office of research on women’s health

Women of Color Health Information Collection

Cardiovascular Disease

office of research on women’s health
Office of Research on Women’s Health 

National Institutes of Health

The Office of Research on Women’s Health (ORWH), established in September 1990 within 

the Office of the Director, National Institutes of Health (NIH), works in partnership with the 

NIH Institutes and Centers (ICs) to ensure that women’s health research is part of the scientific framework at NIH and throughout the scientific community. ORWH collaborates with 

the Advisory Committee on Research on Women’s Health (ACRWH), comprising physicians, 

scientists, and other health professionals; and the Coordinating Committee on Research on 

Women’s Health (CCRWH), composed of the NIH IC Directors or their designees to implement the NIH strategic plan for women’s health and sex differences research. 

The ORWH mission is to: 

• Advise the NIH Director and staff on matters relating to research on women’s health.

• Strengthen and enhance research related to diseases, disorders, and conditions that 

affect women.

• Ensure that research conducted and supported by NIH adequately addresses issues 

regarding women’s health.

• Ensure that women are appropriately represented in biomedical and biobehavioral 

research studies supported by NIH.

• Develop opportunities for, and support of, recruitment, retention, re-entry, and 

advancement of, women in biomedical careers.

• Support research on women’s health issues.

For more information on the ORWH mission, programs, and the NIH strategic plan for 

women’s health and sex differences research, Moving into the Future with New Dimensions 

and Strategies for Women’s Health Research: A Vision for 2020 for Women’s Health Research, 

visit http://orwh.od.nih.gov.
2 • WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE

INTRODUCTION

The Women of Color Health Information Collection highlights the important role culture, 

race/ethnicity, socioeconomic background, geographic location, and other factors have on 

the health status of women of diverse backgrounds. Data on the health status of women of 

color are not readily available from a single source. Although clinical trials and populationbased surveys may include diverse populations, many do not report results disaggregated by 

sex and race/ethnicity or for minority subpopulations. 

This series of publications provides a variety of sources that highlight various diseases and 

conditions in women of color. Scientists, advocates, clinicians, and policymakers can use this 

information to better understand the health status of women of color in the United States to 

formulate policies and research 

priorities, and to develop and 

implement clinical practices 

that promote the health of 

all women.

A challenge inherent to women’s 

health research is to establish a 

scientific knowledge base that 

will permit reliable diagnoses and effective prevention and treatment strategies appropriate 

for all women, including those of diverse racial/ethnic backgrounds. There is a need for better 

understanding of how sex, gender, and cultural and racial/ethnic differences influence the 

pathobiology, etiology, diagnosis, progression, treatment, and outcomes of diseases among 

different populations. 

The expanded concepts of women’s health and women’s health research focus on the study 

and understanding of women’s health as a reflection of the many elements that contribute to 

the overall quality of women’s lives in the United States today. The ultimate goal of biomedical research is to increase knowledge gained through sound science to inform the development 

of policies and clinical practice standards from which all women and men can benefit.

Women of Color Health Information 

Collection: Cardiovascular Disease

The ultimate goal of biomedical research 

is to increase knowledge gained through 

sound science to inform the development 

of policies and clinical practice standards 

from which all women and men can benefit.

A Note about Terms Used in this Booklet

This booklet uses terms established by the U. S. Census Bureau to describe race and ethnic categories of people. 

When presenting data gathered by independent researchers, this booklet retains their terminology. 
WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE • 3

Women’s health issues have gained increased attention since the Office of Research on 

Women’s Health was established two decades ago. Federal offices, programs, legislation, 

and policies have been created to encourage study of women’s health issues and to promote 

including women and minorities in clinical research. This progress reflects the recognition 

that for biomedical and behavioral research results to be widely applicable, researchers and 

clinicians must consider in their research design or healthcare delivery, how cultural, racial, 

sex/gender, and ethnic differences may influence the causes, diagnoses, prognosis, treatment, 

and outcomes of diseases among different populations.

