- Email: [email protected]
Cardiovascular Disease in Women
Well Woman
Cardiovascular Disease in Women How Nurses Can Promote Awareness and Prevention
c
Cardiovascular disease (CVD) is the leading cause of death in U.S. women, killing more than 200,000 women each year. It’s estimated that one in two women will die of heart disease or stroke, compared with 1 in 25 women who will die of breast cancer (Agency for Healthcare Research and Quality, 2009). Heart disease killed 26 percent of the women who died in 2006— more than one in four (Heron et al., 2009). Since
BARBARA MORAN, PhD, MPH, MS, CNM TERESA WALSH, PhD, RN, BSN, MEE
1984, the number of CVD deaths for women has exceeded those for men (American Heart Association, 2012). These are sobering facts. However, many of the risks associated with CVD are modifiable. Nurses can play a vital role in the helping the women we care for understand what they
Abstract Cardiovascular disease (CVD) is the leading cause of death of women in the U.S. and Canada. Experts estimate that one in two U.S. women will die of heart disease or stroke compared with one in 25 women who will die of breast cancer. Risk factors for CVD include hypertension, high cholesterol, obesity and sedentary lifestyle. DOI: 10.1111/1751486X.12008 Keywords cardiovascular disease | heart disease | prevention | women’s health
http://nwh.awhonn.org
© 2013, AWHONN
63
Well Woman
Box 1.
Classifying CVD Risk in Women Risk Status
Criteria
High risk
• Clinically manifested congestive heart disease • Clinically manifested cerebrovascular disease • Clinically manifested peripheral arterial disease • Abdominal aortic aneurysm • End-state or chronic kidney disease • Diabetes mellitus
At risk (at least one major risk factor)
• Cigarette smoking • Systolic blood pressure ≥ 120 mmHg, diastolic blood pressure ≥ 80 mmHg or treated hypertension • Total cholesterol ≥ 200 mg/dL, HDL-C < 50mg/dL or treated for dyslipidemia • Obesity, particularly central adiposity • Poor diet • Physical inactivity • Family history of premature CVD occurring in first-degree relatives in women younger than 65 years of age • Metabolic syndrome • Evidence of advanced subclinical atherosclerosis • Poor exercise capacity on treadmill test and/or abnormal heart rate recovery after stopping exercise • Systemic autoimmune collage-vascular disease • History of pre-eclampsia, gestational diabetes or pregnancy induced hypertension
Optimal risk
• Total cholesterol < 200 mg/dL (untreated) • BP < 120/80 mmHg (untreated) • Fasting blood glucose < 100 mg/dL (untreated) • Body mass index < 25 kg/m2
Barbara Moran, PhD, MPH, MS, CNM, is an assistant professor; Teresa Walsh, PhD, RN, BSN, MEE, is director of the undergraduate program; both authors are at The Catholic University of America in Washington, DC. The authors report no conflicts of interest or relevant financial relationships. Address correspondence to: bmoran1225@ aol.com.
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Nursing for Women’s Health
• Abstinence from smoking • Physical activity at goal for adults > 20 years of age: ≥ 150 min/week moderate intensity, ≥ 75 min/week vigorous intensity or combination • Healthful diet (such as “DASH” diet, see “Get the Facts”) Source: Mosca et al. (2011).
Volume 17
Issue 1
need to know about CVD. February is American Heart Month and we mark the occasion in this article by reviewing the symptoms and risk factors for CVD in women and discussing preventive measures to help women reduce their risk.
Symptoms Women develop heart disease about 10 years later than men, but it occurs more rapidly once menopause has occurred (Lee & Foody, 2008). The symptoms that women experience may differ from the classic symptoms often described for men. The common hallmark symptom of a heart attack is some type of pain, pressure or discomfort in the chest. But for many women, the symptoms of heart disease may be very subtle or even absent. In a landmark study, McSweeney et al. (2003) discovered that women’s symptoms for heart attack were usually fatigue, sleep disturbance and shortness of breath. Almost
two-thirds of women who die suddenly of coronary heart disease have no previous symptoms (Lloyd-Jones, Adams et al., 2010). Often, the early prodromal symptoms women observe are intermittent and resolve spontaneously (McSweeney, Cleves, Zhao, Lefler, & Yang, 2010). Because of this, women having a heart attack might initially think they’re experiencing stress or indigestion and might ignore their symptoms.
