Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion.
Heart disease has the potential to affect all people. The persistent myth that it is primarily a “men’s disease” simply isn’t true. In fact, heart disease is the leading cause of death for women in the United States. Yet only about half of women recognize this. Heart disease accounts for about 1 in 5 deaths among women every year as compared to 1 in 4 deaths in men. About 1 in 16 women age 20 years and older have coronary artery disease, the most common type of heart disease.
About half of all Americans have at least 1 of the 3 predominant risk factors for heart disease: high blood pressure, high low-density lipoprotein (LDL) cholesterol, or current smoking. In addition, multiple other increasingly common factors increase heart disease risk. These include having diabetes, overweight or obesity, eating an unhealthy diet, being less physically active, and drinking too much alcohol.
In addition to these very common risk factors, there are other important risk factors for heart disease that are specific to women. Women who have had preeclampsia (a serious condition characterized by high blood pressure during pregnancy) are at increased risk for coronary artery disease. Women who have experienced menopause are also more likely to get heart disease (because of hormonal changes). Women who have experienced early menopause are more likely than those who haven’t developed heart disease. That’s true regardless of whether menopause occurred naturally or because of medical reasons. And although heart disease can show at any stage in life, women generally experience the onset of symptoms later than men.
Women — and men — can lower their chances of developing heart disease by following several recommendations for preventive measures. Most important is for everyone to be aware of their blood pressure and regularly self-monitor it to maintain that awareness. High blood pressure often occurs without symptoms, and it’s estimated that about half of all U.S. adults have high blood pressure. But many are unaware that they have it. Left unchecked, high blood pressure can increase the risk for not just heart attack but also stroke, vascular dementia, kidney disease, and eye problems. People with high blood pressure are also more likely to get severely ill from COVID-19.
Women and men may also wish to develop a heart health plan with their health care provider. During their routine checkup, adults should discuss whether they need to be tested for conditions that increase the risk of heart disease — such as diabetes or elevated blood cholesterol and triglyceride levels. When diabetes isn’t well managed, it raises the risk of heart disease. And high LDL cholesterol levels can lead to plaque buildup in arteries that can cause heart disease or stroke. In addition, women with a history of preeclampsia should tell their health care providers and take extra care to routinely monitor their blood pressure and try to reduce all heart disease risk factors.
In daily life people can take several steps to immediately lower their risk of heart disease. Those who smoke should quit. Those who don’t smoke shouldn’t start. Likewise, limiting alcohol consumption, per the Dietary Guidelines for Americans, can be beneficial for heart health. Eliminating excessive alcohol use is particularly beneficial.
Being overweight or having obesity and eating a diet high in salt (sodium) increases the risk of high blood pressure and overall heart disease risk. Maintaining a healthy weight and regularly eating healthy foods should be part of everyone’s heart health plan.
As I often write (quite possibly in every blog post), making healthy food choices and getting adequate, regular physical activity is essential to maintaining health and well-being — for both the mind and the body. Moving more and making sure to get at least 150 minutes of moderate-intensity aerobic activity per week (anything that gets the heart beating faster counts) offers benefits far beyond just heart health. It can boost mood, sharpen focus, improve sleep, and even help reduce stress — another risk factor for heart disease. As part of regular physical activity, it’s also important to include muscle-strengthening activities. The recommendation in the Physical Activity Guidelines for Americans is to do activities that make the body’s muscles work harder than usual at least 2 days per week.
Our office offers a number of resources that are helpful to clinical providers and public health professionals looking to do a better job of preventing heart disease in those they serve. Specifically, Healthy People 2030 has established several key objectives related to heart disease and stroke and offers data and a number of evidence-based resources to assist with health promotion efforts. The Dietary Guidelines for Americans and the Physical Activity Guidelines are also indispensable references for those providing guidance on nutrition and physical activity. Move Your Way® provides ready-made communication materials to help people incorporate more physical activity into their everyday routines. Consumers may wish to explore MyHealthfinder, a consumer-oriented tool that provides plain language health content including heart health recommendations. We’ve also recently partnered with the National Heart, Lung, and Blood Institute (NHLBI) to create greater awareness of the impact of heart disease on women. I encourage you to visit NHLBI’s site and incorporate the tools and resources you find there in your own campaigns.
As with all health promotion and disease prevention strategies, minimizing risks for heart disease isn’t achieved solely between individuals and their health care providers. The conditions in the environments where people live their daily lives are critical to mitigating risk. These social determinants of health play the predominant role in one’s opportunity to lead a healthier lifestyle. Simply promoting healthy choices — such as encouraging reduced salt intake or increased physical activity — is not enough. Any public health strategy to improve heart health must include collaborating across sectors to ensure healthy environments that accommodate healthy living. This includes improving equitable access to affordable and nutritious foods and improving physical spaces to help people be more active.
February is American Heart Month. Though the month is nearly over, I urge you to help raise awareness of heart disease, risk factors, and prevention and health promotion strategies — among those you serve, your colleagues, your friends, and your loved ones. Carry that message all year through. Increasing awareness is critical if available guidance and our best efforts are to make real progress in preventing heart disease.
Yours in health,
Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion
In Officio Salutis — In the Service of Health