The NIH Revitalization Act of 1993, Public Law 103-43, requires that NIH-funded clinical 

research include women and minorities, as scientifically appropriate. NIH recognizes that barriers exist to recruiting and retaining women of diverse backgrounds as research subjects. These 

barriers include the effects of historical exclusion of women of child bearing age, mistreatment 

of minorities in clinical research, and current impaired access to health care because of the 

effects of poverty and inadequate health insurance. Cost, however, cannot be considered as 

a barrier, nor can it be used to justify excluding women and minorities from participating in 

clinical research, according to NIH policy based on the NIH Revitalization Act of 1993. 

These barriers can be overcome by increasing cultural diversity among researchers, promoting collaborative relationships between researchers and communities, overcoming logistical 

issues related to women’s roles as caregivers and in the workplace, and appreciating cultural 

beliefs of potential research participants. 

WOMEN OF COLOR IN THE U.S. POPULATION

Of the approximately 307 million estimated U.S. residents in 2009, about 51 percent were 

women according to the U.S. Census Bureau, as shown in Table 1. There is increasing racial 

and ethnic diversity in the United States and a growing population of non-White women. The 

Census Bureau estimated that in 2009, almost 11 percent of women were non-White, and 

Hispanic* women constituted 7.61 percent of the total U.S. population.1

*Hispanic origin is considered an ethnicity, not a race. Hispanics may be of any race.
4 • WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE

Table 1: Estimated Total and Female Population of the United States by Race and 

Hispanic Origin for 2009 Based on 2000 Census Data

Race and Hispanic Origin

Total Male 

and Female

Female % of Total 

Population Female

Total U.S. Population (Hispanic and Non-Hispanic) 307,006,550 50.67% 155,557,060

 White 244,298,393 40.08% 123,062,670

 Black 39,641,060 8.48% 20,704,909

 American Indian/Alaska Native (AI/AN) 3,151,284 0.51% 1,569,803

 Asian 14,013,954 2.36% 7,244,461

 Native Hawaiian/Pacific Islander (NH/PI) 578,353 0.09% 284,281

Two or more races 5,323,506 0.88% 2,690,936

Hispanic (Total) 48,419,324 48.25% 23,362,405

 White 44,447,153 44.18% 21,392,163

 Black 1,959,516 2.04% 990,111

 AI/AN 790,477 0.77% 373,571

 Asian 327,871 0.34% 163,503

 NH/PI 129,843 0.13% 61,229

Two or more races 764,464 0.79% 381,828

Non-Hispanic (Total) 258,587,226 51.12% 132,194,655

 White 199,851,240 39.32% 101,670,507

 Black 37,681,544 7.62% 19,714,798

 AI/AN 2,360,807 0.46% 1,196,232

 Asian 13,686,083 2.74% 7,080,958

 NH/PI 448,510 0.09% 223,052

Two or more races 4,559,042 0.89% 2,309,108

Two or more races 4,559,042 0.89% 2,309,108

Adapted from Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States: April 

1, 2000 to July 1, 2009 (NC-EST2009-03). http://www.census.gov/popest/national/asrh/NC-EST2009-srh.html Date 

Accessed: September 10, 2010.
WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE • 5

LEADING CAUSES OF DEATH IN FEMALES

The seven leading causes of death of women over age 18 in the United States are heart disease, 

cancer, stroke, chronic lower respiratory disease, Alzheimer’s disease, unintentional injuries, 

and diabetes mellitus. Based on 2007 data from the U.S. Centers for Disease Control and 

Prevention (CDC) shown in Table 2, heart disease and cancer are the first and second leading 

causes of death for African-American, White, and Hispanic women in the U.S. However, for 

American-Indian/Alaska-Native and Asian- or Pacific-Islander women, cancer is the leading 

cause of death and heart disease is the second leading cause of death. Stroke is the third 

leading cause of death for all women except for American-Indian/Alaska-Native women. 2