Risk Factors Traditional risk factors for CVD for women are not significantly different than for men. It’s thought that women have a higher prevalence of many risk factors, such as hypertension, total cholesterol > 200 mg/dL, prediabetes, obesity and sedentary lifestyle (Lee & Foody, 2008). In 2008, 10 million women were diagnosed with diabetes (American Heart Association, 2012). In 2011, the World Health Organization (WHO) reported that some of the
preventable risk factors for CVD are unhealthful diet, lack of physical inactivity, tobacco use and harmful use of alcohol (WHO, 2012). According to the American Heart Association (2012), 53.8 million women have total blood cholesterol levels ≥ 200 mg/dL, and 71.3 million women (age 20 and older) are overweight or obese (defined as a body mass index [BMI] ≥ 25.0 kg/m2). In a study by Robertson (2001), women were able to cite obesity as a risk factor for CVD, but many weren’t aware of other factors that negatively impact cardiovascular health, such as smoking or lack of exercise. When women attend community health screening events, they’re often surprised if their blood pressure is elevated, although they may indeed be aware of their risk factors. Another risk factor for CVD is metabolic syndrome, which is a recognizable cluster of indicators associated with an increased risk for CVD (Lakka et al., 2002). It’s important to note that there is an increased risk for CVD among ethnic minority women, yet they are often the group that is most
Women having a heart attack might initially think they’re experiencing stress or indigestion and might ignore their symptoms
ill-informed. Robertson (2001) reports that 42 percent of black women and 34 percent of Hispanic women report discussing heart disease with their physicians, yet 52 percent of black women incorrectly reported that heart disease causes sudden death. An often overlooked risk factor is many women’s lack of knowledge and decreased awareness of evidence-based health information, as well as their underestimation of risk factors. Many women receive their health information
February | March 2013
Nursing for Women’s Health
65
Well Woman
through popular media, such as television and magazines, which may or may not be correct. Early, consistent, informed health prevention can be a very effective way to reduce the risks
An often overlooked risk factor is many women’s lack of knowledge and decreased awareness of evidence-based health information
associated with CV disease in women (Hart, 2005; Robertson, 2001). It’s important to identify underlying risks associated with metabolic syndrome, as well as other educational and social factors, in developing targeted strategies to assist in addressing the lack of knowledge about CVD, especially in groups with disparities (Giardina et al., 2011).
Prevention Although women are just as likely as men to die of heart disease, one in three women do not perceive themselves to be at risk (Mosca et al., 2007). Lifestyle behaviors, such as smoking and diet, are modifiable, whereas gender and ethnicity are not. Prevention can be directly linked to education and behavior modification. Although it appears that most women know about heart disease, when surveyed many do not believe
66
Nursing for Women’s Health
they could be in a high-risk category (Giardina et al., 2011). The U.S Department of Health and Human Services (DHHS) releases a set of public health goals each decade called Healthy People. The Healthy People 2020 report contains sets of objectives and goals for preventive health care for people in the United States. These evidencebased objectives and goals serve as a metric for prevention and a measure for states and local agencies (see “Get the Facts”). A key item in Healthy People 2020 is a subgroup under heart disease and stroke. The 24 standards addressed in this objective are key to monitoring cardiovascular health. Moreover, there are key recommendations for aspirin use in women over age 55, as well as overall education for the entire population. Minority, low-income and ethnically diverse groups of women have proportionally higher risks of CVD. The WISEWOMAN program of the Centers for Disease Control and Prevention (CDC) stands for Well-Integrated Screening and Evaluation for WOMen Across the Nation. In 2008, this initiative was expanded to include low-income, uninsured and underinsured women in 19 states. This initiative has proven successful with the reduction of certain modifiable risk factors among participants, including reduced rates of smoking, increased intake of fruit and vegetables, weight reduction and lowered
Volume 17
Issue 1
Screening The first step in disease prevention is recognizing risk. This can be accomplished through screening. According to Greenland & LloydJones (2008), screening involves the routine evaluation of asymptomatic people and detection of disease. There are many approaches to screening; however, the 2011 updated American Heart Association evidence-based guidelines
unique opportunity to participate in achieving this goal. Assessment and education are embedded in our roles as patient advocates. And it has been shown that the general population considers nurses to be trustworthy. Let’s use that trust to develop programs to identify risks in women, administer creative programs that can change lifestyles to promote cardiovascular health refer high-risk women for appropriate follow-up. Women need to be given information about CVD and its risk factors to enable them to make the lifestyle changes to modify and reduce their risks. The creation of programs such as WISEWOMAN, which focus on low-income, underinsured or uninsured women, can have a positive effect on cardiovascular health among the most vulnerable. Examples of evidence-based programs include incorporating lifestyle interventions by referral services, monitoring blood pressure and cholesterol, healthy cooking classes
Well Woman
blood cholesterol and blood pressure. It appears that education targeted toward women in highrisk groups can help prevent CVD (Vaid, Wigington, Borbely, & Manheim, 2011). Educating and counseling women on how to lower their modifiable risk factors is important. Community resources are also important links that can be used to help support and educate women, especially those facing disparities in health care.
