Rachel Graham of Baltimore suffers from the disease that claimed her mother and her grandmother—mitral valve regurgitation. The condition, which can lead to stroke and heart failure, causes blood to leak backward into the heart.
Graham said her mother was misdiagnosed with pneumonia—and dismissed by her doctor when her symptoms persisted. “By the time they found out what was wrong, it was too late,” she says. “She went under for valve replacement surgery and never came home.”
History began repeating itself when Graham, who had been experiencing symptoms, had an ultrasound on her heart, showing she had mild mitral valve regurgitation. “Even though there was a family history,” she says, “my primary care physician wrote it off and said, ‘You just need to lose weight.’”
But the disease affects all body types, and Graham was diagnosed with it despite being physically active. Luckily, she was able to find a “superhero Black lady doctor” to address her concerns.
Graham belongs to the executive leadership team of the American Heart Association of Greater Maryland’s Go Red for Women campaign. The initiative aims to increase women’s heart health awareness and decrease deaths by heart disease, which kills more women than all cancers combined.
To stay ahead of her condition, she’s cautious about what she eats and how intensely she exercises. What’s the most important step she recommends? “Having a doctor who will sit and listen and think through what the solution should be,” she says.
“We know our bodies better a lot of the time than anyone else does. If you feel like something isn’t quite right, then you need to insist that your physician look deeper until you get the answers you want.”
Inequities in heart health
Graham and her mother’s experiences speak to heart health disparities for women and Black individuals.
Another example? Women are more likely to experience atypical heart attack symptoms like dizziness and indigestion, which providers are often less aware of in their practice.
For women, high blood pressure during pregnancy is an important risk factor for heart disease—even years after a pregnancy.
After menopause, a woman’s risk for heart disease “increases and may even exceed that of males,” says Dr. Ari Cedars, a Johns Hopkins cardiologist. Risk factors for heart disease such as diabetes and smoking cause greater risks to women than men.
Additionally, the Mayo Clinic says that depression and stress—some from gender discrimination and balancing work and family—affect women’s hearts more than men’s hearts.
Black individuals face elevated risk of heart disease largely because of structural racism and related stress, according to the American Heart Association. For example, decades of racist policies have kept Black families segregated in neighborhoods with few fresh or healthy food options.
“Some of what we do is related to genetics and predisposition, but there’s also a huge element that has to do with
things like where you live, what’s your ZIP code, what’s your socioeconomic status,” says Dr. William Ashley, a LifeBridge Health neurosurgeon and president of the board of directors for the AHA of Greater Maryland.
The Johns Hopkins Center for a Livable Future reported in 2019 that about a quarter of Baltimoreans experience food insecurity—in part due to the financial strain of discriminatory employment and educational systems, which also block access to good health insurance.
Cedars says that patients and physicians should make sure to discuss whether certain medications are affordable and find effective substitutes if they are not.
“We think we’ve done our due diligence simply by providing a prescription,” he says. “Physicians can do a better job—I know I could probably do a better job—of addressing the issues that confront patients in a culturally sensitive way.”
Dr. Seth Martin, a Johns Hopkins cardiologist and member of the board of directors for the AHA of Greater Maryland, rolled out a virtual cardiac rehabilitation program that helps bridge heart health inequities for women and Black individuals.
“We’re putting the information and tools for people to be successful after a major cardiac event in the palms of their hands, in their smartphones, rather than them having to take off from work or struggle to get transportation to the hospital,” he says.
Tips for heart health
If doing minimal activity leaves you winded, get your heart checked out, says Dr. Jehan Riar, a primary care physician at Mercy Medical Center.
According to Cedars, chest pain and shortness of breath with exertion can be signs of coronary vascular disease, the most common type of heart disease in the United States. Heart palpitations can suggest an arrhythmia or a potentially life-threatening irregular heartbeat. Swelling legs and feet, he says, can indicate heart failure.
To avoid getting to this point, Cedars recommends avoiding salty foods like lunch meats and restaurant cuisine. High-salt diets are linked to hypertension, one of the top risk factors for heart disease. According to America’s Health Rankings, 34.3% of Marylanders have high blood pressure, higher than the national average (32.5%).
The second top factor is high cholesterol, which 34.9% of Marylanders have, again higher than the national average (33.3%). Your diet, Cedars says, should be mostly fruits, vegetables and fish.
The third top factor is smoking. In this case, Marylanders are lower than the national average—10.9% compared to 15.5%. “Avoid smoking tobacco products,” Cedars says.
How else can you boost your heart health? Thirty minutes of moderate physical activity five days per week, Cedars adds.
Lifestyle changes can only do so much. The probability of heart problems increases with age, just one of many nonmodifiable risk factors.
“I have patients who say to me, ‘I adhere to a healthy diet and exercise regularly, yet I still developed problems with my heart,’” Cedars says. “But if you have a certain genetic predisposition to heart disease and you overlay that with unhealthy lifestyle choices, then the risk will further increase.”
Make modifications progressively. “If you eat pizza every single day of the week, try to eat it once a week,” Riar says.
“If you don’t do any exercise at all, try to start doing one activity a couple days out of the week.” “If you buddy up with someone—a friend, a significant other or your child—you are more likely to be successful.”
The first step is to know what your ideal diet and lifestyle will eventually look like. “And then,” Cedars says, “make steady progress toward your goals.”
More Information …
Visit the American Heart Association’s website at heart.org.