Health Equity

Women deserve women-centered care 

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Many current heart health approaches are adapted from practices based on male physiology. Women are not “small men.” While their hearts are smaller and their blood vessels narrower than men’s,¹ other important differences impact women’s heart health and management.

• Plaque/cholesterol is deposited differently for women and men. Women are more likely to have cholesterol buildup in the smallest blood vessels.²
• Significant heart disease in women develops about seven to 10 years later than in men, and increases two- to threefold after the age of 50.³
• Women’s cholesterol scales are different because women have higher levels of HDL cholesterol than men. The female sex hormone estrogen seems to boost this good cholesterol.⁴ 
• Some heart attack symptoms are the same regardless of sex, but several are unique to women.⁵

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Acknowledging and addressing these crucial differences is a major step forward to better health and equity.

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Learn more about high blood pressure and high cholesterol in women.

Learn more about women’s heart attack symptoms.

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Black women are at particular risk

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The health of non-White people and especially non-White women has been damaged by systemic, long-term inequities in care access, affordability, and appropriateness. Ongoing institutional racism and differential participation in research have produced additional enduring harm.⁶ 

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These disparities disproportionately impact Black women.

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Confronting this reality is imperative in the quest for equitable and inclusive workplaces because  Black women have the highest labor participation rate among women. ⁷ 

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• Black women are nearly 50% more likely to have high blood pressure compared to non-Hispanic White women and are less likely to have it under control.⁸
• Black Americans are 30% more likely to die from heart disease than non-Hispanic White adults.⁹
• The persistent underrepresentation of non-White women in major cardiovascular research and clinical trials contributes to under-treatment and ineffective care.¹⁰

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Multiple factors make women more likely to die from a “cardiac event”

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Women are up to twice as likely to die from complications of a heart attack than men.¹¹ They’re also more likely to have a second heart attack or a stroke.¹² 

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One reason: a woman’s first cardiac “event” usually happens later in life when other conditions and comorbidities like diabetes or Chronic Obstructive Pulmonary Disease (COPD) are more likely to co-exist.¹³ 

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Another factor: time to treatment. Women wait to seek care 37 minutes longer than men.¹⁴ In a situation where seconds count, delaying care is dangerous. 

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Women may be slow to get help because they don’t know their symptoms are heart-related. One study found that over half of women having a heart attack assumed that their symptoms are not heart-related, with 21% of those women instead attributing their symptoms to stress or anxiety. The same study also found that providers also often misdiagnose heart attacks in women, with 53% of women reporting that their provider did not think their heart attack symptoms were heart-related.¹⁵ 

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Women face more barriers to heart health

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Even when they do seek care, women encounter additional barriers to health, including:

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• Medical gaslighting and physician lack of knowledge: A recent NY Times article highlighted the prevalence of healthcare providers ignoring or dismissing symptoms of women, including the story of one woman who had to see multiple providers before being properly diagnosed and getting potentially life-saving heart surgery.¹⁶ In one study focused on heart attack, 53% of women reported that their provider did not think their heart attack symptoms were heart-related.¹⁷
• Unconscious systemic and personal bias: Research shows that providers’ implicit gender bias contributes to disparities in administering cardiac tests for people being evaluated for Coronary Artery Disease (CAD),¹⁸ 
• Research gap: Clinical research practice and the research agenda were set by White men for centuries. Until 2001, most studies enrolled White men and used male lab rats for animal research. This means that the majority of medical research up to that point excluded the majority of people (women make up 50.5% of the American population) and anyone who is non-White.¹⁹

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Many heart disease risk factors are modifiable

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70% of heart disease cases and deaths are caused by modifiable risk factors²⁰ 

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A woman’s heart health is influenced by several factors that can change with behavior modification and medication. Pinpointing hypertension is particularly vital since 44% of adult women have high blood pressure,²¹ and Black women have about 40% higher rates than white women.²²

Personalized interventions and ongoing support can help women understand and address the top and most prevalent risk factors for heart disease: high blood pressure and high cholesterol.²³