Women's Heart Health at the Medical College of Wisconsin 

General statistics

• Heart disease is the No. 1 killer of women in the United States, and is more deadly than all forms of cancer combined.
• While 1 in 31 American women dies from breast cancer each year, 1 in 3 dies of heart disease.
• An estimated 43 million women in the U.S. are affected by heart disease.
• Ninety percent of women have one or more risk factors for developing heart disease.
• The symptoms of heart disease can be different in women and men, and are often misunderstood.
• Only 1 in 5 American women believe that heart disease is her greatest health threat.
• Women comprise only 24 percent of participants in all heart-related studies.
• African American and Hispanic women are at greater risk of cardiovascular disease compared to Caucasian women.

Hispanic women

• Hispanic women are likely to develop heart disease 10 years earlier than Caucasian women.
• Only 1 in 3 Hispanic women are aware that heart disease is their No. 1 killer.
• Only 3 in 10 Hispanic women say they have been informed that they are at a higher risk.
• Only 1 in 4 Hispanic women is aware of treatment options.
• Hispanic women are more likely to take preventive actions for their family when it comes to heart health.

African American women

• Cardiovascular disease is the leading cause of death for African American women.
• Of African American women ages 20 and older, 46.9 percent have cardiovascular disease.
• Only 1 in 5 African American women thinks she is personally at risk.
• Nearly 50 percent of African American women are aware of the signs and symptoms of a heart attack.
• Only 43 percent of African American know that heart disease is their greatest health risk.

The mission of the Women’s Cardiovascular Health Program is to promote cardiovascular health and reduce the burden of cardiovascular disease in women by providing comprehensive clinical care and fostering interdisciplinary research focused on women with cardiovascular risk factors and established cardiovascular disease.

Through clinical collaborations within the Medical College of Wisconsin and local community, our team of cardiovascular providers works closely with primary care providers, obstetrician and gynecologists, oncologists, and endocrinologists to provide each woman with an individualized care plan that specifically addresses their cardiovascular health needs.

The four key components of the program are:

• Providing a broad range of cardiovascular services through a multidisciplinary team using evidence based guidelines.
• Coordinating care with other providers of women’s health services at MCW.
• Facilitating and conducting basic science, translational, and clinical research focused on women’s cardiovascular health in collaboration with other research groups at MCW including the Women’s Health Research Program (WHRP).
• To raise awareness about the burden of cardiovascular disease in women by educating patients, healthcare providers and the local community through lecture series and outreach efforts to local businesses and community groups.

Diagnostic Testing

• Electrocardiogram (EKG)
• Echocardiography – transthoracic echo, stress echo, transesophageal echo
  
• Cardiac MRI (CMR), stress CMR
• Exercise testing – treadmill exercise stress test, cardiopulmonary exercise testing
• Computed tomography (CT) – coronary calcium scoring, CT coronary angiography
• Cardiac Catheterization and Coronary angiography
• Holter and Cardiac Event Monitoring
• Tilt Table Testing
• Vascular Testing – carotid Doppler ultrasound, ABI testing, peripheral CT angiography

Advanced Cardiovascular Risk Assessment and Prevention

• Advanced Lipid clinic
  
• Metabolic clinic
• Nutrition counseling
• Smoking cessation
• Pre-pregnancy risk evaluation
• Evaluation of women with pregnancy related complications

Heart Failure

• Medical therapy
• Advanced Heart Failure Management
  Advanced device therapy including cardiac resynchronization therapy (CRT) and Left Ventricular Assist Device (LVAD) evaluation and implantation.
  Cardiac Transplantation

Ischemic Heart Disease

• Diagnostic Cardiac Catheterization
• Percutaneous coronary intervention: percutaneous balloon angioplasty, stenting, fractional flow reserve, aspiration thrombectomy and rotational atherectomy, intravascular ultrasound (IVUS)

