Cardiovascular disease is the leading killer of American women, responsible for one in five female deaths according to the CDC. This February, in recognition of American Heart Month, it’s critical to understand the risks of heart disease and how to improve heart health, especially for women at the highest risk of disease and death.

Understanding Heart Disease

Cardiovascular disease, or heart disease, refers to numerous problems including heart attack, stroke, heart failure, coronary artery disease, arrhythmia, and more. Some women may show no symptoms of heart disease, while others may have chest pain and discomfort, pain in the jaw or throat, or pain in the upper abdomen or back. Women may also experience nausea, vomiting, and fatigue.

Emergencies, such as a heart attack or stroke, may be the first sign of heart disease in some women. Signs of emergencies are typically more severe experiences of regular symptoms, such as chest and back pain, heartburn, extreme fatigue, shortness of breath, chest palpitations, and more.

Call 911 if any of the following warning signs occur.

Signs of a heart attack:

  • Chest discomfort: Discomfort in the center of the chest that lasts more than a few minutes, or goes away then comes back. This discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
  • Discomfort in the upper body: Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
  • Shortness of breath: This may occur with or without chest discomfort.
  • Other signs: May include breaking out in a cold sweat, nausea, or lightheadedness.

 Spot a stroke F.A.S.T. Signs of a stroke include:

  • Face drooping: Ask the person to smile. Does one side of the face droop or is it numb?
  • Arm weakness: Ask the person to raise both arms. Does one arm drift downward? Is one arm weak or numb?
  • Speech difficulty: Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly? Is speech slurred, are they unable to speak, or are they hard to understand?

Even if the symptoms go away, call 911 and get them (or yourself) to a hospital immediately. 

Risk factors for heart disease include biological, social, and environmental factors. Biological factors include race, age, gender, genetics, family medical history, and personal medical history. Because these risk factors cannot be changed, efforts to improve heart health generally focus on manageable lifestyle changes to reduce risk of health conditions that co-occur with heart disease, such as diabetes.

Other health conditions closely linked with heart health include high blood pressure, high cholesterol, obesity, and family history of heart disease. Behaviors like smoking, unhealthy eating, physical inactivity, and drinking too much alcohol also contribute to higher risk for heart conditions.

The American Heart Association (AHA) released Life’s Essential 8, a new set of guidelines for lifelong good health focused on two areas, health factors and health behaviors. Health factors include managing weight, cholesterol, blood sugar, and blood pressure. Health behaviors include eating better, being more active, quitting tobacco, and getting healthy sleep.

The Life’s Essential 8 web page hosts a variety of resources including fact sheets for each of the health factors and behaviors. The My Life Check tool is an online tool that assesses your own heart health to better understand your risk for heart disease and stroke.

Heart Disease in Black and Hispanic Women

Being a woman already puts you at risk for heart disease, but race and other factors can further increase that risk. Heart disease is not only the leading cause of death among women in general, but for Black and white women specifically. For Hispanic women, heart disease ranks second only to cancer. According to the AHA, Hispanic women on average are more likely to develop heart disease 10 years earlier than non-Hispanics.

According to the Centers for Disease Control and Prevention (CDC), about one in 16 women ages 20 and older have coronary heart disease, the majority being Black women (6.5%), followed by white (6.1%) and Hispanic women (6%). Black women are more likely than any other race or ethnicity to have hypertension, a “silent killer” among women. Black women also have two times the risk of stroke than white women and are more likely to die at an earlier age due to heart disease.

Heart health is of particular concern for Black mothers. Heart disease is the number one killer of new moms, accounting for one-third of maternal deaths which are already high among Black women. High blood pressure, preeclampsia, and gestational diabetes all disproportionately affect Black women, and all greatly increase a woman’s risk for developing heart disease later in life.

According to the AHA, the disproportionate rates of heart conditions among Black and Hispanic women are in part due to a lack of awareness about the severity of heart disease. The AHA reports that Black and Hispanic women are less likely than white women to be aware that heart disease is a leading killer of women. Black and Hispanic women are also less likely to be aware of warning signs of heart attack, stroke, and other cardiovascular emergencies.

Modest lifestyle changes help improve heart health but for Black and Hispanic women, these often aren’t enough. Medical racism, a lack of culturally concordant care, and disparate access to mental health and social support prevent Black and Hispanic women from receiving the quality of care they need for a healthy heart and life.

In some instances, Black and Hispanic women simply aren’t aware of their personal risk for heart disease. By understanding contributing risk factors and how to mitigate cardiovascular events like a stroke or heart attack, women are better equipped to maintain control of their heart health.

Race’s Role in Heart Disease Among Black and Hispanic Women

One glaring thread throughout these disproportionate rates of disease is the issue of racism. For Black women, the prevalence of disease, heart conditions, and negative maternal health outcomes are all linked to discrimination faced at the hands of providers. Black women have long reported not being taken seriously regarding concerns and pain levels and experiencing unnecessarily complicated and traumatic births, among other problems.

