Gender and Ethnic Medicine Project: Cardio-vascular Health
|Video 1: Click the
picture above to listen to Dr Núñez giving the rationale why you should learn about cardiovascular health issues related to gender
||Video 2: Click the
picture above to see Dr Núñez perform an Interview with emphasis
on Cardio-vascular Health ...
Video 3: Click
the picture above to see Drs Núñez and Lee discuss
Cardio-vascular Health issues related to Gender, Ethnicity, and more...
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- The Heart Truth (extensive resources, pbl case, lecture
materials and additional resources)
- DHHS Office of Womens Health
- Agency for Healthcare quality and research
- DHHS Office of Minority Health
Delineate unique and different aspects of heart health risk, clinical presentation,
diagnosis, treatment and outcomes for women as compared to men and to describe
the impact of subcultural differences in outcomes for diverse women.
Knowledge, Attitudes and Skills Objectives by domain:
Risk Factors and Predictive Tools
- Cite prevalence and incidence data of cardiovascular disease (CVD), and
identify racial and gender differences in CVD prevalence and incidence
- Identify known CVD risk factors in women
- Identify gender and racial differences in the relative importance of
the CVD risk factors for women
- Define the concept of CVD risk stratification
- Identify risk reduction strategies, including those involving lifestyle
- Summarize the current state of knowledge of how menopause and hormone
therapy affect a woman’s risk for developing CVD
- Calculate BMI
- Identify common (typical) presentations of CVD and identify gender differences
- Calculate a woman’s 10-year risk for CVD events using the Framingham
Clinical Presentation, Diagnosis and Testing for Disease
- Describe the pathophysiology of stable and unstable coronary syndromes
- Recognize the range of common clinical presentations for stable and
unstable coronary syndromes in women and contrast these with those of
- Describe testing modalities for diagnosing coronary heart disease and
explain differences in test sensitivity and specificity for common tests
- List appropriate initial diagnostic tests (those usually performed in
the emergency department) for a female patient presenting with possible
acute coronary syndrome
- Cite the “Five A’s” for behavioral counseling in smoking
- Identify evidence-based patient education resources to support primary
and secondary prevention and treatment of heart disease
- Apply behavioral change theories and strategies to clinical situations
- Identify stage of change readiness for the standardized patient and
understand how this impacts her ability to modify lifestyle habits and
- Identify the patient’s barriers to change
- Develop a plan to manage barriers and to move the patient toward a
higher stage of readiness
- State what biases may lead to the failure to diagnose CVD in women
- Identify psychosocial factors that influence, interfere with or delay
women seeking treatment and early evaluation for symptoms suggestive of
- Recognize that gender-specific and culture-specific communication styles
may impact the clinician-patient interaction
Prevention of Cardiovascular Disease in Women
- Evidence-based Guidelines for Cardiovascular Disease Prevention in Women http://circ.ahajournals.org/cgi/content/full/109/5/672
- Coronary heart disease incidence, by sex—United States 1971-1987.
MMWR 1992; 41:526-529.
- Carr MC, Kim KH, Zambon A, et al. Changes in LDL density across the menopausal
transition. J Investig Med 2000; 48: 245-250.
- Grundy, SM, Cleeman JI, Daniels SR et al. Diagnosis and management of
metabolic syndrome: an American Heart Association/National Heart, Lung
and Blood Institute scientific statement. Accessed at http://www.circulationaha.org on
October 25, 2005
- Mosca L, Appel LJ, Benjamin EJ, et al. Evidence-based guidelines for
cardiovascular disease prevention in women. Circulation 2004; 109:672-693.
- Nohria A, VaccarinoV, Krumholz HM. Gender differences in coronary artery
disease in women: gender differences in mortality after myocardial infarction:
why women fare worse than men. Cardiol Clin 1998; 16:45-57.
- Charney P. Presenting symptoms and diagnosis of coronary heart disease
in women. J Cardiovasc Risk 2002; 9:303-307.
- Zimmerman GL, Olsen CG, Bosworth MF. A ‘stages of change’ approach
to helping patients change behavior. Am Fam Physician 2000; 61:1409-1416.
- Mieres JH, Shaw LJ, Arai A, et al.
Role of noninvasive testing in the clinical evaluation of women with suspected
coronary artery disease: consensus statement from the Cardiac Imaging
Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging
and Intervention Committee, Council on Cardiovascular Radiology and Intervention,
American Heart Association.Circulation. 2005; 8;111:682-96. http://circ.ahajournals.org/cgi/content/full/111/5/682
- Gibbons RJ, Balady GJ, Bricker JT, et al.
ACC/AHA 2002 guidelines update for exercise testing: a report of the American
College of Cardiology/American Heart Association Task Force on Practice
Guidelines (Committee to Update the 1997 Exercise Testing Guidelines).
J Am Coll Cardiol 2002;40:1531-1540. http://www.acc.org/clinical/guidelines/exercise/exerciseclean.pdf
- Cheitlin MD, Armstrong WF, Aurigemma GP, et al.
ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography:
a report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the
1997 Guidelines for the Clinical Application of Echocardiography). J
Am Soc Echocardiogr 2003; 16:1091-1110. http://www.acc.org/clinical/guidelines/echo/index.pdf
Cultural Issues in Care and Women’s Health
- Berlin EA. & Fowkes WC, Jr.: A teaching framework for cross-cultural
health care--Application in family practice, In Cross-cultural Medicine.
- West J. Med. 1983, 12: 139, 93~98
- Núñez AE. Transforming cultural competence into cross-cultural
efficacy in women's health education. Academic Medicine. 75(11):1071-80,
- Association of American Medical Colleges, Tools for Assessing Cultural
Competence, 2000 http://www.aamc.org/meded/tacct/start.htm
- Institute of Medicine. Exploring the Biological Contributions to Human
Health: Does Sex Matter? 2001
- Office of Minority Health, National Standards on Culturally and Linguistically
Appropriate Services (CLAS), 2001. http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15
- California Endowment P r i n c i p l e s a n d R e c o m m e n d e d
S t a n d a r d s f o r C u l t u r a l C o m p e t e n c e E d u c a t
i o n o f H e a l t h C a r e P r o f e s s i o n a l s, 2001.
- Núñez AE. Robertson, CJ. Multicultural Issues for Women’s
Health. Medical Clinics of North America. 87(2003) 939-954.
- Agency for Healthcare Research and Quality. National Health Care Health
Disparities Report 2006 http://www.ahrq.gov/qual/nhdr06/nhdr06.htm
- Transforming the Face of Health Professions Through Cultural & Linguistic
Competence Education: The Role of the HRSA Centers of Excellence
Appendix A Toolbox, 2002.
- Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic
Disparities in Health Care.2002. http://www.iom.edu/CMS/3740/4475.aspx
Tools and Additional Web Resources:
Compilation by A.Núñez, 2007