Michelle A. Albert, M.D., M.P.H.
Professor of Medicine (Cardiology), Associate Dean of Admissions, University of California, San Francisco School of Medicine
Heart attacks and strokes don’t only happen to men. Heart disease kills 1 in 3 people and is the No. 1 cause of death in women.
Reality debunks the myth that heart disease is an “old person” problem. Another truth is that women of color, particularly Black women, disproportionately succumb to poor outcomes related to cardiovascular disease. In fact, an American Heart Association survey shows that younger women are less aware of their risk of heart disease than they were 25 years ago.
Alarmingly, Black women are at higher risk of dying from heart disease in comparison to some men. Let’s take a look at Michelle Emebo’s experience. She is a 36-year-old Black woman diagnosed with high blood pressure during the third trimester of her pregnancy. High blood pressure is the No. 1 risk factor worldwide for heart ailments. High blood pressure in pregnancy is a risk factor for serious health complications for both mom and baby, and such complications predict overall lower life expectancy.
Fortunately, Emebo delivered a healthy girl, but her blood pressure remained high for months and she struggled to lose weight. Even on medication, the problem persisted.
Pregnancy-related heart problems are more common in Black women than other women. Research indicates that Black pregnant women are 57 percent more likely to have a stroke, 42 percent more likely to develop lung clots, and 45 percent more likely to die in the hospital than women of other races, according to a study in the Journal of American Heart Association.
Reasons for the disparities are complex as differences can persist even after taking into account certain socio-economic factors. As highlighted in a recent American Heart Association presidential advisory, structural bias due to both gender and race or ethnicity in various life sectors, including in healthcare, contribute to the negative experiences of women, especially of Black women.
One study shows that women experiencing heart attacks have a 30 percent longer wait time from symptom onset to arrival at a hospital compared to men. Women also have a 23 percent higher wait time after hospital arrival to the opening of their clogged heart blood vessel than men. Black people and women are less likely to receive necessary interventional procedures for their heart attacks than others.
Thankfully, Emebo is thriving by doing what she can — instead of eating out, she cooks a majority of her meals, and she avoids sugary and high-salt foods, and exercises several times a week. Both her weight and blood pressure are back to normal. She has been able to discontinue her blood pressure medication.
Emebo’s story mirrors so many of the ones we regularly see. The reality is that nearly 80 percent of cardiovascular problems are preventable through education and lifestyle changes like exercise, a healthier diet, and stress management.
“I really wanted it to be about my health, and not just physical health, but mental health,” said Emebo, whose parents both had strokes. “This was about breaking a family legacy of heart disease and stroke, and feeling good.”
Women of all ages, including younger women, must pay attention to and take steps early in life to ensure better cardiovascular health outcomes throughout life. Menopause heralds a time when estrogen production drops in women. The loss of estrogen’s heart-protective effect hastens the pace toward poor heart outcomes in women after menopause.
Depression, anxiety, and sleep disturbances are common in menopause and are associated with increased heart disease risk, according to an American Heart Association scientific statement published in November. Women of every age need to get quality sleep, manage stress, exercise, and seek professional assistance for health issues, particularly mental health concerns.
To decrease heart disease deaths among all women, access to high-quality, affordable, unbiased healthcare and assistance, with the prioritization of exercise, proper nutrition, healthy sleep habits, and stress management is necessary. The health of women is a window into the health of society; not only for their lives, but those in our society who depend on them.