Heart disease is the number one cause of disability and death in the United States, and African American women of all ages are at particularly high risk, for reasons we will touch on below.
As a Black woman in America, it is important to do what you can at a young age—it's never too late to start—to protect yourself from cardiovascular disease, or CVD (the broad category of disorders that involve the heart and blood vessels, or circulatory system). Taking small steps every day can help you feel your best and create a better tomorrow.
Why does heart disease impact so many African American women?
The answers to that question are multilayered and not easy to unpack. It is a little-known fact in America that 49 percent of all Black women over the age of 20 have some form of heart disease, whether they know it or not. That is one out of two! Compare that with all US women over age 20: one in every 16 has heart disease. Black women’s higher rate of coronary illness comes with a higher chance of dying from CVD, at a younger age.
Why? For starters, there is a clear racial health disparity. Compared with white populations, cardiovascular disease is more prevalent among African American women and men alike (the rate for women is slightly higher). Scientific studies continue to reveal and explain the factors that contribute to this, but there are many—including underlying health issues (known as comorbidities), socioeconomic and environmental conditions (known as the social determinants of health), inequitable access to health care, and the root causes of racism, sexism, and discrimination that drive these systemic problems. There also are some biological and lifestyle risk factors that we will discuss below.
Four things Black women should know to protect their heart health:
1. High blood pressure is "the Silent Killer."
“High blood pressure (also known as HBP, or hypertension) means that the force of your blood pushing against the walls of your blood vessels is consistently too high,” said Tyke Ingram, MSN, RN, CRRN, BAYADA Director of Clinical Standards and Leadership. “When the heart beats, it pushes oxygenated blood through a network of blood vessels—arteries, veins, and capillaries—to all the tissues and organs that need it. A blood pressure reading measures two forces: the first force (systolic pressure, the top number) occurs when the heart pumps blood out, and the second force (diastolic pressure, the bottom number) is created when the heart rests between beats.”
High blood pressure is quite common among African Americans; 40 percent have hypertension, and as a group, their HBP tends to develop at an earlier age and become more severe. You can develop it as a child and have it for decades without any symptoms. That’s why early detection is extremely important, because untreated hypertension does damage. The extra stress HBP puts on the heart and blood vessels makes it one of the strongest predictors of heart failure and other ailments. By age 50, the rate of heart failure among Blacks is about twenty times higher than among whites in the US.
Too much dietary sodium (salt) leads to high blood pressure because it causes fluid retention, adding excess volume to the bloodstream. Emerging research suggests that a gene may make some African Americans more sensitive to the hypertensive effects of sodium.
What you can do
Eating a low-sodium diet—no more than 1,500 – 2,000 mg per day—is one of the best things you can do to protect your heart health. Ask your primary care provider (PCP) what blood pressure range is healthy for you, and measure your BP regularly at annual check-ups and at home with a BP monitor. If you have high blood pressure, consult your PCP to help you lower it with diet, exercise, and medication, if needed.
2. Healthy cholesterol levels can protect you from heart disease.
Getting your bloodwork done will show a total cholesterol number and a breakdown of the different kinds of lipids (fats) in your blood, also known as serum cholesterol. The “bad” kind of cholesterol—low density lipoprotein (LDL)—collects on the walls of blood vessels and creates a buildup of fatty deposits (plaque) that can cause high blood pressure, blockages, or blood clots that lead to a stroke. “Good” cholesterol—high density lipoprotein (HDL)—protects heart health by picking up LDL and carrying it out of the circulatory system to the liver, for disposal.
Estrogen, a naturally occurring hormone in women, protects the cardiovascular system by raising beneficial HDL and lowering harmful LDL. At menopause, estrogen levels drop dramatically, increasing the risk of heart disease and death from CVD for women over 65.
What you can do
Keeping your serum cholesterol within normal range is one of the most important things you can do for heart health. Exercise, quit smoking, limit alcohol, and eat a heart-healthy diet rich in soluble fiber (beans, oats, fruits and vegetables) and low in saturated fats (red meat and dairy), with zero trans fats (partially hydrogenated vegetable oil).
Stay on top of your annual checkups with your primary care provider and get your regular bloodwork done without delay. If your lipids are outside normal range, your PCP will help you control them with diet, exercise, and medication if needed.
3. Managing stress and depression can improve your physical health.
Discrimination and safety concerns make it stressful to be a Black woman in America, period. Add stressors like family caregiving, personal trauma, financial worries, or a pandemic, and stress becomes one of the top ten drivers of health inequity—particularly chronic stress over a longer period.
Mental stress and depression are a heart disease risk for women. Not only can stress trigger CVD symptoms, but the signals of a woman’s heart attack can be mistaken and written off as stress or anxiety. The lesser-known symptoms most women experience, which could start months before a heart attack occurs, include:
What you can do
Increasing your physical activity—which could be as simple as a daily walk—is one of the best things you can do to manage stress and support your mental health. (Triple benefit: it also benefits blood pressure and serum cholesterol.) Mindfulness practices like yoga, meditation, and gratitude also help; so do sleep, laughter, and connecting with friends and loved ones.
Critical for everyone’s mental health, however, is talking to a professional—the sooner, the better. Not only in crisis, but as regular preventive care. Many choices of support groups and counselors are out there to suit any individual, and they really do help. The Women’s Initiative (check out their Sister Circle) and Therapy for Black Girls are some places to start.
4. Being engaged and speaking up can lead to better health care and outcomes.
Sad but true, an African American woman may receive less medical testing or treatment than a white person who presents with the same symptoms. Clinician bias is sometimes a factor—misattributing a complaint, or not taking it seriously. Insurance coverage may play a role. Many medical schools still teach risk models for treatment that are based largely on research that underrepresented race and gender.
Reporter Marina Affo tackled this issue in a series of articles published in the Delaware News Journal. “We have been hearing for years now these health care stories from women like Beyoncé and Serena Williams,” Marina explained. “I wanted to investigate if we had the same patterns in Delaware, and of course we do, across all income levels.”
Her series explores new solutions in the health and wellness space that are addressing the needs of women of color. With greater awareness, more work to improve health care equity and outcomes is being done nationwide—but we are not there yet.
What you can do
“Advocate for yourself and take charge of your own health care. Keep records at home and come prepared with notes and questions,” Marina advised. “Trust what your body is telling you, and if you sense that your health care provider isn’t listening or giving you the attention or specialist referral you deserve, find someone who does.”
Health care is an open marketplace, and you are the best custodian of your own health and well-being.
 Barring COVID-19, at the time this article was written