By KELLY CARROLL

There is a dire need to raise awareness about heart disease in women. It is the number one killer of American women, and key data points reveal a lack of cognizance among doctors and women.

An assessment of primary care physicians published in 2019 revealed that only 22% felt extremely well prepared to evaluate cardiovascular disease risks in female patients. A 2019 survey of American women showed that just 44% recognized heart disease as the number one cause of death in women. Ten years earlier, in 2009, the same survey found that 65% of American women recognized heart disease as the leading cause of female death, revealing an alarming decline in awareness. 

Recent evidence suggests that many adults don’t know the important health numbers that can help identify heart disease risk factors, like their blood sugar and cholesterol. A 2024 survey of American adults conducted by The Ohio State University Wexner Medical Center found that only 35% of adults knew their blood pressure and 16% of adults knew their cholesterol levels. In comparison, the study reported that 58% knew their childhood friend’s birthday.

Heart Disease Risk Factors in Women

Women have specific risk factors for heart disease that don’t pertain to men. Nanette Wenger, M.D., a cardiologist and researcher, said in an American Heart Association (AHA) statement, “For most of the last century, heart disease was considered a problem for men, and women were believed to have cardioprotective benefits from female sex hormones such as estrogen. However, emerging evidence shows that there are a substantial number of heart disease risk factors that are specific to women or predominant in women.” Some gender-specific risk factors outlined by the AHA are early onset of menstruation, early menopause, autoimmune disease, anxiety, depression, and pregnancy complications.

Bethany Barone Gibbs, Ph.D., an associate professor at West Virginia University, emphasized in an email that pregnancy is a “critical window” for women’s cardiovascular health. She said, “The cardiovascular and metabolic challenge of pregnancy may unmask risk for conditions like hypertension and diabetes, but it is also possible (though not yet clear) that experiencing an adverse pregnancy outcome may independently contribute to the development of maternal cardiovascular disease.” A history of adverse pregnancy outcomes can be associated with more than two times the risk of cardiovascular disease later in life, she explained. 

Filling in knowledge gaps regarding the connections between pregnancy and long-term cardiovascular health is important to improving outcomes.

One knowledge gap is effective strategies to reduce future cardiovascular disease risk among people who experience adverse pregnancy outcomes. “Though we know these individuals are at much higher risk for poor outcomes, evidence-based approaches that are tailored to the postpartum years (which often includes subsequent pregnancies) are lacking,” Gibbs said. 

Gibbs is working to identify the optimal physical activity, sedentary behavior, and sleep patterns during the postpartum years that may reduce cardiovascular risk. “We are hopeful that we can identify which behaviors are most important for cardiovascular recovery following pregnancy and we can work with these populations to prioritize the most potent interventions to support heart health during the postpartum period,” she said. 

Signs of Heart Disease in Women

Knowing the signs of heart disease in women is an important part of saving lives. Men and women both commonly experience chest pain during a heart attack, but women are more likely than men to have other symptoms unrelated to chest pain. These symptoms include shortness of breath, nausea, vomiting, perspiration, indigestion, atypical fatigue, faintness and pain in the torso, neck, jaw, shoulders and arms.

A February 2020 study reported that women under age 55 display different heart attack symptoms and a wider variety of symptom combinations than men. The study’s lead author, John Brush, Jr., M.D., said in an AHA statement, “As a physician, if you’re looking at a woman, you need to think more expansively. She might not have the prototypical combination of features of chest pain, radiating pain down the arm, shortness of breath and sweating, which are often the examples given in textbooks.” 

It is also common for women to attribute their heart disease symptoms to another ailment, such as the flu, acid reflux or aging. Failure to recognize the symptoms of heart disease can cause women to delay seeking treatment. While chest pain is still the most common symptom of heart disease in both men and women, awareness of other heart disease symptoms can help women get treatment faster.

Heart Disease Prevention

Most heart disease cases are preventable. Wenger said in an AHA statement, “About 80-90% of cardiovascular disease is preventable. Implementing preventative strategies early could have a significant impact on reducing premature cardiovascular disease, stroke and related mortality for women.”

Lifestyle choices like maintaining a healthy diet and prioritizing physical activity can help prevent heart disease. Keeping a healthy weight and steering clear of tobacco products also support cardiovascular health. A person understanding her individual risks of heart disease and factors that may put her at higher risk, such as high blood pressure and diabetes, is also helpful. The AHA has outlined the top 8 factors for cardiovascular health, called Life’s Essential 8. They are: Eat Better, Be More Active, Quit Tobacco, Get Healthy Sleep, Manage Weight, Control Cholesterol, Manage Blood Sugar, and Manage Blood Pressure. 

Efforts to Raise Awareness and Understanding

National efforts are being made to raise awareness of heart disease in women. The AHA hosts the Go Red for Women campaign to fight cardiovascular disease in women. Circulation published the eighth yearly Go Red for Women issue featuring new cardiovascular research in women in 2024. The National Heart, Lung and Blood Institute also hosts a cardiovascular health education program called The Heart Truth. 

While these efforts are underway to improve heart disease outcomes for women, women need more. AHA laid out a constellation of strategies to improve women’s heart health in a May 2022 publication, and several deserve further emphasis here. To make progress, we need more and improved gender-specific cardiovascular disease training for healthcare providers. We need more collaboration between cardiologists, obstetricians-gynecologists, primary care physicians and other healthcare providers to improve the prevention and treatment of cardiovascular disease in women. We need more research on gender-specific cardiovascular disease to fill in knowledge gaps and improve prevention and treatment strategies. 

