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LE CARDIOPATIE AL FEMMINILE Paola Gottardello Roberto Verlato U.O.C. Cardiologia Cittadella, 14 novembre 2013.

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Presentazione sul tema: "LE CARDIOPATIE AL FEMMINILE Paola Gottardello Roberto Verlato U.O.C. Cardiologia Cittadella, 14 novembre 2013."— Transcript della presentazione:

1 LE CARDIOPATIE AL FEMMINILE Paola Gottardello Roberto Verlato U.O.C. Cardiologia Cittadella, 14 novembre 2013

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3 PRINCIPALI PATOLOGIE CARDIOVASCOLARI MALATTIA CORONARICA FIBRILLAZIONE ATRIALE - rischio embolico cerebrale -scompenso cardiaco SCOMPENSO CARDIACO I fattori di rischio per queste patologie sono gli stessi, e la cardiopatia ischemica è causa del 50% dei casi di scompenso cardiaco. Il 50% dei casi di scompenso cardiaco si complicano con fibrillazione atriale. Tutti e tre costituiscono FR di rischio maggiori per stroke

4 FIBRILLAZIONE ATRIALE

5 FIBRILLAZIONE ATRIALE : EPIDEMIOLOGIA Prevalenza nella popolazione genrale

6 Prevalenza stratificata per età e sesso Raddoppia ad ogni decade, < nella donna

7 RISCHIO DI SVILUPPARE FIBRILLAZIONE ATRIALE

8 La fibrillazione atriale e’ associata a: Aumentata mortalità totale e cardiovascolare ad ogni età, in maschi e femmine Embolie sistemiche e cerebrali Scompenso cardiaco Ridotta QoL

9 IMPATTO DELLA FIBRILLAZIONE ATRIALE SULLA MORTALITA’: FRAMINGHAM STUDY

10 GENERE FEMMINILE E RISCHIO DI MORTE NELLA FIBRILLAZIONE ATRIALE IN SVEZIA

11  Incidenza media di stroke in pz con FA: 4.5%/anno  Rischio 4-5 più alto dei pz senza FA  10-15% di tutti gli stroke ischemici  Evento disabilitante e con maggior rischio di morte FA e stroke FA e stroke Fibrillazione atriale: rischio embolico

12 Il rischio tromboembolico non è uniforme ma cresce esponenzialmente con la presenza di fattori clinici aggiuntivi a prescindere dal tipo di FA (parox, pers o perm) CHADS 2 score Fibrillazione atriale: rischio embolico Risk factor Individu al score None0 C (recent CHF) 1 H (hypertension) 1 A (age) 1 D (diabetes mellitus) 1 S 2 (hystory of stroke or TIA) 2

13 Fibrillazione atriale: rischio embolico Eur Heart J 2010;31: Fattori di rischio clinicamente rilevanti (non maggiori) Insufficienza cardiaca o disfunzione ventricolare sn (FE ≤40%) Ipertensione arteriosa Diabete mellito Età a Sesso femminile Malattie vascolari (inclusa c. ischemica) Fattori di rischio maggiori Pregresso ictus Pregresso TIA o episodio embolico periferico Età ≥75 a Fattori di rischio embolico

14 CHA 2 DS 2 -VASc score Eur Heart J 2010;31:

15 FIBRILLAZIONE ATRIALE: TROMBI IN AURICOLA SX E IN ATRIO SX

16 MRI diffusione pesata (DW) Aree ischemiche “silenti”, come conseguenza di microembolie asintomatiche o pauci-sintomatiche sono molto frequenti nei soggetti con FA non in TAO

17 FIBRILLAZIONE ATRIALE E RISCHIO CARDIOEMBOLICO CEREBRALE

18 IN QUESTO RECENTE STUDIO IL 18-31% DEI CASI DI ICTUS SONO STATI CAUSATI FIBRILLAZIONE ATRIALE ASINTOMATICA O DI BREVE DURATA (2600 pts)

19 Prevalence of stroke by age and sex (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

20 Annual rate of first cerebral infarction by age, sex, and race (Greater Cincinnati/Northern Kentucky Stroke Study: 1999). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

21 Estimated 10-year stroke risk in adults 55 to 84 years of age according to levels of various risk factors (Framingham Heart Study). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

22 Proportion of patients dead within 5 years after first stroke. Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

23 SCOMPENSO CARDIACO Patologia in grande aumento. A livello epidemico Prevalenza 2% della popolazione Principale causa di ricovero per DRG medico in Europa ed USA negli ultimi anni

24 Prevalence of heart failure by sex and age (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

25 Incidence of heart failure (heart failure based on physician review of medical records and strict diagnostic criteria) by age and sex (Framingham Heart Study: 1980–2003). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

26 Hospital discharges for heart failure by sex (United States: 1980–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

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28 Eziologia dello scompenso cardiaco in 5 trials randomizzati CARDIOPATIA ISCHEMICA, DONNE: 18% CARDIOPATIA NON ISCHEMICA: 31% > ETA’, >DIABETE, > IPERTENSIONE, NYHA AVANZATA NELLE DONNE VS UOMINI MORTALITA’ CORRELATA AL GENERE ED EZIOLOGIA

29 LA SOPRAVVIVENZA E’ MIGLIORE NELLE DONNE, CON EZIOLOGIA NON ISCHEMICA vs GLI UOMINI. NESSUNA DIFFERENZA DI GENERE, E PROGNOSI PEGGIORE (mortalità > 15% per anno) PER L’EZIOLOGIA ISCHEMICA

