Question

As part of learning Critical Thinking & Analysis for this course, you need to learn to evaluate and respond to political statements on public health issues. Please, respond to the scenario below.

Your Public Health Dept Supervisor evaluates the American Heart Association (AHA)– Women’s Health Initiative and decides that the following Go Red for Women assertion is NOT a compelling message…

AHA: “…The fact is: Cardiovascular disease (CVD) is the No. 1 killer of women, causing 1 in 3 deaths each year. That’s approximately one woman every minute...!”

In fact, he proclaims, “Of course CVD is the number one killer of women--- this is a trivial and non-compelling fact. CVD is an appropriate leading cause of death for women--- What do you WANT to be the leading cause of death for women--- Cancer…???...”

The AHA and a number women’s groups are outraged at his remarks and attitude.

Answer 1

Cardiovascular diseases (CVD) is the No. 1 cause of death in American women, claiming over 400,000 lives each year, or one death every 80 seconds CVD kills approximately the same number of women as all forms of cancer, chronic lower respiratory disease and diabetes combined. In 2014, one in 32 female deaths was from breast cancer, but one in three was from cardiovascular disease. Unfortunately, the statistics are even worse when race and age are considered. The prevalence of CVD among African-American women (nearly 48%) is much higher than among Caucasian women (35%). For the past 3 decades, dramatic declines in CVD mortality for women have been observed. However, recent data suggest stagnation in the improvements in CVD mortality for women.

Heart disease remains the leading cause of death among all women combined in the United States by a narrow margin. The relative mortality burden of heart disease versus cancer in United States women cannot be properly understood without detailed consideration of age and race and ethnicity. However, cancer predominantly kills middle-aged and young women, and heart disease predominantly kills the very old. American women aged 60 to 64 years are more than twice as likely to die from cancer as from heart disease. Furthermore, only one in six deaths among women aged 15 to 64 years is caused by heart disease. In light of these facts, the purported reluctance of middle-aged women to believe exhortations about the “killer” status of heart disease seems less unreasonable. As for cancer, it is well-known among health professionals that lung cancer, not breast cancer, is the leading cause of cancer mortality for U.S. women. However, this fact may be less well-understood by patients and the general public.

In some instances, effects of CVD can be worse in women than in men: Younger women who have a heart attack have higher mortality than men of the same age. Women are more likely than men to become disabled after a stroke. Women with diabetes have higher CVD mortality than men with diabetes. Immediately following stroke, women are more likely to experience serious problems compared to men. Women themselves tend to under-estimate the risk of dying or becoming seriously unwell due to heart disease. Young women still feel more threatened by cancer than they do by CVD, despite being statistically more likely to die of heart disease.

Educating women greatly increases their willingness and ability to take heart-protective action, which is why the World Heart Federation, together with its members, runs campaigns and activities to inform women worldwide that heart disease and stroke is their number one killer and that they can take appropriate action to prevent them.

CVD represents one-third of all deaths among women. Heart attacks claim the lives of 3.3 million women every year, with another 3.2 million women dying from stroke and the remaining 2.1 million women succumbing to other CVD. In low- and middle-income countries, women who develop CVD are more likely to die from it than women in industrialized nations. Some of the symptoms in women can be different to that in men and as a result they are often under-diagnosed and under-treated when compared to men. The risk of dying or becoming seriously unwell due to heart disease and stroke is largely underestimated in women.

Most of our ideas about heart disease in women used to come from studying it in men. But there are many reasons to think that it's different in women. A woman's symptoms are often different from a man's, and she's much more likely than a man to die within a year of having a heart attack. Women also don't seem to fare as well as men do after taking clot-busting drugs or undergoing certain heart-related medical procedures. Research is only now beginning to uncover the biological, medical, and social bases of these and other differences. The hope is that new knowledge will lead to advances in tailoring prevention and treatment to women..

RAISING AWARENESS

• A 2012 survey conducted by the AHA found that only 56% of women were unaware that heart disease is the leading cause of death among women, although awareness has nearly doubled since 1997.

• Furthermore, only 36% of black women and 34% of Hispanic women knew that heart disease is their leading cause of death, compared to 65% of white women.

• Less than 25% of women can name hypertension and high cholesterol as risk factors for heart disease, and less than 50% know the major symptoms of heart disease.

  • Black and Hispanic women are less likely than white women to be aware of heart attack symptoms.

DISPARITIES IN RISK FACTORS

• Women are significantly less likely than men to meet the Federal Guidelines for Physical Activity.