Women need to be given information about CVD and its risk factors to enable them to make the lifestyle changes to modify and reduce their risks
for CVD provide a new algorithm for risk classification in women that stratifies women into three categories—high-risk, at risk and optimal risk. The American Heart Association panel that developed the classifications emphasized that health care professionals should take “several factors into consideration…including medical and lifestyle history, family history of CVD, markers of preclinical disease and other conditions” (Mosca et al., 2011, p. 1245) (see Box 1). This classification system can be a very useful tool for nurses for initial screening and identifying high-risk women and referring them for follow-up, as necessary.
Implications for Nurses According to the American Heart Association’s strategic impact goal for 2020 and beyond, we need to “improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent” (Lloyd-Jones, Hong et al., 2010). With the importance of screening and prevention, women’s health nurses have a
February | March 2013
and demonstrations, walking clubs and smoking cessation classes and support groups. There are many opportunities for nurses to affect the cardiovascular health of women and we can start by incorporating CVD risk assessment into all our encounters with the women we care for. NWH
References Agency for Healthcare Research and Quality. (2009). Cardiovascular disease and other chronic conditions in women: Recent findings. Retrieved from www.ahrq.gov/research/womheart.htm American Heart Association. (2012). AHA 2020 Goal—2012 Statistical fact sheet. Retrieved from www.heart.org/idc/groups/heart-public/@ wcm/@sop/@smd/documents/downloadable/ ucm_319831.pdf Giardina, E. G., Sciacca, R. R., Foody, J. M., D’Onofrio, G., Villablanca, A. C., Leatherwood, S., … Haynes, S. G. (2011). The DHHS Office on Women’s Health Initiative to improve women’s heart health: Focus on knowledge and awareness among women and cardiometabolic risk factors. Journal of Women’s Health, 20(6), 893–900. Greenland, P., & Lloyd-Jones, D. (2008). Defining a rational approach to screening for cardiovascular
Nursing for Women’s Health
67
Well Woman
Get the Facts American Heart Association
www.americanheart.org CDC—Heart Disease
www.cdc.gov/heartdisease Healthy People 2020
www.healthypeople.gov National Heart, Lung and Blood Institute
www.nhlbi.nih.gov What is the DASH Eating Plan?
www.nhlbi.nih.gov/health/health -topics/topics/dash/
Lee, V., & Foody, J. M. (2008). Cardiovascular disease in women. Current Atherosclerosis Reports, 10, 295–302. Lloyd-Jones, D., Adams, R., Brown, T., Carnethon, M., Dai, S., De Simone, G., … Wylie-Rosett, J. (2010). Heart disease and stroke statistics—2010 update. Circulation, 121, e46–e215. Retrieved from http://circ.ahajournals.org/content/121/7/ e46.extract Lloyd-Jones, D., Hong, Y., Labarthe, D., Mozaffarian, D., Appel, L. J., Van Horn, L., … Rosamond, W. D. (2010). Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s Strategic Impact Goal Through 2020 and Beyond. Circulation, 121, 586–613. Retrieved from circ.ahajournals.org/content/121/4/586.full McSweeney, J., Cleves, M., Zhao, W., Lefler, L., & Yang, S. (2010). Cluster analysis of women’s prodromal and acute myocardial infarction symptoms by race and other characteristics. Journal of Cardiovascular Nursing, 25(4), 311–322. McSweeney, J., Cody, M., O’Sullivan, P., Elberson, K., Moser, D., & Garvin, B. (2003). Women’s early warning symptoms of acute myocardial infarction. Circulation, 108, 2619–2623. Mosca, L., Banka, C. L., Benjamin, E. J., Berra, K., Bushnell, C., Dolor, R., … Wenger, N. (2007). Evidence-based guidelines for cardiovascular disease prevention in women, 2007 update. Circulation, 115, 1481–1501. Mosca, L., Benjamin, E., Berra, K., Bezanson, J., Dolor, R., Lloyd-Jones, D., … Wenger, N. (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. Robertson, R. M. (2001). Women and cardiovascular disease: The risks of misperception and the need for action. Circulation, 103, 2318–2320.
