February is the month of red roses, lacy cards, and heart-shaped boxes of chocolates. Hearts are spotlighted for another reason in February, too. It’s American Heart Month, designated to raise awareness about the number one killer of Americans — heart disease.

Heart Disease Facts

Heart disease, also called cardiovascular disease, includes several types of conditions. Two of the most common are coronary artery disease, which is a narrowing of the blood vessels that carry blood to the heart, and stroke when the blood supply to the brain is blocked or a blood vessel in the brain bursts, causing brain tissue to die.

Per the Centers for Disease Control and Prevention (CDC), one person dies every 33 seconds in the United States from cardiovascular disease, and someone has a heart attack every 40 seconds. Every year, over 800,000 people experience a heart attack (also known as a myocardial infarction or MI); 75% are first-time heart attacks, and 25% happen to people who have already had a heart attack. About one in five heart attacks are “silent” — the person may not even be aware of it. While heart disease is the leading cause of death for Americans of all racial and ethnic groups, Black people account for almost one-quarter (22.6%) of all heart disease-related deaths.

Black Women are at Higher Risk — and Racism Could Be Contributing

Black Americans are two to three times more likely to have a stroke and 1.2 times more likely to die of a stroke than white Americans. Black women, in particular, experience stroke and stroke-related death at higher rates and earlier onset than women in any other racial group. The median age for having a stroke tends to average around age 60s to 70s, but Black women are having strokes in their 50s.

Results of a 25-year study conducted by researchers at Boston University suggest that the effects of racism can increase a Black woman’s risk of heart disease. The Black Women’s Health Study began tracking more than 59,000 Black women in 1995; none had heart disease at the time of study inception. Participants answered initial onboarding questions about their perceived experience of racism both in everyday life (interpersonal racism) and in situations that included housing, employment, and interactions with law enforcement (institutional or structural racism). Structural racism is the ways society perpetuates racial discrimination through education, housing, employment, health care, and the criminal justice system. Participants completed follow-up questionnaires at two-year intervals to gauge changes in health status and participants’ perceived racism experiences from 1997 until the onset of stroke, death, loss to followup, or end of the study in December 2019. By study conclusion, 1664 total participants (3.58%) had experienced a stroke sometime during the study.  

Researchers concluded that participants who reported experiencing structural racism in employment, housing, and law enforcement had an estimated 38% increased risk of stroke compared with women who reported no such experiences, even after accounting for vascular risk factors and demographics. Yvette Cozier, one of the study researchers, noted that 80% of participants were well-educated having education levels beyond high school. These findings suggest that the high burden of racism experienced by Black U.S. women may contribute to racial disparities in stroke incidence.

The American Heart Association acknowledged in a 2020Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: A Presidential Advisory From the American Heart Association” that “racism persists; racism is experienced; and the task of dismantling racism must belong to all of society. It cannot be accomplished by affected individuals alone.” The report outlines reasons why structural racism contributes to poor Black health outcomes, including concentrated poverty and other nonmedical factors that result in poor health outcomes, known as social determinants of health (SDoH). These can include poor housing conditions and physical environment, poorly funded schools, and lack of access to health care, among others. These factors combined can lead to toxic stress and increase cardiovascular disease and stroke risk factors. The body’s physiological flight-or-fight response to stress causes increased heart rate, constricted blood vessels, and elevated blood pressure. If those conditions are sustained long-term, damage occurs to the heart and vascular system, which can lead to a stroke if blood supply to the brain is reduced or blocked.

How To Lower Heart Disease Risks

Per the Centers for Disease Control and Prevention (CDC), follow the ABCS of heart health.

A = Aspirin: Speak with a doctor about whether aspirin is safe. Aspirin is a blood thinner and is not appropriate for everyone. Be sure to discuss with your doctor before beginning aspirin, especially if you have a history of bleeding or clotting disorders.  

B = Blood pressure control: Blood pressure measures the force of blood pushing against the walls of the arteries. High blood pressure (hypertension) is often called the silent killer, as it increases risk for heart attack and stroke more than any other risk factor. Sometimes high blood pressure is hard to detect without symptoms. Monitoring blood pressure at home can help keep blood pressure under control. Learn more about measuring blood pressure here.

C = Cholesterol management:  Consuming too many foods that are high in “bad” cholesterol, such as red meat, fried foods, baked goods, and sweets, increase the risk of building up a waxy residue in your arteries which can reduce blood flow, leading to heart disease, heart attack, and stroke. However, some foods contain “good” cholesterol and can keep your cholesterol balanced, such as oatmeal, fish, nuts, and avocados. There are also prescription medications that can help control cholesterol.

S = Stop smoking: Smoking contributes to heart disease in several ways, including raising blood pressure, lowering “good” cholesterol, and making blood thicker and stickier, reducing blood flow. It’s never too late to quit smoking. Call 1-800-QUIT-NOW today.

Per the American Heart Association, heart disease is preventable in most cases if people adopt a healthy lifestyle, maintain a healthy weight, control blood sugar and cholesterol, treat high blood pressure, stop smoking and limit alcohol, and try to be active on most days, aiming for at least 150 minutes of moderate-intensity physical activity a week.

Learn More

Pulse Check @Live to the Beat is a new collaborative initiative of the CDC and the Centers for Medicare and Medicaid Services that helps you customize your small steps for heart-healthy living. Find it here.

NIH National Heart, Lung, and Blood Institute: The Heart Truth