Table 2: Leading Causes of Death in Females Age 18 and Older for the United 

States in 2007 by Percentage*

Condition All

American Indian or 

Alaska Native Asian or Pacific Islander Black White Hispanic**

Heart disease 25.5 18.2 22.9 26.0 25.6 23.8

Cancer 22.4 19.6 27.9 22.7 22.3 23.2

Stroke 6.8 5.0 9.5 7.0 6.7 5.7

Chronic lower respiratory diseases5.5 5.0 2.5 2.7 6.2 2.9

Alzheimer’s disease 4.4 N/A 2.4 2.6 4.8 3.0

Unintentional injuries 3.4 8.2 3.6 2.7 3.4 4.3

Diabetes mellitus 3.0 6.7 4.2 5.1 2.5 5.8

Adapted from U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal 

and Child Health Bureau. Women’s Health USA 2010. Rockville, Maryland: U.S. Department of Health and Human 

Services, 2010. http://mchb.hrsa.gov/whusa10/hstat/hi/desc/208lcdTre.html. Date Accessed: September 19, 2011.

*The data represent the percentage of total deaths in the race category due to the disease indicated. 

**The racial groups (White, Black, American Indian or Alaska Native, and Asian or Pacific Islander) include only persons of 

non-Hispanic origin. Persons of Hispanic origin may be of any race. 

Leading causes of death for each race/ethnicity appear in bold type. 
6 • WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE

Cardiovascular disease (CVD) is an abnormal functioning of the heart or blood vessels.3

Heart disease (HD) is a general term for a variety of heart conditions.4 The most common 

form of HD in women is coronary heart disease (CHD), also called coronary artery disease 

(CAD) because it involves the coronary arteries. Other types of CVD include hypertension, 

congestive heart failure, stroke, congenital cardiovascular defects, hardening or narrowing 

(atherosclerosis) of the blood vessels, including the coronary arties, and other diseases of the 

circulatory system.5 Diabetes, hypertension, high cholesterol, obesity, lack of exercise, smoking, increased age, and family history are risk factors for cardiovascular (or heart) disease. 

In the United States, HD is the 

leading cause of death for Whites 

(men and women), Blacks (men 

and women), Hispanics (men and 

women), and American-Indian/

Alaska-Native men. Cancer is the leading cause of death for American-Indian/Alaska-Native 

men and women and American-Indian/Native-American women.6

In 2007, 421,918 women died from all forms of CVD. More female lives were claimed by 

CVD than were claimed by cancer, chronic lower respiratory disease, Alzheimer disease, and 

accidents combined.5 In the same year, heart disease accounted for significant shares of all 

deaths among women of each racial/ethnic subpopulation: White (25 percent), Black (25 

percent), Hispanic (22 percent), Asian/Pacific Islander (22 percent), and American Indian/

Alaska Native (17 percent).6

Background

Research also indicates that women are 

less likely than men to receive evidencebased cardiac care after a heart attack.
WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE • 7

Many women are living with heart disease, but may not be aware of it: In 2008, about 5.8 

percent of all non-Hispanic White women, 7.6 percent of non-Hispanic Black women, and 

5.6 percent of Mexican-American women had coronary heart disease.5 Almost two-thirds of 

the women who die suddenly of coronary heart disease have had no previous symptoms.5

More women than men die each year from CVD.7 However, in a 2009 survey, 30 percent 

of women underestimated their risk for heart disease, with racial and ethnic minority women 

being more likely to underestimate their risk.8 Surprisingly, only 53 percent of women surveyed 

said that they would call 9-1-1 if they believed they were having a heart attack. Additionally, 

only 54 percent of women chose CVD as the leading cause of death among women, and 

women of color (Black, Hispanic, or Asian) were significantly less likely to identify CVD as 

the leading cause of death.9 While women of all races and ethnicities are affected by CVD, 

a disparity exists between women of color and other women in their awareness and 

personalization of the risk for the disease.

Furthermore, although 1 in 4 women in the United States dies from heart disease, a 2003 

study showed that women comprised only 27 percent of participants in all heart-related 

research studies,10 and a 2011 study found that in 325 landmark cardiovascular trials, the 

overall rate of enrollment of women was 30 percent.11 Research also indicates that women 

are less likely than men to receive evidence-based cardiac care after a heart attack.12
8 • WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE

MAJOR RISK FACTORS FOR CARDIOVASCULAR DISEASE

Hypertension: Hypertension is defined as an average systolic blood pressure greater than 

or equal to140 mmHg or an average diastolic blood pressure of greater than or equal to 90 

mmHg. Hypertension is more common in African-American women than in White women, 

and has a much higher prevalence among Black women than other women of color.5 In 2008 

in the U.S., 46 percent of non-Hispanic black women age 20 and older had hypertension, 

compared to about 31 percent of non-Hispanic White and 29 percent of Mexican-American 

women.5 These rates of hypertension have been shown to vary with education level: the 

prevalence of hypertension among Black women with a high school education or higher is 37 

percent, compared to 51.2 percent of Black women with less than a high school education. 