risk in asymptomatic patients. Journal of the American College of Cardiology, 52(5), 330–332. Hart, P. (2005). Women’s perceptions of coronary heart disease. Journal of Cardiovascular Nursing, 20(3), 170–176. Heron, M. P., Hoyert, D. L., Murphy, S. L., Xu, J. Q, Kochanek, K. D., & Tejada-Vera, B. (2009). Deaths: Final data for 2006. National Vital Statistics Reports (Vol. 57, no. 14). Hyattsville, MD: National Center for Health Statistics.
Vaid, I., Wigington, C., Borbely, D., & Manheim, D. (2011). WISEWOMAN: Addressing the needs of women at high risk for cardiovascular disease. Journal of Women’s Health, 20(7), 977–982. World Health Organization. (2012). Cardiovascular diseases (CVDs). Retrieved from www.who. int/mediacentre/factsheets/fs317/en/index.html
Lakka, H. M., Laaksonen, D. E., Lakka, T. A, Niskanen, L. K., Kumpusalo, E., Tuomilehto, J., & Salonen, J. T. (2002).The metabolic syndrome and total and cardiovascular disease mortality in middle aged men. Journal of the American Medical Association, 288, 2709–2716.
68
Nursing for Women’s Health
Volume 17
Issue 1
Cardiovascular Disease in Women How Nurses Can Promote Awareness and Prevention
c
Cardiovascular disease (CVD) is the leading cause of death in U.S. women, killing more than 200,000 women each year. It’s estimated that one in two women will die of heart disease or stroke, compared with 1 in 25 women who will die of breast cancer (Agency for Healthcare Research and Quality, 2009). Heart disease killed 26 percent of the women who died in 2006— more than one in four (Heron et al., 2009). Since
BARBARA MORAN, PhD, MPH, MS, CNM TERESA WALSH, PhD, RN, BSN, MEE
1984, the number of CVD deaths for women has exceeded those for men (American Heart Association, 2012). These are sobering facts. However, many of the risks associated with CVD are modifiable. Nurses can play a vital role in the helping the women we care for understand what they
Abstract Cardiovascular disease (CVD) is the leading cause of death of women in the U.S. and Canada. Experts estimate that one in two U.S. women will die of heart disease or stroke compared with one in 25 women who will die of breast cancer. Risk factors for CVD include hypertension, high cholesterol, obesity and sedentary lifestyle. DOI: 10.1111/1751486X.12008 Keywords cardiovascular disease | heart disease | prevention | women’s health
http://nwh.awhonn.org
© 2013, AWHONN
63
Well Woman
Box 1.
