I’m A Size 4 And My Cholesterol Is High

February is American Heart Health Month. Here’s what you need to know to take care of the vital organ, as heart disease is still the leading cause of death for Americans, men and women alike.

“I’m a size four and my LDL is high. How is that even possible?”

That was my first reaction after reviewing the results of my blood work after my yearly physical in December 2023. My LDL, or bad cholesterol, was 113, and my total cholesterol was 202. A good LDL range for adults is said to be under 100. According to the Center for Disease Control and Prevention (CDC) BMI calculator, I have a “healthy weight.” I exercise at least three times per week, a combination of Pilates and swimming, and I eat fairly well, consuming lots of fruits and vegetables, few fried foods, and only drink when I attend an evening function. What gives? The health writer in me went digging for answers and what I found was shocking: Close to 50% of Black women over 20 years old in the U.S. have some form of heart disease.

Black Women and Heart Disease

The data about Black women and heart disease in the U.S. is sobering. According to a recent report by EH Project, 47.3% of Black women are affected by it, which includes several types of conditions, from high blood pressure to congestive heart failure. The risk of Black women developing heart disease is 2.4 times that of white women, and we are 50% more likely than white women to have high blood pressure. Most alarmingly, the same report shows that as of 2019, the age-adjusted death rate from heart disease was 165.0 per 100,000 in Black women, compared to 129.6 per 100,000 in white women. Black women also have the highest rates of hypertension, coronary artery disease, heart failure, and stroke of any ethnicity of U.S. women.

“Social determinants of health play a significant role in the development of heart disease among Black women,” says Rachel M. Bond MD, FACC, chair of the Women and Children’s Committee, Association of Black Cardiologists. “Factors such as socioeconomic status, access to healthcare, education, and the core contributor of systemic racism, contribute to 80% of health outcomes.”

Bond shares that data has supported that these psychosocial stressors Black women endure in the face of misogyny, sexism, racism, and their overall lived experiences leads to an increased release of inflammatory markers and adrenaline that impact their overall heart health and can predispose them to premature cardiovascular conditions.

Are You a Black Woman at Risk for Heart Disease?

Latrice Baxter, a Black woman living in Tennessee, says that her family had a history of heart problems but healthcare professionals minimized her concerns about her own wellbeing. They suggested lifestyle changes like drinking hibiscus tea. In August 2020, Baxter noticed that she got winded easily. Unbeknownst to her, she was living with an LDL of 300.

“Just walking to my car or around the block with my spouse was a struggle,” she says. “Once during this period, I had a scary pain and numbness in my left arm.” Baxter says this was despite keeping active and doing pretty intense workouts regularly. After she saw her primary care doctor, she did a lung X-ray and was referred to a cardiologist. Minutes into her stress test, she was sent for an ultrasound and angiogram. That same night she had a double-bypass surgery because of a massive blockage in a major artery.  

Black women are at higher risk for developing heart disease for a variety of reasons including genetic predisposition, lifestyle factors, and medical conditions. “Genetic predisposition is hard to quantify but can be roughly estimated by knowing the family history of members of the same family who suffer from the same disease. They may have some shared genetic risk,” says Karol Watson, MD, PhD, a professor of medicine and cardiology at the David Geffen School of Medicine at UCLA. They may also have shared lifestyle factors such as obesity, lack of physical activity, or high salt diets, that increase their risk for developing heart disease.

Salt affects the cardiovascular system because it causes our bodies to retain fluid. “When we consume a diet that is high in salt, then our bodies have a more difficult time eliminating fluids,” explains Tiffany C. Randolph, MD, MHA, FACC, a non-invasive cardiologist who says, “over time, this contributes to hypertension.” High blood pressure increases the risk of developing heart failure and chronic kidney disease, both of which are conditions that make it even more difficult for our bodies to balance fluid levels and blood pressure. The American Heart Association recommends limiting daily sodium intake to less than 2,300 mg.