Among Mexican-American and White women, 15.5 percent and 31 percent of women with 

higher levels of education have hypertension, compared to 24.2 percent and 47.4 percent of 

their less educated counterparts, respectively.13 African-American women also are at greater risk 

for severe complications from hypertension, such as stroke and heart failure.14

Diabetes Mellitus: Diabetes mellitus (DM) is a group of diseases marked by high levels of 

blood glucose resulting from inadequate insulin production or insulin action. DM can cause 

serious complications and premature death, and it is one of the leading causes of death and 

disability in the United States, especially among women of color.9 As of 2011, an estimated 

25.8 million children and adults, or 8.3 percent of the population, suffer from DM. It has 

major complicating effects on the cardiovascular system and frequently causes or exacerbates 

conditions such as kidney and nervous system disease.15

Elevated Total Cholesterol: High serum cholesterol is defined as 240 mg/dl and is one 

of the major risk factors for CVD. It was found in roughly equal proportions among all 

subpopulations of women age 20 and older in 2008. At that time, nearly one sixth of all 

non-Hispanic White (16.9 percent) and non-Hispanic Black (13.3 percent) women had 

high serum cholesterol, as did 14.0 percent of Mexican-American women.5 The percentage 

of women with high serum cholesterol has decreased for all three groups of women since 

2003-2004, and has decreased for men and women in each of these racial and ethnic 

groups since 1988-94.5

Susceptibility and Impact
WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE • 9

Tobacco Use: According to the American Heart Association, cigarette smoking is the “most 

important preventable cause of premature death in the United States.”16 Smoking leads to 

the accumulation of plaque in the arteries; this build-up blocks blood flow and can cause 

coronary heart disease and heart attacks.16 American Indians/Alaska Natives have an especially 

high prevalence of tobacco use: among American Indians/Alaska Natives age 18 and older in 

2007, 36.7 percent of men and 36 percent of women smoked, compared to only 23.1 percent 

of White men and 19.8 percent of White women who smoked.17

Physical Inactivity: The American Heart Association recommends at least 150 minutes of 

moderate exercise per week (or 75 minutes per week of vigorous exercise) to promote cardiovascular fitness, since regular physical activity reduces the risk of dying from CVD.18 In a survey 

conducted in the US from 2004-2008, 35.4 percent of White women, 54.2 percent of Black 

women, 53.9 percent of Hispanic women, 41 percent of Asian women, and 43.1 percent of 

American Indian/Alaska Native women said that they were “inactive,” defined as no light, 

moderate, or vigorous leisure-time physical activity lasting at least 10 minutes.19

Overweight or Obesity: The terms “overweight” and “obesity” refer to a person’s overall 

body weight. The NIH defines “overweight” as having extra body weight from muscle, bone, 

fat, and/or water and “obesity” as having a high amount of extra body fat.20 Obesity can have 

significant effects on the body, especially the cardiovascular system; coronary heart disease, 

hypertension, and stroke are some of the major effects of obesity.21 As of 2009, 23.3 percent of 

White women, 41.9 percent of African-American women, and 30.8 percent Hispanic-American 

women were categorized as obese.22 One widely used measure of whether an individual is 

overweight or obese is body mass index (BMI). BMI is based on height and weight and can be 

used for men and women of all ages. Instructions on calculating BMI can be found at the web 

site for the National Heart, Lung, and Blood Institute: http://www.nhlbisupport.com/bmi/. 