Classifying CVD Risk in Women Risk Status
Criteria
High risk
• Clinically manifested congestive heart disease • Clinically manifested cerebrovascular disease • Clinically manifested peripheral arterial disease • Abdominal aortic aneurysm • End-state or chronic kidney disease • Diabetes mellitus
At risk (at least one major risk factor)
• Cigarette smoking • Systolic blood pressure ≥ 120 mmHg, diastolic blood pressure ≥ 80 mmHg or treated hypertension • Total cholesterol ≥ 200 mg/dL, HDL-C < 50mg/dL or treated for dyslipidemia • Obesity, particularly central adiposity • Poor diet • Physical inactivity • Family history of premature CVD occurring in first-degree relatives in women younger than 65 years of age • Metabolic syndrome • Evidence of advanced subclinical atherosclerosis • Poor exercise capacity on treadmill test and/or abnormal heart rate recovery after stopping exercise • Systemic autoimmune collage-vascular disease • History of pre-eclampsia, gestational diabetes or pregnancy induced hypertension
Optimal risk
• Total cholesterol < 200 mg/dL (untreated) • BP < 120/80 mmHg (untreated) • Fasting blood glucose < 100 mg/dL (untreated) • Body mass index < 25 kg/m2
Barbara Moran, PhD, MPH, MS, CNM, is an assistant professor; Teresa Walsh, PhD, RN, BSN, MEE, is director of the undergraduate program; both authors are at The Catholic University of America in Washington, DC. The authors report no conflicts of interest or relevant financial relationships. Address correspondence to: bmoran1225@ aol.com.
64
Nursing for Women’s Health
• Abstinence from smoking • Physical activity at goal for adults > 20 years of age: ≥ 150 min/week moderate intensity, ≥ 75 min/week vigorous intensity or combination • Healthful diet (such as “DASH” diet, see “Get the Facts”) Source: Mosca et al. (2011).
Volume 17
Issue 1
need to know about CVD. February is American Heart Month and we mark the occasion in this article by reviewing the symptoms and risk factors for CVD in women and discussing preventive measures to help women reduce their risk.
Symptoms Women develop heart disease about 10 years later than men, but it occurs more rapidly once menopause has occurred (Lee & Foody, 2008). The symptoms that women experience may differ from the classic symptoms often described for men. The common hallmark symptom of a heart attack is some type of pain, pressure or discomfort in the chest. But for many women, the symptoms of heart disease may be very subtle or even absent. In a landmark study, McSweeney et al. (2003) discovered that women’s symptoms for heart attack were usually fatigue, sleep disturbance and shortness of breath. Almost
two-thirds of women who die suddenly of coronary heart disease have no previous symptoms (Lloyd-Jones, Adams et al., 2010). Often, the early prodromal symptoms women observe are intermittent and resolve spontaneously (McSweeney, Cleves, Zhao, Lefler, & Yang, 2010). Because of this, women having a heart attack might initially think they’re experiencing stress or indigestion and might ignore their symptoms.
Risk Factors Traditional risk factors for CVD for women are not significantly different than for men. It’s thought that women have a higher prevalence of many risk factors, such as hypertension, total cholesterol > 200 mg/dL, prediabetes, obesity and sedentary lifestyle (Lee & Foody, 2008). In 2008, 10 million women were diagnosed with diabetes (American Heart Association, 2012). In 2011, the World Health Organization (WHO) reported that some of the
preventable risk factors for CVD are unhealthful diet, lack of physical inactivity, tobacco use and harmful use of alcohol (WHO, 2012). According to the American Heart Association (2012), 53.8 million women have total blood cholesterol levels ≥ 200 mg/dL, and 71.3 million women (age 20 and older) are overweight or obese (defined as a body mass index [BMI] ≥ 25.0 kg/m2). In a study by Robertson (2001), women were able to cite obesity as a risk factor for CVD, but many weren’t aware of other factors that negatively impact cardiovascular health, such as smoking or lack of exercise. When women attend community health screening events, they’re often surprised if their blood pressure is elevated, although they may indeed be aware of their risk factors. Another risk factor for CVD is metabolic syndrome, which is a recognizable cluster of indicators associated with an increased risk for CVD (Lakka et al., 2002). It’s important to note that there is an increased risk for CVD among ethnic minority women, yet they are often the group that is most
Women having a heart attack might initially think they’re experiencing stress or indigestion and might ignore their symptoms
ill-informed. Robertson (2001) reports that 42 percent of black women and 34 percent of Hispanic women report discussing heart disease with their physicians, yet 52 percent of black women incorrectly reported that heart disease causes sudden death. An often overlooked risk factor is many women’s lack of knowledge and decreased awareness of evidence-based health information, as well as their underestimation of risk factors. Many women receive their health information
February | March 2013
Nursing for Women’s Health
65
Well Woman
through popular media, such as television and magazines, which may or may not be correct. Early, consistent, informed health prevention can be a very effective way to reduce the risks
An often overlooked risk factor is many women’s lack of knowledge and decreased awareness of evidence-based health information
associated with CV disease in women (Hart, 2005; Robertson, 2001). It’s important to identify underlying risks associated with metabolic syndrome, as well as other educational and social factors, in developing targeted strategies to assist in addressing the lack of knowledge about CVD, especially in groups with disparities (Giardina et al., 2011).
