized that the reason that women have a 50% higher chance of dying during heart surgery as compared to men may be related to a fundamental difference in the way a womans heart works. These differences may also be linked to the fact that women are more likely than are men to die after their first myocardial infarction Ricciotti. Approximately 25% of men die in the first year following their first myocardial infarctino, compared with 38% of women Krupa online. Women are also approsimately twice as likely to experience a second myocardial infarction deep down 6 years of the first. Additionally, women are approximately twice as likely to die following bypass surgery. From Ricciotti onlineHeart disease itself therefore affects the hearts of women in differen t ways than it does men. Following a heart attack, a womans heart is more likely to sustain its systolic function effectively. C. Noel Bairey Merz, the Director of the Womens Heart Center at Cedars-Sinai Heart institute, has suggested that this reflects that cardiovascular disease affects the microvasculature in women, while in men it affects the microvasculature Krupa.Conventional research has indicated that the most prevalent form of cardiovascular disease is coronary arterial blood vessel disease, where plaques narrow or block the major arteries of the heart, which in turn cuts off the supply of oxygen to the heart. The duration and severity of the impairment determines the severity of the acute event unstable angina or myocardial infarction can result. This ultimately affecst the hearts ability to warmness blood correctly. However, Bairey Merz found that womens hearts were much less likely than were mens to lose the ability to pump blood following a myocardial infarction. Addi tionally, women were much less likely to present with coronary artery disease that was obstructive. This led Bairey Merz to conclude that in women the oxygen deprivation to the heart and the ensuing legal injury is more likely to happen when the small blood vessels become disfunctional, as opposed to the major arteries Krupa-online. Bairey Merz further believes this is a major reason why women are misdiagnosed or suffer adverse heart events, beause practitioners typically look for the patterns of cardiovascular disease progression that are present in men as opposed to inquisitory for patterns that are present in women.The Womens Ischemic Syndrome military rating (WISE) study concurred and has indicated that women may experience chest disorder and abnormal tensity testing even when there is no critical, flow limiting lesion (50% luminal stenosis in a coronary artery) present in one of the major arteries. In this study, 60% of women who underwent coronary angiography did not have a lesion present. Even without experiencing critical blood flow problems, women in the study without lesions undergo persistent symptoms. The persistence of the symptoms, combined with abnormal stress testing results was therefore attributed to endothelial dysfunction and disease affecting the microvasculature.A number of factors may contribute to endothelial dysfunction and disease affecting the microvasculature. Hypertension, beta-lipoprotein cholesterol, diabetes, the chemicals in tobacco, circulating vasoactive amines, and infections can all contribute.Women are not beyond danger regarding plaque and intermission of forward blood flow in the arteries, however. This is primarily because women have smaller coronary arteries than do men, even after correcting for total body surface area 7 Kusnoor. Therefore, anything that affects flow may prove to be critical. Additionally, women are two times more likely than men to have plaque erosion with subsequent blood clot formation 8 kus noor. From Kusnoor online bookmarkedRisk FactorsFrom Schenk-GustaffsenRisk factors for heart disease are roughly the comparable for both sexes however, gender specific differences are present (Rollini). There are some unique risk factors that exist for women older age at presentation is a major risk factor, as women are more likely to suffer from comorbities, including diabetes and hypertension.Given the fact that 6 out of every 10 deaths schenk from cardiovascular disease in women can be prevented, it is extremely important to understand the risk factors associated with the disease in women. consort to the InterHeart study 2 schenck there are nine factors that are responsible for 90% of all cardiovascular disease cases. These factors are fastballStressDyslipidemiaDiabetesHypertensionObesityPoor diet, specially one that does not include sufficient inhalant of fruits and vegetablesPhysical inactivityConsumption of inebriant in excessThe same cardiovascular risk factors have been used in risk calculations for the past 40 years, despire increasing knowledge regarding gender differences and the disease. Ridker et al schenck, find ref suggested in 2007 to use the Reynolds scoring system for women. This suggestion is based on a 10 year study of data from the Womens Health Study for cardiovascular events in 25,558 women, all over 45 years of age. The conclusion was that this scoring system predicted cardiovascular disease risk in women check than classical scoring systems.ModifiableDiabetes mellitus is one of the most important risk factors, and coronary heart disease mortality is 3 5 times higher in those women who are diabetic as compared to those who are not diabetic. In contrast, the risk is only 2 3 times higher in men who are diabetic. Women also have a 3 5 times higher chance than men of developing cardiovascular disease to begin with 30 schenck. Higher glucose levels as well as insulin resistance serve to counter the protective effects of estrogen, which places women at this higher risk Johnson. Cardiovascular events are the primary cause of death, particularly in type II diabetes. The Nurses Health Study indicated that coronary heart disease mortality in women who have diabetes was 8.7 times higher than non-diabetics 31 schenck. An additional