Watson says weight and BMI are not the best indicators of weight-related heart disease risk. Neither of these measures truly captures the amount of “fat” in an individual body and heart disease risk is more closely related to this amount. In June 2023, the American Medical Association (AMA) released a statement advising that body mass index (BMI) is not the sole indication of optimal health.

“Weight and BMI are important numbers to follow, however, both can be misleading,” explains Randolph. She explains that a person can have a weight or BMI that is within the target range, but if they are not eating healthy or exercising, they are still at increased risk of developing cardiovascular disease. Obesity, or having a BMI greater than 30, does increase the risk of cardiovascular disease and death, however, weight distribution also matters. “Two people could be the same height and weight, but if one person carries more of their excess fat around their abdomen, they are at higher risk than a person who carries more fat in their hips and thighs,” Randolph adds. She advises that women should aim for a waist circumference of 35 inches, and for men, 40 inches.

How Cancer Affects Your Risk

Another subset of Black women at greater risk of developing heart disease are Black women being treated for or who have received treatment for breast cancer. Black women are three times more likely to develop cardiovascular disease after a breast cancer diagnosis. It is not clear exactly why this happens.

“Some cancer patients have cardiac disease, such as heart failure, or they’ve had a heart attack or stroke, so we are concerned that the cancer treatment they are about to start is going to affect their heart,” says Tochukwu M. Okwuosa, DO, director of cardio-oncology at RUSH. She went on to say that other cancer patients may not have heart disease or major risk factors for heart disease, but they start their cancer treatment and they find themselves with an issue. There is a concern that treatment methods for breast cancer can have long-term consequences on the heart, whether from radiation therapy to the chest or from doxorubicin, anthracycline or cisplatin chemotherapy treatments — medications that may affect women as they get older.

Patients should understand what kind of treatments they’re getting and feel empowered to ask questions. After breast cancer treatment, Okwuosa advises Black women to pay attention to their blood pressure – whether it’s high or low – and their hydration. “Patients need to stay hydrated. From a cardiovascular standpoint, from a heart standpoint, that is a number one concern,” advises Okwuosa.

Cancer treatment often makes patients tired because of dehydration. Vomiting and diarrhea from nausea can also exacerbate dehydration. It’s important to learn how to replenish with fluids that have electrolytes.

Keeping a blood pressure log is also important. Patients with high blood pressure need to watch for that, but low blood pressure is also a concern. If your blood pressure is low, you aren’t going to get enough blood flow to your heart arteries, which increases the likelihood of developing a heart issue.

Simultaneously, cancer treatment may cause blood pressure to increase. Some cancer medicines can raise blood pressure to really alarming levels, so it is necessary to keep a blood pressure log to monitor pressure readings.

It’s also essential to exercise regularly. When you exercise, you strengthen your heart. In addition, take your medications for your heart. If you and your doctor decide these groups of medicines are good for you to help strengthen your heart while you’re going through treatment, take them. And if for any reason you can’t take them, possibly because you have side effects, talk to your doctor about it.

Taking Your Heart in Your Hand

All people should know, at a very minimum, their regular blood pressure level, cholesterol level and blood sugar level.

“A ‘normal’ blood pressure is less than 120/80,” says Randolph. “However, for those with hypertension, the goal is to maintain a blood pressure less than 130/80.” Randolph says hypertension is the leading modifiable risk factor when it comes to lowering risk for developing cardiovascular disease, so keeping your blood pressure at goal level significantly lowers your risk of having a heart attack, stroke, kidney failure, heart failure or death.

She shares five tips for a “heart reset”: Reduce alcohol intake, eat plant-based, schedule time for yourself, exercise 150 minutes per week, and lastly, take an assessment of your risk. These efforts can greatly impact the likelihood of becoming one of the many Black women affected by heart disease.

As Bond says, “The great thing about cardiovascular disease is that it’s largely preventable 80% of the time through the understanding of your risk factors, which you can modify often through nutrition, physical activity, and if needed, medication.”