INCIDENCE AND DEATH RATES FROM CARDIOVASCULAR DISEASE

Heart Disease in Asians and Native Hawaiians/Pacific Islanders: Asian-American 

adults have the lowest prevalence of heart disease, hypertension, or stroke of any major 

racial or ethnic group (among White, Black, Native Hawaiian/Pacific Islander, or Hispanic 

adults). These statistics are likely partly due to decreased behavioral risk factors for CVD in 
10 • WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE

the population: Asian-American adults are the least likely among the racial and ethnic groups 

to be current smokers or to be overweight or obese, and they are the most likely to get some 

leisure-time physical activity. However, when the population of “Asian” is disaggregated 

and different subgroups are analyzed independently, Native Hawaiians/Pacific Islanders are 

actually more likely than Whites to be obese or to classify themselves as inactive; more than 

45 percent of Native Hawaiians/Pacific Islanders say they are inactive (defined as no light, 

moderate, or vigorous leisure-time activity lasting at least 10 minutes).23 In 2007, the heart 

disease death rate was 82 per 100,000 Asian- and Pacific-Islander women, or approximately half 

the death rate from heart disease of non-Hispanic White women (Table 3).24

Table 3: Age-Adjusted Heart Disease Death Rates in 2007

Race and Hispanic* Origin

Men Women

Rate per 100,000

Ratio to NonHispanic White Rate per 100,000Ratio to NonHispanic White

Non-Hispanic White 239.8 1.00 153.0 1.00 

Asian/Pacific Islander 126.0 0.53 82.0 0.54

Black/African American 305.9 1.28 204.5 1.34

American Indian/Alaska Native 159.8 0.67 99.8 0.66

Hispanic or Latino(a) 165.0 0.69 111.8 0.73

Source: Table 3. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD. 2011.

*The race groups Black, Asian or Pacific Islander, and American Indian or Alaska Native include persons of Hispanic and 

non-Hispanic origin. Persons of Hispanic origin may be of any race. Death rates for the American Indian or Alaska Native 

and Asian or Pacific Islander populations are known to be underestimated.

Heart Disease and African Americans: African-American adults have the highest 

prevalence of coronary heart disease, hypertension, and stroke of all racial and ethnic groups 

studied (among White, Black, Native Hawaiian/Pacific Islander, or Hispanic adults). Among 

women, African-American women are more likely to suffer from each of these conditions 

than their non-Hispanic White and Hispanic counterparts.23 African-American women also 

had the highest age-adjusted death rate from heart disease in 2007 (204.5 per 100,000), more 

than 1.3 times that of non-Hispanic White women (100 per 100,000, Table 3).24 In 2009, 

nearly 11 percent of African-American women suffered from heart disease, while over 35 

percent had high blood pressure.23
WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE • 11

Heart Disease and American Indians/Alaska Natives: American-Indian/Alaska-Native 

adults are more likely to be obese than White adults; they are also more likely than white 

adults to describe themselves as “inactive,” or having no light, moderate, or vigorous leisuretime activity for at least 10 minutes. Among American Indians or Alaska Natives age 18 and 

older, 8 percent have heart disease, 4.1 percent have coronary heart disease, and 21.8 percent 

have hypertension.23 In 2007, the death rate for heart disease was 99.8 per 100,000 American 

Indian or Alaska-Native females (Table 3).23

Heart Disease and Hispanics: Hispanic-American women are slightly less likely to have 

any form of heart disease than non-Hispanic women,23 and Hispanic women are less likely to 

die from heart disease than White women.9 Hispanic women are also less likely to be current 

smokers, but they are more likely than non-Hispanic White women to be obese and to be 

physically inactive in their leisure time. In 2009, 8.4 percent of Hispanic women had heart 

disease and 22.5 percent had hypertension.23 In 2007, the death rate for heart disease was 

111.8 per 100,000 Hispanic women (Table 3).24
12 • WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE

Research Highlights

American Heart Association Survey of Awareness, Knowledge, and Perceptions Related 

to Heart Disease and Stroke: U.S. Minority Women Know Less about Heart Disease

Though women of color are at greater risk for CVD, they know less about risks and signs of 

the disease than White women, according to an American Heart Association (AHA) survey. 

