NEW YORK NURSE: January/February 2012
by Katie Powell, BS, RN, Faculty, St. Joseph’s College of Nursing, Syracuse; Gina Myers, PhD, RN, Assistant Professor, Le Moyne College, Syracuse, Foundation of New York State Nurses Center for Nursing Research Steering Committee
Cardiovascular disease (CVD) is the leading cause of death in the United States (US). For years, men have held the spotlight when talking about cardiac health, however, it may be surprising to learn that heart disease is the leading cause of death for women. This number is even higher for African American women (Mosca, et al., 2011). CVD causes approximately one female death per minute in the US, yet only 53 percent of women recognize that calling 9-1-1 is the first action to take if they think they are having a heart attack (Mosca, et al., 2011). Since the majority of heart disease research has been conducted with male subjects, there is less understanding among healthcare providers of what will benefit their female patients.
It is often said that “an ounce of prevention is worth a pound of cure.” The American Heart Association (AHA) (2011) recently released an update to guidelines for CVD prevention in women, suggesting prevention is a key factor in the maintenance of cardiovascular health. An expert panel consisting of members from major professional and government organizations that have a strong focus on CVD prevention reviewed the 2007 guidelines, performed a literature search and updated information regarding CVD risk-reducing interventions specific to women.
The AHA most recently described “ideal cardiovascular health” in women as maintaining a blood pressure less than 120/80 mmHg, total cholesterol levels less than 200 mg/dL, fasting blood glucose less than 100 mg/dL, a body mass index of less than 25 kg/m2, not smoking, physical activity at recommended levels, and healthy eating patterns. It is said that when these ideals are achieved and maintained, there is an association with greater quality of life in older age, reduced risk for events caused by CVD, and even lower Medicare costs later in life.
The AHA (2011) reports approximately 66% of women in the United States over age 20 are either overweight or obese, with 55,000 more women dying of stroke than men. Why are women so different when it comes to stroke and heart disease? Women have unique risk factors such as pregnancy, menopause, hormone therapy, and a propensity for delaying diagnosis and treatment for symptoms of cardiac events (Waller, 2006). Women often see themselves as the caregivers for others and are, subsequently, less likely to place their own care and treatment first. Heart disease is oftentimes silent until the occurrence of a myocardial infarct. CVD can also be more difficult to notice in women. Women do not typically show the same cardiac symptoms as men and present with complaints of nausea, fatigue, heartburn, shortness of breath, or general malaise, rather than simple “chest pain.” As a result, a woman may put off these concerns in favor of attending to priorities other than her health.
It is important for nurses to understand cardiovascular disease, and how it can differ between genders. As mentioned, pregnancy provides a special opportunity to estimate a woman’s lifetime risk for CVD (Mosca, et al., 2011). It has been found that women with a history of preeclampsia have nearly double the risk for ischemic heart disease, stroke, and thrombotic events in the five to 15 years following a pregnancy, pointing to a need for cardiac follow up postpartum. It has also been found that women with a history of gestational diabetes may be at a higher risk for developing CVD due to an increased likelihood of becoming pre-diabetic, insulin resistant, and having higher triglyceride levels (King, Gerich, Guzick, King, and McDermott, 2009).
It is suggested that with female patients, the initial assessment questions are more focused on pregnancy history, including gestational diabetes, preeclampsia, and preterm birth, as these factors increase CVD risk. Nurses need to talk in depth with female patients to understand their barriers to treatment and adherence to risk-reducing activities surrounding diet and exercise; conversation must include family responsibilities, stress, sleep deprivation, and lack of personal time. Lack of financial support has been an issue reported more often by African American women, and Hispanic women report being fearful of change when it comes to their cardiac health (Mochari-Greenberger, Millis, Simpson, & Mosca, 2010). In providing education specific to our female patients’ needs, we can develop personalized interventions to better care for them in the home, office, and hospital. Nurses are the link to increasing treatment adherence and engagement in healthy behaviors in a population not always carefully followed when it comes to heart disease.
King, K. B., Gerich, J. E., Guzick, D. S., King, K. U., and McDermott, M. P. (2009). Is a history of gestational diabetes related to risk factors for coronary heart disease? Research in Nursing & Health, 32, 298-306. doi: 10.1002/nur.20325
Mochari-Greenberger, H., Millis, T., Simpson, S. L., and Mosca, L. (2010). Knowledge, preventive action, and barriers to cardiovascular disease prevention by race and ethnicity in women: An American heart association national survey. Journal of Women’s Health, 19(7), 1243-1249. doi: 10.1089/jwh.2009.1794
Mosca, L., Benjamin, E. J., Berra, K., Bezanson, J. L., Dolor, R., J., Lloyd-Jones, D. M., … Wenger, N. K. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women – 2011 update: A guideline from the American Heart Association. Circulation, 123, 1243-1262. doi: 10.1171/CIR.0b013e31820faaf8
Waller, C. G. (2006). Understanding prehospital delay behavior in acute myocardial infarction in women. Critical Pathways in Cardiology, 5(4), 228-234. doi: 10.1097/01.hpc.0000249621.40659.cf