For Hispanic women, navigating the health care system in general can be a daunting and exclusionary process. Spanish-speaking women may face barriers due to lack of translators, translated materials, and user-friendly scheduling or communication services. Seasonal migrant farmworkers may face scheduling conflicts if providers don’t have availability outside of harvesting hours. Undocumented women may not be able to or feel comfortable attempting to access health care at all.

For both Black and Hispanic women, cultural stigmas also play a role in whether access to health and social support is available. For example, Black women face the highest risk for maternal health problems throughout pregnancy and postpartum. Many of these concerns can be addressed with breastfeeding and postpartum support, yet these efforts are typically not targeted toward Black communities. 

Additionally, healthy eating is frequently promoted among Black and Hispanic communities which are at higher risk for health concerns, including diabetes and heart disease. However, these communities also tend to be ones experiencing food deserts. As a result, families are forced to opt for the inexpensive, convenient fast food option, perpetuating unhealthy eating in the community.

Lifestyle changes are undoubtedly important for Black and Hispanic women to improve and maintain their heart health. However, structural changes are also necessary to ensure that women have the agency and access to the necessary resources to be able to make these lifestyle changes.

Improving Efforts to Address Women’s Heart Health Disparities

Young women who are otherwise healthy may not see heart health as a priority if there have not been any major warning signs or a strong family history of cardiac events. Personal testimonies shared by the AHA show that Black and Hispanic women, who often act as caregivers for family members, sometimes focus more on the heart health of their elders than themselves and put their own health on the back burner.

However, waiting until there is an emergency could have fatal consequences. Women can help prevent future complications or disease by knowing their unique risk factors, reviewing their personal and family heart health history, and making healthy lifestyle choices.

Additionally, it’s important to recognize and be aware of any barriers preventing the ability to take the steps necessary to prevent heart disease. This includes ensuring access to quality primary health care, perinatal care from pregnancy through postpartum, mental health care, and social support.

Some of the primary social determinants of health (SDoH) that play a role in women’s health outcomes include transportation, as they must be able to get to and from health appointments; nutritious food, as reducing risk of heart disease requires a healthy diet; and affordable and stable housing and utilities, as healthy food and transportation are ineffective without a place to sleep, cook, eat, bathe, and feel safe.

Structural-level efforts to address bias and develop strategies to provide equitable care can have a ripple effect that improves care delivery at every subsequent level. Counties focused on equity can better identify gaps in communities, such as food deserts, lack of transportation, inadequate broadband, and more.

From there, facilities are better equipped to connect patients to available resources and identify needs that are still unmet, allowing the opportunity for improvement. For example, while improved broadband infrastructure may increase telehealth access that helps patients, lack of translator-friendly options may create another barrier for Hispanic patients.

One significant part of the problem remains the lack of diversity in some care facilities. This helps address language and cultural barriers and provides patients a safe place to share what they truly need to not only live but thrive, as well as ask for the support they need.

Being able to discuss health concerns with someone from a shared racial and cultural background offers a level of empathy, trust, and support that is priceless for Black and Hispanic patients. It also helps to address some of the cultural stigmas that may be difficult for communities to otherwise combat alone.

Mental health, for example, is already a taboo among Black communities, despite the prevalence of transgenerational, historical trauma due to slavery and the treatment of Black people in America since its conception. Black women specifically face compounding trauma from multiple angles: this historical trauma; the specific trauma Black slave women faced regarding pregnancy, childbirth, and child-rearing; misogynoir and obstetric violence; the pressure to save others while not being saved; and countless other stressors.

For Hispanic women, mental health may be difficult to discuss or treat for a number of reasons. In some families, conversations about mental health are overruled by the belief that faith can overcome all obstacles, including struggles like depression or anxiety. Women who speak little to no English or immigrated to America may face isolation or loneliness due to language barriers or a lacking sense of community.

In both Black and Hispanic families, where women are caretakers, homemakers, and the epitome of stable strength, it can be difficult to be transparent about struggling with mental health. It can be even more uncomfortable to disclose struggles with racism, which contribute to trauma and mental health conditions, although this link is rarely acknowledged by individuals experiencing it.

Improving heart health for Black and Hispanic women is equally about improving mental health support among these populations as it is raising awareness of risks or underscoring the importance of a healthy lifestyle. Whole-person health, especially for Black and Hispanic women, includes mental health and access to support services that address the unique challenges these women face.

Regain Control of Your Heart Health

During American Heart Month this February, regain control of your heart health. Use the My Life Check tool to assess your risks for heart disease, then talk to your provider about your questions and concerns. Ask them to work with you to create an action plan and note any areas you are lacking support or have questions, such as help accessing affordable healthy food or instructions for simple, at-home cardio exercises.

Go Red for Women Day, February 3, is an annual day to raise awareness of the issue of heart health in women and spark conversation with people in your network about disparities your community faces. Wear red and talk to the women in your life about the risks of heart disease and the importance of early prevention and action. Discuss warning signs of heart conditions with friends and family and what to do in an emergency.

Cardiovascular disease is the leading killer of women, but it doesn’t have to be. Learn more.