Arrhythmia Diagnosis and Management

• Holter and cardiac event monitors
• Diagnostic electrophysiology (EP) study
• Catheter ablation procedures
• Pacemaker and defibrillator implantation
• Syncope evaluation and management

Care of Women at Risk for CVD or with Established CVD as a result of Cancer Treatment

• Surveillance of non-clinical cardiac disease with advanced imaging techniques including echocardiography and cardiac MRI
• Medical management of cardiac complications related to cancer treatment including heart failure management, arrhythmia management, ischemic heart disease management

Traditional risk factors for cardiovascular disease are similar between men and women. However, women with traditional risk factors are more likely to develop serious cardiovascular disease compared to men. Our Women’s Cardiovascular Health Program team members are knowledgeable about these women specific differences in cardiovascular risk and work to not only better identify women at increased cardiovascular risk, but to work with individuals and their primary care providers to optimally manage their risk factors.

Do You Have Ideal Cardiovascular Health?

• Total cholesterol 200 mg/dL (untreated)
• BP 120/80 mm Hg (untreated)
• Fasting blood glucose 100 mg/dL (untreated)
• Body mass index 25 kg/m2
• Abstinence from smoking
• Physical activity at goal:
• 150 minutes per week of moderate intensity exercise
• 75 minutes per week of vigorous intensity exercise
• Healthy (DASH-like) diet

Are You At Risk for Cardiovascular Disease?

If you have one or more of the following risk factors, then you are at risk:

• Smoking
• Poor diet
• Sedentary lifestyle (less than 150 minutes per week of physical activity)
• Obesity, especially belly fat
• Family history of cardiovascular disease (female < 65, male < 55)
• High blood pressure (>120/80 mmHg)
• Abnormal lipids (high bad cholesterol, low good cholesterol, high triglycerides)
• Metabolic syndrome (insulin resistance, central obesity, abnormal lipids, high blood pressure)
• Poor exercise tolerance
• Subclinical atherosclerosis (abnormal coronary calcium scan, ABI, or carotid ultrasound)
• Systemic autoimmune collagen-vascular disorder (Lupus, rheumatoid arthritis)
• History of gestational hypertension, preeclampsia, gestational diabetes

Personalized Cardiovascular Health Evaluation

As part of your personalized cardiovascular health evaluation, the Advanced Cardiovascular Risk Assessment and Prevention team will provide you with a comprehensive cardiovascular risk assessment based on:

• Your completed medical questionnaire with diet with activity log
• A thorough medical and family history
• A complete cardiovascular physical examination
• Screening laboratory tests, ECG, and exercise treadmill test

We understand that, because traditional risk assessment tools often underestimate cardiovascular risk in women, a combination of tests including cardiac and vascular imaging techniques may be necessary for us to determine whether or not you are at increased risk for serious cardiovascular disease.

Additional diagnostic tests may include:

• Advanced lipid profile testing
• Coronary Calcium Score Determination
• Ankle-Brachial Index Determination
• Carotid Ultrasonography and Intimal Medial thickness Determination
• Echocardiography
• Stress Echocardiography
• Stress Cardiac MRI (magnetic resonance imaging)
• Stress Nuclear Imaging
• Arrhythmia (heart beat) event monitoring
• Cardiac Catheterization/Coronary Angiography

Whether you know you already know you are at increased risk for cardiovascular disease or we are establishing that you are at risk for the first time, the Advanced Cardiovascular Risk Assessment and Prevention team at the Women’s Cardiovascular Health Program will work with you to form a comprehensive management plan that you can incorporate into your daily life now and in the future.

Management plans may include:

• Blood pressure management through lifestyle modification (nutrition/exercise ) and medication
• Cholesterol management through lifestyle modification (nutrition/exercise ) and supplements and medication
• Blood sugar (diabetes) management through nutrition, exercise and medication
• Nutrition counseling
• Smoking cessation programs
• Personalized exercise program
• Weight management programs
• Stress management techniques