• Women have a 25% increased risk for coronary artery disease conferred by cigarette smoking compared to men.

• Women with diabetes are 44% more likely to develop CVD than men with diabetes.

• Certain risk factors such as high blood pressure and diabetes increase heart attack risk in women more severely than in men.

• Women are more likely than men to be obese.

• Several female reproductive factors, including early menarche, early menopause and miscarriage, are associated.

10000 +Heart Disease Death Rate (95% CL) +Heart Disease Death Rate (95% CL) -Cancer Death Rate (95% CL) Cancer Death Rate (95% CL) Deaths per 100,000 Population Deaths per 100,000 Population 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85. 0-1 15+ 15-19 20-24 25-29 30-14 15-19 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 Ape at Death Age at Death

Figure 1

(A) Age-specific death rates for heart disease and cancer women in the United States, 2013 (logarithmic scale emphasizes relative disparities). (B) Age-specific death rates for heart disease and cancer women in the United States, 2013 (numeric scale emphasizes absolute disparities). Abbreviation: CL, confidence limit.

For women aged 80 to 84 years old, the rates converged. Although these rates appear nearly identical in Figure 1A, in fact a statistically significantly 15% higher rate of death from heart disease emerged in this age group (heart disease, 1,212 deaths per 100,000 population [95% CI, 1,200–1,223] vs. cancer, 1,058 deaths per 100,000 population [95% CI, 1,047–1,069]). In the oldest age band, mortality from heart disease greatly exceeded the death rate from cancer (relative risk, 2.8).

Figure 1B presents the same data as Figure 1A, but plotted on an arithmetic scale. This plot emphasizes the absolute differences in the rates. Figure 1B reveals an exponential increase in heart disease mortality with age, and a non-exponential increase in cancer mortality with age. The rate difference for heart disease versus cancer mortality was very large for women aged 85 years of age and older (rate difference, 2,423 deaths/100,000)

Heart Disease Cancer All Other Causes 3.9 4.2 6.3 9.6 7.7 10.0 8.3 15.2 10.5 20.8 27.0 13.0 14.2 30.8 15.2 34.8 16.0 37.6 15-19 years old 20-24 years old 25-29 years old 30-34 years old 35-39 years old 40-44 years old 45-49 years old 50-54 years old 55-59 years old 60-64 years old 65-69 years old 70-74 years old 75-79 years old 80-84 years old 85-89 years old 90-94 years old 95-99 years old 100+ years old 86.5 88.1 83.71 76.5 68.7) 60.00 55.0 50.0 46.4 44.00 44.7|| 47.5 52.5 56.8 60.2 61.6 62.9) 63.0 17.1 17.7 37.6 18.6 20.2 27.3 23.1 20.1 26.2 13.6 29.7 8.7 31.5 5.6 33.8 3.2 0 10 20 30 40 50 60 70 80 90 Percent of All Deaths Within Each Age Group (Each Horizontal Bar Adds to 100%) 100

Figure 2 presents the age-specific proportions of all deaths attributable to an underlying cause of heart disease or cancer for women in 2013. This graph reveals the different age structures of heart disease and cancer mortality in women. The percent of all deaths attributable to heart disease increased steadily with age, peaking for women ages 100 years and older (33.8% of all deaths in this age group). In contrast, the percent of all deaths attributable to cancer peaked among women aged 60 to 64 years old, and then declined among older women. Only 3.2% of decedents aged 100 years and older had cancer reported as their underlying cause of death.

10000 Heart Disease 15-44 Cancer 15-44 Heart Disease 45-64 .-Cancer 45-64 +Heart Disease 65-84 Age-Adjusted Death Rate per 100,000 Population Cancer 65-84 +Heart Disease 85+ Cancer 85+ *The death rates for women 85+ years old were not ape-adjusted 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year

Temporal trends in heart disease and cancer death rates for the years 2000 through 2013, by age, are presented in Figure 3. There was a significant relative excess in cancer mortality among young (aged 15–44 years old) and middle-aged (aged 45–64 years old) women, which persisted over the study period. Among older women (aged 65–84 years old), the heart disease death rate was significantly higher than the cancer rate in 2000, but by 2004 a crossover (owing to more steeply declining heart disease mortality) resulted in a significantly higher cancer death rate. This relative excess in cancer mortality has widened over time. Among the oldest women (aged ≥85 years), a large and significant excess in heart disease mortality has narrowed slightly over the years, owing to greater decreases in the heart disease death rates.