30 MORTALITA’ SIGNIFICATIVAMENTE INFERIORE NELLE DONNE CON NISCM, MA ENDPOINT COMPOSITO IDENTICO

31 TASSO DI OSPEDALIZZAZIONE PER WHS NELLA DONNA IDENTICO A QUELLO DEGLI UOMINI, SIA CON CARDIOPATIA ISCHEMICA CHE NON ISCHEMICA

32 CARDIOPATIA ISCHEMICA LA MALATTIA CORONARICA E’ LA PIU’ FREQUENTE MALATTIA CARDIOVASCOLARE ANCHE NELLA DONNA. ALCUNE PECULIARITA’ DI QUESTA PATOLOGIA NEL SESSO FEMMINILE SONO: -NETTO AUMENTO DI FREQUENZA DOPO LA MENOPAUSA -SINTOMI ATIPICI PIU’ SPESSO CHE NEGLI UOMINI -MAGGIOR PREVALENZA DI ANGINA VASOSPASTICA - SD DI TSAKO-TSUBO (miocardiopatia acuta da stress)

33 Coronaronarie delle donne: piu’ esili, tortuose, con un minor numero di collaterali

34 Trends in prevalence (unadjusted) of meeting criteria for Ideal Cardiovascular Health, for each of the 7 metrics of cardiovascular health in the American Heart Association 2020 goals, among US children aged 12 to 19 years, National Health and Nutrition Exam... Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association FATTORI DI RISCHIO CARDIOVASCOLARE

35 Diabetes mellitus awareness, treatment, and control (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

36 Oltre a questi FRCV modificabili, ce ne sono altri 2 NON MODIFICABILI ETA’: correlazione lineare con le patologie CV SESSO: il sesso maschile rappresenta un FRCV aggiuntivo, per un effetto protettivo degli estrogeni nella donna, che viene perso dopo la menopausa. Per questo le patologie CV, in particolare la C.I., si presentano con una decade di ritardo circa nel sesso femminile, ma dopo i aa le differenze si riducono

37 Prevalence of coronary heart disease by age and sex (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

38 Prevalence of myocardial infarction by age and sex (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

39 Annual number of adults having diagnosed heart attack or fatal coronary heart disease (CHD) by age and sex –(Atherosclerosis Risk in Communities Surveillance: 2004–2009 and Cardiovascular Health Study). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

40 Incidence of heart attack or fatal coronary heart disease by age, sex, and race (Atherosclerosis Risk in Communities Surveillance: 2004–2009*). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

41 Estimated 10-year coronary heart disease risk in adults 55 years of age according to levels of various risk factors –(Framingham Heart Study). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

42 Hospital discharges for coronary heart disease by sex (United States: 1970–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

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45 US age-standardized death rates* from cardiovascular diseases, *Directly standardized to the age distribution of the 2000 US standard population. †Total CVD (Cardiovascular Disease): ICD-10 I00-I99, Q20-Q28. §Stroke (All cerebrovascular disease):... Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

46 Prevalence (%) of students in grades 9 to 12 reporting current cigarette use by sex and race/ethnicity (Youth Risk Behavior Surveillance System, 2011). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

47 Prevalence (%) of current smoking for adults >18 years of age by race/ethnicity and sex (National Health Interview Survey: 2008–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

48 Prevalence of students in grades 9 to 12 who did not participate in at least 60 minutes of physical activity on any day by race/ethnicity and sex (Youth Risk Behavior Surveillance: 2011). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

49 Prevalence of overweight and obesity among students in grades 9 through 12 by sex and race/ethnicity. Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

50 Age-adjusted prevalence of obesity in adults 20 to 74 years of age by sex and survey year (National Health Examination Survey: 1960–1962; National Health and Nutrition Examination Survey: 1971–1974, 1976–1980, 1988–1994, 1999–2002, and 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

51 Age-adjusted trends in the prevalence of total serum cholesterol ≥200 mg/dL in adults ≥20 years of age by sex, race/ethnicity, and survey year (National Health and Nutrition Examination Survey 2005–2006, 2007–2008, and 2009–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

52 Prevalence of high blood pressure in adults ≥20 years of age by age and sex (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

53 Extent of awareness, treatment, and control of high blood pressure by race/ethnicity and sex (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

54 Age-adjusted prevalence of physician-diagnosed diabetes mellitus in adults ≥20 years of age by race/ethnicity and sex (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

55 Age-adjusted prevalence of physician-diagnosed type 2 diabetes mellitus in adults ≥20 years of age by race/ethnicity and years of education (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

56 Trends in diabetes mellitus prevalence in adults ≥20 years of age by sex (National Health and Nutrition Examination Survey: 1988–1994 and 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

57 Prevalence of cardiovascular disease in adults ≥20 years of age by age and sex (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

58 Incidence of cardiovascular disease* by age and sex (Framingham Heart Study, 1980–2003). *Coronary heart disease, heart failure, stroke, or intermittent claudication. Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

59 Deaths attributable to cardiovascular disease (United States: 1900–2009). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

60 Percentage breakdown of deaths attributable to cardiovascular disease (United States: 2009). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

61 Cardiovascular disease (CVD) deaths vs cancer deaths by age (United States: 2009). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

62 Cardiovascular disease (CVD) and other major causes of death in males: total, <85 years of age, and ≥85 years of age. Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

63 Cardiovascular disease (CVD) and other major causes of death in females: total, <85 years of age, and ≥85 years of age. Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

64 Cardiovascular disease and other major causes of death for all males and females (United States: 2009). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

65 Cardiovascular disease and other major causes of death for white males and females (United States: 2009). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

66 Age-adjusted death rates for coronary heart disease (CHD), stroke, and lung and breast cancer for white and black females (United States: 2009). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association

67 Cardiovascular disease mortality trends for males and females (United States: 1979–2009). Go A et al. Circulation 2013;127:e6-e245 Copyright © American Heart Association


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