Why do we need to prioritize Women's Heart Health?

By Kamala Nelson , Priyanka Vemuru & Dr. Maria Espinola

Cardiovascular disease is often called a “man’s disease”. Yet, it is the number one cause of death for women in the United States. Despite the fact that one in three women are dying of cardiovascular disease, 50% of women still do not know that heart disease is their greatest killer.

Women of color are disproportionately impacted. Black women face the highest rates of cardiovascular disease (CVD), with about 60% of Black women, 20 years and older, affected. Heart disease often presents 10 years earlier in Hispanic women and 70% of Hispanic women have at least one major risk factor. Women of color bear the burden of this disease, partly due to socioeconomic inequities, discrimination, racism, and higher rates of stress and trauma. Chronic stress due to inadequate access to or reduced quality of resources leads to immune dysregulation and promotes pro-inflammatory processes, which are known risk factors for the development of CVD. Examples of restricted access to resources include inability to partake in safe physical activity, lack of access to healthy food, and inability to access health care or afford treatment.?

Women of color are particularly vulnerable to the effects of discrimination and racism on cardiovascular outcomes because they experience both gender and race-related biases. Studies have shown that chronic stress due to racism increases inflammation, which raises the risk of chronic illnesses, including cardiovascular disease. Discrimination and racism in the healthcare system exacerbate inequities in the diagnosis and treatment of CVD.

Additionally, studies have demonstrated that women are particularly susceptible to the adverse effects of psychosocial stressors on the cardiovascular system. Compared to men, women generally experience more adverse childhood events, and their rates of PTSD and depression are twice as high. Women with cardiovascular disease are more likely to have experienced traumas early in life such as emotional neglect, emotional abuse, and sexual abuse. These adverse childhood experiences are associated with a 50% higher risk of developing CVD. Other psychosocial factors known to negatively impact cardiovascular health include job strain, depression, loneliness, and social isolation.?

Given that cardiovascular disease is underrecognized as the leading cause of death in women, it is crucial to spread awareness regarding which behaviors can prevent it. There are many structural factors that contribute to racial and sex-based differences in cardiovascular risk factors, diagnosis, and treatment. These may not be easy to target or eliminate on an individual basis. Advocacy and policy-based changes are fundamental to address these systematic disparities.

Traditional risk factors for heart disease include: smoking, high blood pressure, high cholesterol, diabetes, and obesity. These risk factors are extremely prevalent in the U.S. and represent urgent targets for intervention.?

Smoking is a known risk factor for CVD that has been shown to have particularly dangerous effects in women over 35. It is estimated that around 11% of women in the U.S. currently smoke cigarettes.

Mediterranean-style diets are associated with a 30% reduction in the risk of stroke, heart attack, and cardiovascular-related death. It has been estimated that less than 10% of adults in the US meet the guidelines for recommended daily intake of whole grains, whole fruits, and non starchy vegetables. Nearly 50% of US adults have poor diet quality as measured by the AHA’s primary diet score.?

Physical activity helps to reduce the risk of cardiovascular disease. Less than 20% of American women achieve the recommended 30 minutes of physical activity five times per week that is necessary to help prevent CVD.?

Finally, too many doctors and patients are unaware that cardiovascular disease can look different in men and women. The classic teaching is that heart attacks present as crushing chest pain, left arm pain, sweating, and difficulty breathing. While chest pain or discomfort is the most common symptom experienced during a heart attack, regardless of gender, women are more likely to experience other symptoms that may not be recognized as indicators of a life-threatening cardiovascular event. These symptoms may include subtle, slow-building nausea, fatigue, palpitations, and atypical chest pain. As Dr. Bairey Merz says in her Ted Talk, during a heart attack, men “explode” and women “erode”. Researchers and healthcare systems have largely ignored female-pattern heart disease -- the result is that women are dying from heart disease for the simple reason that they are not presenting like men do. Studies have shown that women presenting with a heart attack have a 50% higher likelihood of being initially misdiagnosed than men, resulting in a 70% higher risk of death within the next 30 days compared to those who were managed correctly.?

Cardiovascular disease is preventable.?

Awareness campaigns work. We have seen it. The Susan G. Komen foundation helped to change the perspective on breast cancer from incurable to treatable and preventable. Women rallied around this cause and one another--advocating, joining campaigns, fundraising, and raising awareness for proper screening. Women participate. Now, it's time for us to use that same passion to bring women’s heart health into the spotlight. Today, heart disease kills far more women than breast cancer. Now more than ever, we must rise to the call and fight for women’s cardiovascular health.?

It is fundamental that we come together to reduce disparities in care and promote the cardiovascular health of all women.

Here's how you can take action:

1. Watch this interview by Morgan Parrish on WXIX to learn more about our work. The interview features Dr. Odayme Quesada, MD, MHS, FACC, FAHA, FESC (Endowed Chair, Women's Heart Center at The Christ Hospital Health Network and Go Red for Women Campaign Co-Chair) and Dr. Maria Espinola (CEO, Institute for Health Equity and Innovation and Psychologist with expertise in women's issues, trauma and diversity).

2. Attend one or more upcoming events:

• Saturday March 18, 2023 at 1PM. Black Women Health Movement (BWHM) Just for Us Event.
• Sunday March 19, 2023 at 7:30AM. Heart Mini-Marathon & Walk
• Sunday March 19, 2023 at 12PM. Tan Latina Como Tu Expo. More information about our Latina Heart Awareness Campaign was shared in this article by Movers & Makers Magazine .
• Wednesday March 22, 2023 at 6PM. Heart Healthy Yoga.
• Thursday March 23, 2023 at 7PM. A Heartfelt Celebration of Music, Mediterranean Food, & Wine.
• Saturday March 25, 2023 at 1PM. Free Workout for Heart Health.
• Friday March 31, 2023 at 6PM. GlobeMed Gala.
• Friday October 6, 2023 at 7AM. 2nd Annual Women's Cardiovascular Symposium.

3. Donate to the Go Red for Women's WOI campaign.

Kamala Nelson is a Research Fellow at the Institute for Health Equity and Innovation and a medical student at the University of Cincinnati College of Medicine.

Priyanka Vemuru is a Research Fellow at the Institute for Health Equity and Innovation and a medical student at the University of Cincinnati College of Medicine.