A presentation by Dr. Karin Humphries, the UBC – Heart & Stroke Foundation Professor in Women’s Cardiovascular Health. All rights reserved.

1. Heart Disease in BC Women
Karin Humphries, MSc MBA, DSc
UBC-HSF Professor in Women’s Cardiovascular Health

2. Outline
• Overview of the Epidemiology of CVD in Women
• Trends in CVD and CVD death
• Sex Differences
• Disease
• Presentation
• Treatment
• Outcomes
• Research Priorities over the Next Decade

3. CVD Mortality Trends by Sex
AHA Heart and Stroke Statistics 2011

4. Canadian Statistics
• In 2008 cardiovascular disease accounted for:
• 29% of all deaths in Canada (69,648 deaths)
• 28% of all male deaths
• 29.7% of all female deaths
Statistics Canada 2008

5. Trends in Hospitalization and Death after
a Heart Attack
• Overall hospitalization rates are declining, except in
younger adults (France, Canada, US, BC)
• Women < 60 years age increased by 13.7%
• Men < 60 years increased by 10.9%
• All other age and sex groups declined by 2.1 – 8.9%
• Overall 30-day mortality is also declining
• 1995-2010 30-day death declined from 11.3% to 4.4% in
France
• Canadian data and BC show similar trends

6. Mortality rates are not declining in
younger women
Puymirat E et al JAMA 2012

7. DIFFERENT DISEASE?

8. Microvascular Disease

9. K-M curve – Freedom from Hospitalization for
ACS/Chest Pain with Cardiac Catheterization

10. PRESENTATION

11. “…young women least likely to present with
chest pain…”
quote from heart.org

12. Presentation

13. Presentation
Women Chest Pain/Discomfort No Chest Pain / Discomfort
< 45 81.5% 18.5%
45-54 78.4% 21.6%
55-64 71.1% 28.9%
65-74 62.1% 37.9%
75-84 49.6% 48.7%
Men
<45 87.0% 13.0%
45-54 84.3% 15.7%
55-64 78.2& 21.8%
65-74 67.3% 32.7%
75-84 53.4% 46.6%

14. TREATMENT

15. Drug Therapy
Use of aspirin, beta-blockers, ACE-I, statins after a heart attack
can reduce the risk of another heart attack or death by up to
80%
Are these drugs equally effective in women and men?
• Beta-blockers trials were done decades ago when
women were rarely if ever included in studies
• ACE-I/ARBs appear to be equally efficacious in women
• Statins are equally effective for secondary prevention,
but in primary prevention there is still some debate
• Aspirin for primary prevention reduces risk of stroke in
women, but MI in men.

16. OUTCOMES

17. Coronary
Interventions
• If women get cardiac catheterization post heart attack,
there is no sex difference in use of PCI
• Current era, no sex difference in outcomes following PCI;
initially women had worse outcomes
• Women more likely to die after open heart surgery, but
the gap is closing….
• Benefits of Drug Eluting Stents are generalizable to
women

18. Transcatheter Heart Valves in BC

19. Top Seven Research Questions to
Improve CVD Outcomes in Women
1. What factors influence or explain disparities in
cardiovascular disease epidemiology and disease outcomes
between men and women?
2. What are the best strategies to assess, modify, and prevent a
woman’s risk of heart disease?
3. What are the most accurate and effective approaches to
assess and recognize chest pain and other symptoms
suggesting CHD in women?

20. Top Seven Research Questions to
Improve CVD Outcomes in Women
4. What role does a woman’s reproductive history and
menopausal hormone therapy play in the development of
heart disease?
5. What biological variables most influence the development
and clinical outcomes of HD and what can be done to
reduce mortality rates in women?
6. Why are young women more likely than men to die after
MI?
7. How do psychosocial factors affect CVD in women?