Women's heart health

Heart Disease Prevention

Risk Factors

High Blood Pressure

What is high blood pressure

Hypertension, or high blood pressure, is a chronic medical condition in which there is an increase in the force of the blood against artery walls. Think about it in terms of water, which represents your blood, in a garden hose, which represents your artery walls. You want just the right pressure of the water flowing through your garden hose so that you can water your plants—which in the case of this metaphor can represent your bodily organs that need the oxygen and nutrients from your blood. You don’t want too much pressure from the water in your garden hose, otherwise the hose can get damaged and break down, and your delicate plants get hit with a high pressure stream of water, which can be permanently damaging.

Blood pressure is written as two numbers, such as 118/78 mm Hg.  The top number, systolic, is the pressure when the heart beats. The bottom number, diastolic, is the pressure when the heart rests between beats.  A “normal blood pressure” is less than 120/80 mm Hg. You can understand your blood pressure by considering which category it falls in: 1

  • Normal: <120/<80 mm Hg – Congrats, and keep doing what you’re doing!
  • Elevated: 120-129/<80 mm Hg - Consider this as a warning sign, as people with elevated blood pressure are likely to develop high blood pressure unless they take steps to control the condition
  • Stage 1 hypertension: 130-139 mm Hg/80-89 mm Hg - At this stage of hypertension, doctors are likely to recommend lifestyle changes, although you may need blood pressure medications based on your risk of developing heart problems
  • Stage 2 hypertension: >140/>90 mm Hg - At this stage of hypertension, doctors are likely to recommend lifestyle changes and prescribe blood pressure medications. 
  • Hypertensive crisis: >180/>120 mm Hg - If your blood pressure falls in this range, this requires medical attention!

Why is high blood pressure dangerous

High blood pressure or hypertension is often called the “silent killer” because you may not feel warning signs or symptoms.1 Even still, the elevated blood pressure is doing damage to the body’s organs, like your heart, brain, kidneys, and eyes.2 That’s why it is important to check your blood pressure routinely.

How does high blood pressure impact women

Hypertension, or high blood pressure, is a preventable risk factor for heart attack, heart failure, stroke, kidney failure and a host of other conditions. Pinpointing hypertension is particularly vital since 44% of adult women have high blood pressure,3 and women represent almost 52% of deaths from high blood pressure (hypertension).4 Hypertension is even more common among Black women - ​​57.6% of Black females have hypertension — more than any other race or ethnicity. 5

Not only is hypertension common, but nearly 80% of patients with hypertension do not have it under control.6

Improving blood pressure control by knowing your numbers

Knowing truly is half the battle in improving awareness around the dangers of high blood pressure and altering a persons’ health trajectory. The good news is that high blood pressure, the silent killer, is hiding in plain sight. Blood pressure is easy to check, does not require an invasive test or blood draw to measure, and can be evaluated on a regular basis from home.  

The American Heart Association has released guidelines recommending home self-measurement of blood pressure as an important tool in evaluating the effectiveness of treatment in people diagnosed with high blood pressure.7 Sporadic visits to the doctor may not give an accurate picture of what is going on in a person's day to day life. For example, there is a well-described phenomenon called “white coat” hypertension,8 which is a transient rise in blood pressure when it is measured in the doctor’s office. Increasing the data points of care through home measurement may provide a more accurate and reliable picture of a person’s true blood pressure over time, allowing for more effective monitoring of treatment strategies.

Not all patients who have high blood pressure need medications. There are some simple measures that can improve your heart health and may reduce your risk of having a serious medical event like a heart attack or stroke. These include regular exercise, eating a healthy diet, and limiting salt intake.9 For many people, high blood pressure medications are needed, and it is best to consult with your physician to determine the optimal treatment plan. Unfortunately, many people who meet criteria for medication remain untreated. It all starts with raising awareness and knowing your numbers.

High Cholesterol

What is high cholesterol

High cholesterol, or hyperlipidemia, is defined as having total cholesterol above 200 mg/dl.10 Nearly 94 million U.S. adults aged 20 or older have total cholesterol levels higher than 200 mg/dL, and 28 million adults in the U.S. have total cholesterol levels higher than 240 mg/dL.11 However, there are different types of cholesterol,11 and abnormal levels of these can also cause problems:

  • low-density lipoprotein (LDL) cholesterol: sometimes called “bad” cholesterol because  high levels can increase the risk for heart disease or stroke. Optimal level is about 100 mg/dl.
  • High-density lipoprotein (HDL) cholesterol: sometimes called “good” cholesterol because high levels can lower risk of heart disease and stroke. Optimal level is at least 40 mg/dl in men and 50 mg/dl in women.
  • Triglycerides: a type of fat in your blood that your body uses for energy. Elevated levels can also increase risk for heart attack and stroke. Optimal level is less than 150 mg/dl 

Why is high cholesterol dangerous

Too much LDL cholesterol or not enough HDL cholesterol  can lead to buildup called “plaque” in the inner walls of the arteries that feed the heart, brain, and other organs.11 This can narrow the arteries and make them less flexible, a condition known as atherosclerosis.12 If one of these plaques breaks, a blood clot forms around the plaque and can block the artery. When this occurs in one of the arteries that feeds the heart muscle, the result is a heart attack.13 Having high blood cholesterol raises the risk for heart disease (i.e., the number one cause of death) and stroke (i.e., the fifth-leading cause of death). 14 

Similarly to high blood pressure, high cholesterol typically has no symptoms — and as such, many people do not know that their cholesterol is too high. There is an opportunity to tackle high cholesterol by helping people understand their cholesterol, and learning how to improve it. 

