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C. Giannattasio Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile.

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Presentazione sul tema: "C. Giannattasio Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile."— Transcript della presentazione:

1 C. Giannattasio Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano aprile 2010

2 Prevalence of Cardiovascular Disease in Americans Age 20 and Older by Age and Sex NHANES III: Source: © American Heart Association 2004

3 Cumulative Incidence of CVD Adjusted for the Competing Risk of Death for Men and Women according to Aggregate Risk Factor (RF) Burden at 50 Years of Age Cumulative Incidence of CVD Adjusted for the Competing Risk of Death for Men and Women according to Aggregate Risk Factor (RF) Burden at 50 Years of Age M Lloyd-Jones DM et al., Circulation 2006; 113: 791 Adjusted cumulative incidence Attained age MenWomen 2 major RFs 2 major RFs 1 major RF 1 Elevated RF 1 Elevated RF 1 Not optimal RF 1 Not optimal RF All optimal RFs 69% 50% 36% 46% 5% 50% 39% 27% 8%

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5 Distribuzione dei fattori di rischio in Italia in rapporto al sesso (dati Istituto Superiore di Sanità, anno 2003)

6 Rosamond W et al., Circulation 2007; 115: e69 CVD Mortality Trends for Males and Females (United States: ) CVD Mortality Trends for Males and Females (United States: ) M Years Deaths in thousands Males Females

7 Deaths by Cause, Women, Latest Available Year, EU 6979 M European Cardiovascular Disease Statistics, 2000 CHD15% Stroke14% Other CVD 17% Stomach cancer 1% Colo-rectal cancer 3% Lung cancer 2% Other cancer 12% Respiratory disease 8% Injuries and poisoning 4% Other causes 20% Breast cancer 4%

8 Acute MI Mortality by Age and Sex Source: Adapted from Vaccarino N Engl J Med 1999; 341(4):

9 Prognosis After MI 38% of women die within first year Compared to 25% of men 35% of women will have second MI within 6 years Compared to 18% of men Source: Wenger Circulation 2004; 109:

10 10 Linfarto nella donna giovane

11 Diagnosis of Coronary Artery Disease in Women Chest pain is experienced by most women with CHD, but non-chest pain presentations are more common in women than men Other Presenting Symptoms –Upper abdominal pain, fullness, burning sensation –Shortness of breath –Nausea –Neck, back, jaw pain Associations –Precipitated by exertion –Precipitated by emotional distress Source: Charney Cardiovasc Risk 2002, 9: , Goldberg Am Heart J :

12 Value of the Exercise ECG in Women SensitivitySpecificity Men Women Source: Kwok Y, Am J Cardiol (5):

13 Women Receive Less Interventions to Prevent and Treat Heart Disease Less cholesterol screening Less lipid-lowering therapies Less use of heparin, beta-blockers and aspirin during myocardial infarction Fewer referrals to cardiac rehabilitation Source: Chandra 1998, Nohria 1998, Scott 2004, OMeara 2004, Hendrix 2005

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15 Mortality in Recent Cohort Studies of Patients Hospitalized with Heart Failure according to LVEF Mortality in Recent Cohort Studies of Patients Hospitalized with Heart Failure according to LVEF M Hogg et al., JACC 2004; 43: 317 % death Follow-up (years)

16 Processes Underlying Diastolic Dysfunction 9421 M HypertensionAgingAtherosclerosisDiabetesHypertensionAgingAtherosclerosisDiabetes Diastolic Dysfunction Heart Failure with Preserved Systolic Function Blood Vessels HypertrophyFibrosis Altered elastin & collagen calcification Endothelial dysfunction Loss of compliance Blood Vessels HypertrophyFibrosis Altered elastin & collagen calcification Endothelial dysfunction Loss of compliance Myocardium Hypertrophy (LVH) Fibrosis Cellular dysfunction Ischemia Increased stiffness Impaired relaxation Myocardium Hypertrophy (LVH) Fibrosis Cellular dysfunction Ischemia Increased stiffness Impaired relaxation

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22 MEN Risk of Coronary Heart Disease Coronary Risk Chart WOMEN Risk of Coronary Heart Disease Non-smoker mmol/l45678 mg/dl mmol/l45678 mg/dl Cholesterol mmol/l45678 mg/dl mmol/l45678 mg/dl Cholesterol Smoker age70 age60 age50 age40 age Non-smoker mmol/l45678 mg/dl mmol/l45678 mg/dl Cholesterol mmol/l45678 mg/dl mmol/l45678 mg/dl Cholesterol Smoker age70 age60 age50 age40 age30 Very high HighModerateMildLow over 40% 20% to 40% 10% to 20% 5% to 10% under 5% 10 Year Risk Level 5334 M SBP (mmHg)

23 Staessen JA, 1983 AM J Edipemiol

24 Focus sulla sindrome metabolica in menopausa

25 2328 G Age-Specific Prevalence of the Metabolic Syndrome among 8814 US Adults, NHANES III, Age-Specific Prevalence of the Metabolic Syndrome among 8814 US Adults, NHANES III, Ford S et al., JAMA 2002 Age (years) Prevalence (%)

26 Terapia dellipertensione nella donna --I benefici del trattamento antipertensivo sono simili nei due sessi. È tuttavia sconsigliato limpiego di ACE-inibitori e sartani nelle donne durante il periodo fertile e la gestazione per i potenziali effetti teratogeni Contraccettivi orali La terapia con contraccettivi orali a basso contenuto di estrogeni si associa ad un incremento del rischio di ipertensione,ictus e infarto del miocardio…… Terapia ormonale sostitutiva Le informazioni disponibili suggeriscono che gli unici vantaggi della terapia ormonale sostitutiva sono rappresentati da una minor frequenza di fratture ossee e di neoplasie del colon, mentre è aumentato il rischio di eventi coronarici e tromboembolici, ictus… Linee Guida ESH/ESC 2007

27 ….Che farmaco usare? Tutti i farmaci antiipertensivi attraversano la placenta Dati comparativi tra i diversi farmaci riguardanti sia lefficacia sia la sicurezza fetale e materna sono ancora inadeguati ACE inibitori e ARB controindicati perché teratogeni: stopparli anche nelle donne fertili che stanno programmando una gravidanza! METILDOPA (simpaticolitico centrale). Aldomet os 250 mg x 2/die, max 3 g/die Sicuro per madre e feto, blando antiipertensivo. Effetti collaterali: stipsi, depressione, sonnolenza, secchezza fauci LABETALOLO* (alfa 1 bloccante e beta bloccante non selettivo) 100 mg x 2/die, max 2.4 g/die I beta bloccanti cardioselettivi Beta1 (atenololo) possono ridurre la crescita fetale e placentare. I beta bloccanti non selettivi (propranololo) possono interferire con il rilassamento miometriale (processo beta2 relato) Calcio antagonisti (Adalat* mg/die max 120 mg/die) Sicuri per madre e feto, sebbene non esistano molti studi per Ca antagonisti non diidropiridinici (verapamil, diltiazem), ed amlodipina. Maggiori informazioni per nifedipina * Consigliati anche durante lallattamento Treatment (2)


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