More American women die from heart disease than any other cause, but the disease exacts a bigger toll on Black American women. One-half of Black women in the United States have some form of cardiovascular disease, according to the American Heart Association, and Black women are more likely to die of heart disease, and at younger ages, than white women. At the same time, just one in five Black women believes she is personally at risk.
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We spoke with Columbia cardiologist Marwah Abdalla, MD, MPH, assistant professor of medicine at Columbia University Vagelos College of Physicians, about the reasons for these statistics and what measures patients, physicians, and policymakers can take to improve heart health in this vulnerable population. Most of the major risk factors for cardiovascular disease—including high blood pressure, obesity, diabetes, physical inactivity, and smoking—are very common among Black American women, Abdalla says. These combine to make heart disease the No. 1 killer in this population.
In addition, greater stress may deepen the disparity. In the Jackson Heart Study, the largest study of cardiovascular disease in Black Americans, Abdalla and her colleagues found that Black women report unusually high levels of chronic stress. “More chronic stress in these women was associated with more hypertension,” Abdalla says, “which we know increases the risk of heart attacks, stroke, and other cardiovascular disease.”
An added stress is that women are typically responsible for the care of their children as well as elderly parents. “They put their health last, and that takes a toll,” she says. When women do seek medical care, symptoms of heart disease in women can present atypically and may be missed. Variables beyond your control, for example where you live, impact heart health.
“We know that poverty is a driver of inequity and worse heart health. Individuals who live in poor, crowded areas, with inadequate access to health care and healthy foods, and where it may be not safe or feasible to exercise, have a high risk of heart disease,” Abdalla says. Structural racism—the ways in which society fosters discrimination through housing, education, employment, and criminal justice—also contributes to and exacerbates stress, depression, and other risk factors for heart disease.
The good news is that women can reduce their heart disease risk by up to 82% through various lifestyle changes, such as eating a healthy diet, maintaining a healthy weight, quitting smoking, and exercising. “Of course, none of those is an easy fix, as most people know,” Abdalla says. “I would advise women to talk with their physicians and health care providers, who can offer guidance and support. Physicians, for their part, need to do better at screening patients for heart disease risk factors and teaching them how to lower those risks.”
In working with the Jackson Heart Study, Abdalla and her colleagues noticed that more than half of Black Americans have high blood pressure while asleep. “That’s not normal, and it’s dangerous for heart health,” Abdalla says. The researchers suspect that this condition may be related to imbalances in the nervous system at night: Instead of the body adopting a calm and composed state at night, the body seems to be alert and ready to respond to danger.
Longer and better sleep may help. Abdalla’s team is now using a grant from the NIH to study whether treatments that improve sleep have a positive effect on the nervous system and blood pressure. Individual women can do only so much, and more action at the local and national levels is needed. “In studies, barbershops and beauty salons have proven to be excellent venues for promoting healthy behaviors,” Abdalla says. “We need to also extend outreach to community centers, faith-based organizations, and pharmacies—anywhere that women regularly gather.”
National efforts to improve Black heart health, akin to what Vice President Kamala Harris announced in December to improve Black maternal health, could help reduce disparities. Reducing serious pregnancy-related complications, which are extremely common in Black American women, is important, Abdalla says, “but we need to think more broadly about protecting Black women throughout their lives, beginning in childhood.”
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