Heat Centre Nursing Education Day 2016 Lucy and the Iceman: Epidemiology of Ischemic Heart Disease Karin H Humphries, DSc UBC-Heart and Stroke Foundation Professor in Women’s Cardiovascular Health
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
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
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
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
*
*
*
*
*
*
*
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
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
Related Documents