Prevention Although women are just as likely as men to die of heart disease, one in three women do not perceive themselves to be at risk (Mosca et al., 2007). Lifestyle behaviors, such as smoking and diet, are modifiable, whereas gender and ethnicity are not. Prevention can be directly linked to education and behavior modification. Although it appears that most women know about heart disease, when surveyed many do not believe
66
Nursing for Women’s Health
they could be in a high-risk category (Giardina et al., 2011). The U.S Department of Health and Human Services (DHHS) releases a set of public health goals each decade called Healthy People. The Healthy People 2020 report contains sets of objectives and goals for preventive health care for people in the United States. These evidencebased objectives and goals serve as a metric for prevention and a measure for states and local agencies (see “Get the Facts”). A key item in Healthy People 2020 is a subgroup under heart disease and stroke. The 24 standards addressed in this objective are key to monitoring cardiovascular health. Moreover, there are key recommendations for aspirin use in women over age 55, as well as overall education for the entire population. Minority, low-income and ethnically diverse groups of women have proportionally higher risks of CVD. The WISEWOMAN program of the Centers for Disease Control and Prevention (CDC) stands for Well-Integrated Screening and Evaluation for WOMen Across the Nation. In 2008, this initiative was expanded to include low-income, uninsured and underinsured women in 19 states. This initiative has proven successful with the reduction of certain modifiable risk factors among participants, including reduced rates of smoking, increased intake of fruit and vegetables, weight reduction and lowered
Volume 17
Issue 1
Screening The first step in disease prevention is recognizing risk. This can be accomplished through screening. According to Greenland & LloydJones (2008), screening involves the routine evaluation of asymptomatic people and detection of disease. There are many approaches to screening; however, the 2011 updated American Heart Association evidence-based guidelines
unique opportunity to participate in achieving this goal. Assessment and education are embedded in our roles as patient advocates. And it has been shown that the general population considers nurses to be trustworthy. Let’s use that trust to develop programs to identify risks in women, administer creative programs that can change lifestyles to promote cardiovascular health refer high-risk women for appropriate follow-up. Women need to be given information about CVD and its risk factors to enable them to make the lifestyle changes to modify and reduce their risks. The creation of programs such as WISEWOMAN, which focus on low-income, underinsured or uninsured women, can have a positive effect on cardiovascular health among the most vulnerable. Examples of evidence-based programs include incorporating lifestyle interventions by referral services, monitoring blood pressure and cholesterol, healthy cooking classes
Well Woman
blood cholesterol and blood pressure. It appears that education targeted toward women in highrisk groups can help prevent CVD (Vaid, Wigington, Borbely, & Manheim, 2011). Educating and counseling women on how to lower their modifiable risk factors is important. Community resources are also important links that can be used to help support and educate women, especially those facing disparities in health care.
Women need to be given information about CVD and its risk factors to enable them to make the lifestyle changes to modify and reduce their risks
for CVD provide a new algorithm for risk classification in women that stratifies women into three categories—high-risk, at risk and optimal risk. The American Heart Association panel that developed the classifications emphasized that health care professionals should take “several factors into consideration…including medical and lifestyle history, family history of CVD, markers of preclinical disease and other conditions” (Mosca et al., 2011, p. 1245) (see Box 1). This classification system can be a very useful tool for nurses for initial screening and identifying high-risk women and referring them for follow-up, as necessary.