Significantly more women surveyed in 2009 were aware that heart disease is the top killer of 

women than were aware in 1997 (54 percent in 2009 versus 30 percent in 1997). Awareness 

that heart disease is the leading cause of death for women approximately doubled among 

Hispanic women and nearly tripled among Black women surveyed between 1997 and 2009. 

However, the disparity in awareness of heart disease’s mortality ranking among Black and 

Hispanic women (43 percent and 44 percent, respectively) compared to white women (60 

percent) had not significantly improved since 1997. Even though more women surveyed in 

2009 considered themselves well-informed about heart disease compared to women surveyed 

in 1997 (45 percent vs. 34 percent), knowledge of heart attack warning signs did not differ 

appreciably between the surveys.12

The study authors suggest that, 

“one potential way to eliminate 

or reduce health disparities in the 

United States is through more 

targeted efforts to raise awareness 

among racial and ethnic minorities who are least aware of heart 

disease and stroke, and also at 

greatest risk.”25

Hot Flashes and Subclinical Cardiovascular Disease: Findings from the Study of 

Women’s Health Across the Nation Heart Study

Studies suggest that hot flashes may be related to changes in the vasculature in the perimenopausal period, but it is not known if hot flashes are associated with CVD. This study, initiated 

in 1996, examined the relation between menopausal hot flashes and several measures of subclinical CVD, with the hypothesis that women who experienced hot flashes would be more 

likely to have certain indices of subclinical CVD. The study analyzed data from the Study 

of Women’s Health Across the Nation (SWAN) Heart Study and included 492 women (35 

Though women of color are at greater 

risk for CVD, they know less about risks 

and signs of the disease than White 

women, according to an American 

Heart Association survey
WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE • 13

percent African American, 65 percent White), ages 45-58, who were free of clinical CVD. 

Measurements in this study included a brachial artery ultrasound to assess flow mediated 

dilation, electron beam tomography to assess coronary artery and aortic calcification, reported 

hot flashes (any/none, previous two weeks), and a blood sample for measurement of estradiol 

concentrations. Hot flashes were associated with significantly lower flow mediated dilation. 

The researchers found that women with hot flashes had arteries that did not dilate as well 

with increased blood flow, as well as increased calcification of the aorta. Study authors suggested that hot flashes may mark adverse underlying vascular changes among midlife women, 

meaning that this menopausal symptom could have clear clinical significance, in addition to 

its impact on quality of life.26

The Women’s Ischemia Syndrome Evaluation

This multicenter study initiated in 1996 greatly increased understanding about CHD in 

women and about gender-specific symptoms, risk factors, and pathology. The study enrolled 

and studied over 900 women who had symptoms of CHD (chest pain, shortness of breath) 

and were referred for diagnostic angiography. It found that women are more likely to have 

plaque build-up that spreads evenly along artery walls rather than forming large blockages. 

Even though women with this condition may have angina similar to people with large blockages and often go on to have heart attacks, they may be categorized as low risk for heart events 

because their arteries look clear. These findings indicate that CHD risk factors should be 

addressed aggressively in women with symptoms, even in the absence of a positive imaging 

for arterial blockages, and that better approaches to evaluate cardiac ischemia in women should 

be developed and used.27

Women’s Health Study of Low-Dose Aspirin in Apparently Healthy Women

This study, initiated in 1993, found that low-dose aspirin and vitamin E supplements play 

a minor role, if any, in protecting women from CVD. Contrary to results seen in men, 

aspirin use in women 45 and older did not prevent first heart attacks or CVD deaths. It did, 

however, reduce strokes by 17 percent in the overall study cohort and lower the risk of major 

CVD events by 26 percent among women who were 65 years of age or older.28 The study 

also showed that vitamin E supplementation had no effect on heart attacks, strokes, or total 

deaths and, with regard to another hypothesized benefit, did not reduce rates of breast, lung, 
14 • WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE

colon, or other cancers.29 Rather than an aspirin or vitamin E regimen, the NIH continues to 

recommend that women focus on other well-proven approaches for reducing their risk of 

heart disease and stroke: eating healthfully, getting regular physical activity, maintaining 

a healthy weight, abstaining from smoking, and controlling high cholesterol, high blood 

pressure, and diabetes.