We also need more awareness. Spreading awareness of the risk factors and symptoms of heart disease in women can help save lives. Campaigns can help spread this message, and men and women sharing this information with other men and women can also help. If we all know the risk factors and symptoms of heart disease in women, all our mothers, sisters, daughters, neighbors and friends will be better off. 

More than 300,000 women in the U.S. died from heart disease in 2021. Let’s make sure that number is much lower in 2031 and beyond. 

Kelly Carroll is a freelance health writer based in Kentucky. More at her site

By ROSEMARIE DAY and DEBORAH GORDON

Mothers deserve more than a day of recognition this year—they deserve the whole month, and more. The pandemic has been particularly hard on women, especially poor women and women of color. 

To demonstrate the appreciation mothers deserve this Mother’s Day, we should get them something they really need: health care. To improve maternal health, we should look to the Medicaid program, long a pathway to accessible, quality health care for low-income Americans. Medicaid is especially important for mothers; it covers close to half of all births in the U.S.

Now, states have the opportunity to do even more for moms.

The American Rescue Plan signed into law in March gives every state the option to extend Medicaid maternity coverage for up to 12 months postpartum, a significant increase from the current limit of just 60 days. Illinois has already announced it will extend postpartum coverage; other states should follow. Extending the guaranteed coverage period will increase access to postnatal care during this ‘fourth trimester’ to ensure that women can access treatment for common conditions like postpartum depression as well as preventing organ prolapse or hemorrhage. Not only mothers will benefit. Parental insurance is associated with better health for children, including a lower risk of adverse childhood experiences.

In addition, the American Rescue Plan offers an opening to expand Medicaid with even more federal funding than is currently available through the Affordable Care Act. The 12 states, mostly in the South, that have not expanded their Medicaid programs are  leaving hundreds of thousands of women without the support they deserve. 

Expanding Medicaid programs will provide robust access to health care to more women and reduce maternal morbidity and mortality, which has reached crisis proportions among many women of color. Black and Indigenous women are more likely than other women to die during pregnancy, childbirth, and the postpartum period. According to the CDC, the maternal mortality rate is 2.5 times higher for Black women than white women. Disparate access and uneven quality of care, higher rates of chronic illness, and racism all play a part in that grim statistic.

The disproportionate burden of maternal mortality and adverse outcomes from childbirth has long-lasting effects on mothers and their children. Black newborns have an increased risk for long-term complications resulting from pre-birth complications. They may also face generational poverty and trauma in the long run if they are born to a mother who dies during childbirth.

Racial disparities in maternal health are getting much-needed attention. Celebrities from Serena Williams to Beyonce have spoken out about their own experiences with maternity complications. The Black Maternal Health Momnibus Act was reintroduced in Congress this past February. The bill would fund community-based services, mental health care, research, and data collection to better understand and improve Black maternal health outcomes. And a major health insurer recently announced its commitment to reducing Black maternal mortality by 50% in five years.

One of the most important ways to reduce Black maternal mortality is by expanding Medicaid. Expanding the Medicaid program works. Fewer moms die. A 2020 study found that maternal mortality rates were lower by 6.65 maternal deaths per 100,000 live births in states that had expanded Medicaid. This effect was concentrated among non-Hispanic Black women, which suggests that Medicaid expansion alleviates some of the disparities in health outcomes for Black women.

Maternal mortality rates were even lower in Medicaid expansion states (by 7.01 maternal deaths per 100,000 live births) later in the postpartum period (more than 42 days after birth). Longer-term postnatal care may have a substantial impact on reducing maternal mortality. And because the majority of the states that haven’t expanded Medicaid are in the South and have a higher proportion of Black residents, Black women will benefit significantly from these Medicaid expansion efforts.

The time for states to act is now. The American Rescue Plan’s incentives for states to expand Medicaid, which provide enhanced federal dollars for two years after expanding, comes off the table as soon as March 2022.  The opportunity to expand postpartum coverage starts in April 2022 and would be available for five years, but we shouldn’t wait—too many mothers are dying unnecessarily.

Mothers everywhere—and the people who love them—also have a role to play. We can all push states to expand their Medicaid programs through our own advocacy. Each state requires its own strategy for Medicaid expansion. Some states can do ballot initiatives, others need the state legislature to act. Organizations like Community Catalyst and U.S. of Care know the local landscapes. The rest of us can support these organizations that help citizens in those states to get it done.

Making sure all mothers in the U.S. have health insurance will take an ongoing effort. It’s more than an election-year issue, and we can provide this critical support now. Mothers deserve no less. 

Rosemarie Day is the Founder & CEO of Day Health Strategies and author of Marching Toward Coverage:  How Women Can Lead the Fight for Universal Healthcare (Beacon Press, 2020).  Follow her on Twitter:  @Rosemarie_Day1

Deborah Gordon is author of The Health Care Consumer’s Manifesto: How to Get the Most for Your Money (Praeger, 2020) and an Aspen Institute Health Innovators Fellow. Follow her on Twitter: @gordondeb

The authors greatly appreciate the research contributions of Allie Dawson, MPH (Consultant at Day Health Strategies) to this piece.