Implications for Nurses According to the American Heart Association’s strategic impact goal for 2020 and beyond, we need to “improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent” (Lloyd-Jones, Hong et al., 2010). With the importance of screening and prevention, women’s health nurses have a
February | March 2013
and demonstrations, walking clubs and smoking cessation classes and support groups. There are many opportunities for nurses to affect the cardiovascular health of women and we can start by incorporating CVD risk assessment into all our encounters with the women we care for. NWH
References Agency for Healthcare Research and Quality. (2009). Cardiovascular disease and other chronic conditions in women: Recent findings. Retrieved from www.ahrq.gov/research/womheart.htm American Heart Association. (2012). AHA 2020 Goal—2012 Statistical fact sheet. Retrieved from www.heart.org/idc/groups/heart-public/@ wcm/@sop/@smd/documents/downloadable/ ucm_319831.pdf Giardina, E. G., Sciacca, R. R., Foody, J. M., D’Onofrio, G., Villablanca, A. C., Leatherwood, S., … Haynes, S. G. (2011). The DHHS Office on Women’s Health Initiative to improve women’s heart health: Focus on knowledge and awareness among women and cardiometabolic risk factors. Journal of Women’s Health, 20(6), 893–900. Greenland, P., & Lloyd-Jones, D. (2008). Defining a rational approach to screening for cardiovascular
Nursing for Women’s Health
67
Well Woman
Get the Facts American Heart Association
www.americanheart.org CDC—Heart Disease
www.cdc.gov/heartdisease Healthy People 2020
www.healthypeople.gov National Heart, Lung and Blood Institute
www.nhlbi.nih.gov What is the DASH Eating Plan?
www.nhlbi.nih.gov/health/health -topics/topics/dash/
Lee, V., & Foody, J. M. (2008). Cardiovascular disease in women. Current Atherosclerosis Reports, 10, 295–302. Lloyd-Jones, D., Adams, R., Brown, T., Carnethon, M., Dai, S., De Simone, G., … Wylie-Rosett, J. (2010). Heart disease and stroke statistics—2010 update. Circulation, 121, e46–e215. Retrieved from http://circ.ahajournals.org/content/121/7/ e46.extract Lloyd-Jones, D., Hong, Y., Labarthe, D., Mozaffarian, D., Appel, L. J., Van Horn, L., … Rosamond, W. D. (2010). Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s Strategic Impact Goal Through 2020 and Beyond. Circulation, 121, 586–613. Retrieved from circ.ahajournals.org/content/121/4/586.full McSweeney, J., Cleves, M., Zhao, W., Lefler, L., & Yang, S. (2010). Cluster analysis of women’s prodromal and acute myocardial infarction symptoms by race and other characteristics. Journal of Cardiovascular Nursing, 25(4), 311–322. McSweeney, J., Cody, M., O’Sullivan, P., Elberson, K., Moser, D., & Garvin, B. (2003). Women’s early warning symptoms of acute myocardial infarction. Circulation, 108, 2619–2623. Mosca, L., Banka, C. L., Benjamin, E. J., Berra, K., Bushnell, C., Dolor, R., … Wenger, N. (2007). Evidence-based guidelines for cardiovascular disease prevention in women, 2007 update. Circulation, 115, 1481–1501. Mosca, L., Benjamin, E., Berra, K., Bezanson, J., Dolor, R., Lloyd-Jones, D., … Wenger, N. (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. Robertson, R. M. (2001). Women and cardiovascular disease: The risks of misperception and the need for action. Circulation, 103, 2318–2320.
risk in asymptomatic patients. Journal of the American College of Cardiology, 52(5), 330–332. Hart, P. (2005). Women’s perceptions of coronary heart disease. Journal of Cardiovascular Nursing, 20(3), 170–176. Heron, M. P., Hoyert, D. L., Murphy, S. L., Xu, J. Q, Kochanek, K. D., & Tejada-Vera, B. (2009). Deaths: Final data for 2006. National Vital Statistics Reports (Vol. 57, no. 14). Hyattsville, MD: National Center for Health Statistics.
Vaid, I., Wigington, C., Borbely, D., & Manheim, D. (2011). WISEWOMAN: Addressing the needs of women at high risk for cardiovascular disease. Journal of Women’s Health, 20(7), 977–982. World Health Organization. (2012). Cardiovascular diseases (CVDs). Retrieved from www.who. int/mediacentre/factsheets/fs317/en/index.html
Lakka, H. M., Laaksonen, D. E., Lakka, T. A, Niskanen, L. K., Kumpusalo, E., Tuomilehto, J., & Salonen, J. T. (2002).The metabolic syndrome and total and cardiovascular disease mortality in middle aged men. Journal of the American Medical Association, 288, 2709–2716.
68
Nursing for Women’s Health
Volume 17
Issue 1