danger is that women who are diabetic develop cardiovascular disease earlier, at approximately the same age men do. Why this is the case is currently alien 33. Diabetes is largely preventable or well-controlled through making healthy dietary and seaworthiness decisions, sometimes in tandem with medication.Cigarette smoking is a very significant risk factors for coronary heart disease in women. Smoking in women prompts more negative cardiovascular and lung consequences than does smoking in men. One electromotive force reason for this may be that the dimensions of the coronary arteries and the lungs are smaller in women than in men therefore, a woman smoking the same make sense as a man would do more damage to her body. Women who are less than 55 years of age have 7 times increase in risk attributable to smoking than do men, and the increase in risk depends on dose. It is undisputable that smoking predisposes the individual to atherosclerosis 24, 25 schenck. The Nurses Health Study, which examined more than 120,000 haelthy nurses, indicated that only 4 5 cigarettes a day nearly doubled the risk, and 20 cigarettes a day compounded the risk 6 times 26 schenck. Smoking has declined a bit in men however smoking in women has not declined at the same rate, particularly in younger women. This can lead to significant vascular problems later on in life. Further, individuals who are routinely exposed to second hand smoke see a 25% increase in the risk of developing cardiovascular disease. Therefore, it is not simply direct smoking that causes the problem. Additionally, smoking combined with other factors such as use of contraceptives containing estrogen multiplies risk f or cardiovascular events and for clot formation ROllini. hormonal contraception is in fact contraindicated for women over 35 years of age who smoke as a result of the multiplied risk. Refraining from smoking lessens the risk of developing heart disease and helps reduce potential cardiovascular risk factors.Alcohol consumption poses a risk for the development of cardiovascular disease. A conceal intake may be protective to the heart, but too much alcohol is harmful 45, 46 schenck. The type of alcohol consumed is not as crucial as are the drinking patterns. Low to moderate day by day intake may be protective, whereas conversely binge drinking can be harmful to the heart. If a patient has already experienced a first myocardial infarction, it is not necessarily a questioning thing to continue drinking moderately. However, it is also not necessarily recommended that patients start drinking in search of the protective benefits of alcohol consumption following a first myocardial infarct ion schenck. Light to moderate drinking is defined as defined as one standard drink for women per day and two per day for men. The difference exists because men and women metabolize alcohol differently specifically women metabolize slower than do men. A standard drink is defined as 12 grams of alcohol this is equivalent to 15 cl of wine.It is well established that there is an association between LDL cholesterol and an increased risk of cardiovascular disease. Individuals who reduce their LDL cholesterol also reduce their risk for cardiovascular disease. Further, this reduction in cabal with raising their HDL cholesterol serves to further reduce risk. A study conducted by the Lipid Research Clinic indicated that low HDL cholesterol in women was the most significant predictor of death from ischemic heart disease 12 schenck. It has been shown that having low HDL levels affects women more than it does men 16 schenck, so it is important that practitioners encourage the reversal of low H DL.Hypertension is also a risk factor for cardiovascular disease. A meta-analysis that included data from more than 1 million adults ages 40 69 indicated that an increase of 20 mmHg systolic or 10 mmHg diastolic in an individuals normal blood pressure doubles the mortality from coronary heart disease 22 schenck. There is a 3 times increase in coronary heart disease as well as stroke in women with 185 mmHg systolic when compared to women who are less than 135 mmHg systolic 23 schenck. The way hypertension is treated is currently the same in both emn and women. Most of the time, pharmacotherapy and lifestyle changes is the preferred treatment.A sedentary lifestyle and obesity pose a significant risk as well. Obesity is more common in women (35.5% ) than in men (32.2%), and 27% of women are obese 1 schenck. People who are active and on a regular basis exercise their heart muscle are at a much lower risk of developing heart disease. In particular, obese women are more likely to also ha ve metabolic conditions such as polycystic ovarian syndrome or Syndrome X than are lean women, which multiplies risk Johnson.Exercise and physical fitness play a big role, and lack of physical activity is a major risk factor for developing cardiovascular disease. One study found that less fit individuals experiences a 4.7 times increased risk of stroke and myocardial infarction, independent of other risk factors 37 schenck. The beneficial effects of exercise are not as great in women as they are in men women experience smaller increases in HDL resulting from similar exercises as men 38 schenck. The Nurses Health Study has indicated though, that two aspects are particularly beneficial to women, namely that brisk walking delivered the same benefits as did vigorous exercise, and women who had previously been sedentary experienced benefits that were similar to those who had exercised earlier in life. This means that it is better to exercise late than to never do so. The recommended amou nt of exercise is 30 minutes of exercise daily.Diet. A poor diet is a major risk factor for the development of cardiovascular disease. The Mediterranean diet has been shown to have beneficial effects on alleviating cardiovascular disease risk. The diet has a high proportion of fruits and vegetables, and has a positive impact on total cholesterol, LDL