The connection between high blood pressure and high cholesterol

Individuals with high cholesterol can develop fatty deposits called plaque in their blood vessels. These plaques cause arteries to become stiff and narrow, which causes blood pressure to go up.15 It makes sense then that 63% of people with high blood pressure also have high cholesterol.16 

Cholesterol risk factors that are unique to women

It’s also important to be aware of risk factors for high cholesterol unique to women, such as pregnancy-related high blood pressure17 and gestational diabetes,18 as well as understand that: 

  • Women with diabetes are more likely than men with diabetes to develop high cholesterol and heart disease. 19
  • Stress and depression have a stronger effect on women’s hearts than on men’s.  
  • Smoking is a stronger risk factor for high cholesterol in women than in men.
  • Menopause significantly increases women’s risk of developing high LDL cholesterol and heart disease.  
  • A family history of early-onset heart disease may be a stronger risk factor for women than for men. 

What is considered a healthy cholesterol level is the not the same for women and men

Cholesterol is deposited differently for women and men. Women are more likely than men to have damage to the heart’s smallest arteries, called coronary microvascular disease.20 In addition, women’s cholesterol scales are different because women have higher levels of HDL cholesterol than men.

The healthy level of HDL cholesterol is 40 mg/dL or higher in men and 50 mg/dL or higher in women. Women naturally have estrogen in their body. Estrogen acts on the liver to cause an overall reduction in the total amount of cholesterol in the body, an increase in the amount of HDL cholesterol, and a decrease in the amount of LDL cholesterol.21 Women’s cholesterol levels generally change as their hormones change, which is especially important to be aware of when pregnant or going through menopause.

  1. Why High Blood Pressure is a "Silent Killer". American Heart Association Web Site. https://www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-a-silent-killer. Accessed March 29, 2023.
  2. High Blood Pressure Symptoms and Causes. CDC Web Site. https://www.cdc.gov/bloodpressure/about.htm. Accessed March 29, 2023.
  3. Facts About Hypertension. CDC Web site. https://www.cdc.gov/bloodpressure/facts.htm. Published July 12, 2022. Accessed December 13, 2022.
  4. High Blood Pressure and Women. Go Red for Women Web Site. https://www.goredforwomen.org/en/know-your-risk/high-blood-pressure-and-women. Accessed December 13, 2022.
  5. The Facts about Women and Heart Disease. Go Red for Women Web Site. https://www.goredforwomen.org/en/about-heart-disease-in-women/facts. December 13, 2022.
  6. Estimated Hypertension Prevalence, Treatment, and Control Among U.S. Adults. Million Hearts Web Site. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html. Accessed March 29, 2023.
  7. Monitoring Your Blood Pressure at Home. American Heart Association Web Site. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home. Accessed March 29, 2023.
  8. White Coat Syndrome. Cleveland Clinic Web Site. https://my.clevelandclinic.org/health/diseases/23989-white-coat-syndrome. Accessed March 29, 2023.
  9. 10 ways to control high blood pressure without medication. Mayo Clinic Web Site. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974. Accessed March 29, 2023.
  10. About Cholesterol. CDC Web Site. https://www.cdc.gov/cholesterol/about.htm. Accessed March 29, 2023.
  11. High Cholesterol Facts. CDC Web Site. https://www.cdc.gov/cholesterol/facts.htm. Accessed March 29, 2023.
  12. Arteriosclerosis / atherosclerosis. Mayo Clinic Web Site. https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569. Accessed March 29, 2023.
  13. What is a Heart Attack?. American Heart Association Web Site. https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks. Accessed March 29, 2023.
  14. Leading Causes of Death. CDC Web Site. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Accessed March 29, 2023.
  15. High Cholesterol Diseases. Cleveland Clinic Web Site.  https://my.clevelandclinic.org/health/articles/11918-cholesterol-high-cholesterol-diseases. Accessed March 29, 2023.
  16. Based on 2017-2020 data from the CDC’s National Health and Nutrition Examination Survey. CDC Web site. https://wwwn.cdc.gov/Nchs/Nhanes/. Accessed August 22, 2022.
  17. Stuart J., et al. Cardiovascular Risk Factors Mediate the Long-Term Maternal Risk Associated With Hypertensive Disorders of Pregnancy. J Am Coll Cardiol. 2022 May, 79 (19) 1901–1913. https://www.jacc.org/doi/10.1016/j.jacc.2022.03.335. Accessed March 29, 2023.
  18. Rahnemaei FA., et al. Effect of gestational diabetes mellitus on lipid profile: A systematic review and meta-analysis. Open Med (Wars). 2022; 17(1): 70–86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8678474. Accessed March 29, 2023.
  19. Why are women with diabetes at greater risk for poor heart health? American Heart Association Web Site. https://www.heart.org/en/news/2019/05/14/why-are-women-with-diabetes-at-greater-risk-for-poor-heart-health. Accessed March 29, 2023.
  20. Women and Heart Disease. Brigham and Women’s Hospital Web Site. https://www.brighamandwomens.org/medical-resources/women-and-heart-disease. Accessed March 29, 2023.
  21. How Estrogen Affects a Woman's Heart. Very Well Health Web Site. https://www.verywellhealth.com/how-does-estrogen-protect-against-heart-disease-1763978. Accessed March 29, 2023.