INTRODUCTION

This poster presentation is about coronary heart disease and women. Along with the supporting paper I will attempt to identify women’s perception of CHD and some of the risk factors. The author will define coronary heart disease (CHD), and show its implication for women

TOPIC AND RATIONALE

Coronary heart disease (CHD) is the single largest killer of women in the United Kingdom (Hatchett and Thompson, 2002; Julian et al 2005; Mikhail, 2005).
Women perceive breast cancer as a greater risk than CHD though 16% of all deaths in women in the United Kingdom (UK) were from CHD, in comparison to 4% for breast cancer (British Heart Foundation, 2005). It is suggested that these misperceptions may lead women to underestimate their risk for CHD and fail to seek early interventions to prevent unnecessary morbidity and mortality (Hart, 2005).

I chose this topic for my poster presentation after reading an article in the newspaper regarding women’s perception of CHD. It sparked my interest as the article made me realize that breast and cervical cancer were at the forefront of my mind, with CHD rarely thought about. This perception I realized was due to the media; in women’s magazines where the campaign for breast awareness is highly visible and the general media where CHD is portrayed as the preserve of the white middle aged male. The BHF, which published the report on women and CHD, seem to perpetuate this view in their current campaign (BHF, 2006a). The campaign features a white middle age male displaying the typical symptoms of CHD, despite the high CHD mortality rate of women living in Glasgow and Belfast and the high incidence in South Asian women (BHF, 2005).
My elective placement on a cardiac ward and cardiac theatre further inspired my choice as I was able to see the debilitating impact the disease had on a female patient. This topic I felt was important as women needs to be informed of CHD and be educated to lifestyle changes that can be made to modify their risk.

The target audience for the poster is women and is aimed at raising their awareness of CHD. The poster is intended for display in well women’s clinic, women’s magazine and GP’s surgeries.
The educational approach model of health promotion (Naidoo and Willis, 2000) was used to guide the poster design. The aim of the model is to provide information to raise awareness of health issues. My main focus was to provide key facts on women and CHD deaths in order to highlight women’s misconceptions and key messages to enable them to take control of their health.

MAIN ISSUES

The predominant cause of CHD is arteriosclerosis, where the coronary arteries become progressively narrowed or completely occluded due to the build up of fatty deposits (atheroma). The most common clinical manifestations of CHD are; angina pectoris which is the discomfort felt when there is a transient loss of oxygen to the heart muscle (Marieb, 2003; Hatchett and Thompson, 2005) and myocardial infarction (heart attack) which is the necrosis (death) of a portion of the myocardium as a result of inadequate blood supply to the myocardial tissues (Julian et al, 2005).

The CHD mortality rates for women in the UK are among the highest in the world.
CHD accounted for 114,000 and one in six occurred in women. Every six minutes a woman dies in the UK and Europe from CHD. In the USA a woman dies every minute. Death rates have been falling in both male and female, however the fall has been slower among younger women (35-44 years) (BHF, 2005).

CHD is the major cause of morbidity (illness) and disability among women. The incidence of CHD is greater in men, however women tend to live longer than men and have co- morbidities such as diabetes, hypertension and arthritis and therefore extra years of disability (National Forum For Coronary Heart Disease Prevention, 1994; BHF, 2005).

Women tend to present later in life than men and also well into the disease process, with atypical symptoms such as nausea, back pain and tiredness. They are likely to be diagnosed later than men and less likely to be given appropriate treatment (Sharp, 1994; Mikhail 2005; Hart 2005).

The major risk factors for CHD are alike for both sexes (Marmot and Brunner, 1994). However it has been suggested that environmental factors such as, diet and physical activity increases the chance of women developing CHD than it does men (BHF, 2006b).

Diabetes is a greater risk factor for women than men. Women diagnosed with diabetes have 2.6 times the risk of dying from CHD than women without diabetes compared with a 1.8-fold risk among men with diabetes (Mikhail 2005).
Type 2 diabetes, in women, will magnifies the effect of other risk factors for CHD (BHF, 2005; BHF, 2006b)
Obesity is more prevalent in women and is an important determinant of CHD in women (BHF, 2005).

Smoking is the single most important preventable cause of CHD. Women who smoke have almost twice the risk of developing CHD than men do (BHF, 2003)

Physical inactivity is an important risk factor in CHD, however women are more likely to be inactive than men and therefore increase their risk factor to CHD (Marmot and Brunner, 1994; BHS, 2006b).

IMPLICATION FOR PRACTICE

It has been suggested that women think they can postpone attempts to reduce their risk to CHD, as CHD is a disease of the older woman (Mikhail, 2005). Women’s perceptions of CHD need to be addressed.

Young people are becoming less physical active, with young women more so, leading to an increase in obesity and type 2 diabetes with the increased risk in later life to CHD. Physical activity is associated with a reduction in the risk of CHD. It also has beneficial effects on obesity and hypertension, which are also both risk factors. Women need to be educated at a younger age so they can become heart aware and take care of their hearts.

It is very important that as a future professional I am aware of the risk of CHD among women, as it is argued that professionals who do not see women as potential victims of CHD are less likely to offer preventive advice for CHD and less likely to offer appropriate interventions (National Forum For Coronary Heart Disease Prevention).

A lack of knowledge among professionals regarding women’s risk to CHD was highlighted by Mihail and the BHF (Mikhail, 2005; BHF, 2006b). As a future practitioner I will need to participate in opportunistic health promotion (Naidoo and Willis, 2000) to help women modify their risk to CHD.