cholesterol, blood pressure, and myocardial infarction 47 schenck. One study of 600 men and women who were randomized into either a group using the Mediterranean diet or a control group indicated that after 27 months a marked difference was found in mortality and morbidity for cardiovascular disease as well as total mortality in favor of the Mediterranean diet 48 schenck. The mechanisms behind this are multiple, with the recommendation that diet always be combined with other changes to lifestyle, such as exercise or medication. The effects are likely the same in women as in men, but there has not been much gender specific research into why the Mediterranean diet proves beneficial 49, 50 schenck feeling serves as a risk factor for the development of cardiovascular disease, particularly if the patient is also winning antidepressant medication. Mood in general is a risk factor, particularly if the individual experiences a high level of stress on a consistent basis. As compared to other risk factors, psychosocial variables are much more difficult to define or to measure objectively. Nonetheless, there are several different aspects within the broad definition of psychosocial factors that are currently associated with increased risk of myocardial infarction. These aspects include work and family stress, lack of control, low socioeconomic status, negative life events, and a poor social support system. These aspects, along with depression, affect the risk of ischemic heart disease as well as the prognosis. There are several studies that show a clear correlation between stress and cardiovascular disease. One study indicat ed that family stress including marital stress increases the risk of ischemic heart disease 41 schenck. Another study indicated that work stresses as well as home stresses were more common in those patients who had suffered a myocardial infarction, and that stress represented 30% of the individuals total risk 42 schenck. Where depression is involved, it has been found that both women and men tend to get more depressed following myocardial infarction 43, 44 schenck. This increases the risk of a second myocardial infarction. It is important to note regarding depression that more women experience depression than men, and it is therefore a more important risk factor in women.Recent evidence indicates that sleep deprivation and disturbances may be associated with cardiovascular disease, particularly in women 23 stranges. Three independent studies have indicated an association between increased hypertension and sleep deprivation. This phenomenom occurred only in women 24 26 stranges. T hese findings are particularly significant because sleep disturbances and deprivation are more common in women than in men in both developed as well as developing countries 27, 28 strangesNon-modifiableGenetics. Congenital heart disease is something the individual is born with. However, an individual may also have a familial predisposition to develop certain cardiovascular problems, as seen through examining family history of heart disease. In the latter, a predisposition does not mean the individual is guaranteed to develop the specific cardiovascular problem they are predisposed to healthy lifestyle choices such as eating well, not using alcohol to excess, not smoking, and exercising regularly can go a long way toward fighting genetic predisposition. It is interesting to note that simply having a family history of the disease can lead to stress and breakdown in mood for some individuals, both risk factors for cardiovascular disease. In one study that examined data collected from 60 women and 31 men who averaged 21.4 years of age it was found that a family history impacts stress responsivity, which can contribute to future heightened cardiovascular disease risk wright.Menopause poses a risk for coronary heart disease in women because the reduced production of estrogen leads to worsening of coagulation, vasculature, and the lipid profile. Early menopause in particular is a known risk factor results of a study utilizing the Womens Ischemic Syndrome Evaluation (WISE) indicate that estrogen deficiency poses a very strong risk factor for coronary heart disease 8, from RolliniEndothelial dysfunction frequently occurs post-menopause. Its detection can precede more overt diseases such as hypertension and diabetes. One study indicated 13 Rollini of women without hypertension development of endothelial dysfunction was linked with hypertension. oer the next four years. Another study indicated 14 Rollini and examining a cohort ofeuglycemic women who were not obese, mar ked endothelial dysfunction at the baseline was linked with development of diabetes. Also over the next four years. Further, in postmenopausal women with hypertension changes in endothelial function that occur as a result of antihypertensives may be used to identify women who have a better prognosis 15 Rollini.Metabolic syndrome is a complicated condition that involves hypertension, low HDL levels, elevated LDL levels, abdominal obesity, insulin resistance and elevated triglycerides. Metabolic syndrome has a marked roll in increasing the risk of cardiovascular disease, particularly in menopausal women. Further, there is a strong link between metabolic syndrome and depression. Depression is a commonly known risk factor for cardiovascular disease.Age. As women advance in age, they are more likely to develop cardiovascular disease, and in particular it is more likely that women will have one or more comorbidity associated with cardiovascular disease risk, such as diabetes or obesity.Ki dney disease increases the risk of cardiovascular disease in women more than men.Resting heart rate is an independent risk factor for patients who have known cardiovascular disease as well as for those with acute myocardial infarction 133-135, 136-140. Women possess a lower resting sympathetic output than do men, but after an uncomplicated acute myocardial infarction, women have greater sympathe