The Growth and Health Study 

Results from the NHLBI Growth and Health Study, an observational study that followed 

cohorts of White and African-American girls from childhood to early adulthood, highlight 

the importance of teaching girls as young as age 9 about behaviors to maintain a healthy 

weight. Rates of being overweight increased from age 9 to 18 from 7 percent to 10 percent 

among White girls, and from 17 percent to 23 percent among African-American girls, with 

the greatest jump in weight gain occurring between ages 9 and 12 years. Girls who were 

overweight during childhood were 11 to 30 times more likely to be obese in young adulthood. Moreover, being overweight was significantly associated with high blood pressure and 

high cholesterol during adolescence. The findings underscore that efforts to reduce CVD risk 

in women should begin early in life.30
WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE • 15

U.S. Centers for Disease Control and Prevention

Heart Disease and Stroke Prevention Program: In 1998, Congress provided 

funding to the U.S. Centers for Disease Control and Prevention (CDC) to create a 

national state-based heart disease and stroke prevention program. The goals of this 

program are to increase state capacity by planning, implementing, tracking, and sustaining population-based interventions that address heart diseases, stroke, and related risk 

factors (high blood pressure, high blood cholesterol, tobacco use, physical inactivity, and 

poor nutrition). The population-based strategies in this program focus on an identified 

population (women aged 35-65 years) or area (residents of state) rather than individual 

behavior change. Health departments in 41 states and the District of Columbia currently 

receive funding. The program stresses policy and education to promote heart-healthy 

and stroke-free living and working conditions.31 http://www.cdc.gov/dhdsp/programs/

nhdsp_program.

Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Program: WISEWOMAN provides low-income, under-insured, 40- to 

64-year-old women with the knowledge, skills, and opportunities to improve their diet, 

physical activity, and other lifestyle behaviors to prevent, delay. and control cardiovascular and other chronic diseases. WISEWOMAN also provides cholesterol tests and other 

chronic disease risk factor screening. CDC funds 21 WISEWOMAN projects in 19 

states and two tribal organizations.32 http://www.cdc.gov/wisewoman/.

Women and Heart Disease: An Atlas of Racial and Ethnic Disparities in Mortality: 

This publication presents national and state maps depicting disparities in county-level heart 

disease death rates among the five largest U.S. racial and ethnic groups. This information 

can help government agencies and communities tailor prevention policies and programs 

to areas with the greatest burden of heart disease. The second edition is currently available: 1-800-CDC-INFO (800-232-4636).

Office of Women’s Health, U.S. Department of Health and Human Services

“Make the Call—Don’t Miss a Beat” Campaign: According to a 2009 American 

Heart Association survey only half of women indicated they would call 9-1-1 if they 

Cardiovascular Disease 

Prevention Programs
16 • WOMEN OF COLOR HEALTH INFORMATION COLLECTION • CARDIOVASCULAR DISEASE

thought they were having a heart attack and most women, especially among minorities, were unaware of the five most common heart attack symptoms.12 This is a national 

public education designed to educate, engage, and empower women and their families to 

learn the seven most common symptoms of a heart attack and encourage them to call 

9-1-1 as soon as those symptoms arise. A woman suffers a heart attack every minute in 

the United States.33 http://www.womenshealth.gov.

33

National Heart, Lung, and Blood Institute, NIH

“The Heart Truth” Campaign: The Healthy Heart Handbook for Women, 20th 

Anniversary Edition: This handbook contains the latest scientific information about 

heart disease in women and offers practical suggestions that women can use to reduce 

their risk of heart-related problems, including tips on following a nutritious eating plan, 

tailoring a physical activity program to specific personal goals, and getting the whole 

family involved in heart-healthy living. The handbook also contains a sample eating plan 

and a chart on how to read a nutrition label.34 http://www.nhlbi.nih.gov/health/public/

heart/other/hhw/hdbk_wmn.pdf

Additional Information

Additional information on CDV and the health of women and women of color is available 

from these federal government sources:

• The NIH Office of Research on Women’s Health: http://orwh.od.nih.gov/ 

• The National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/

• The NHLBI Health Information Network: http://hp2010.nhlbihin.net/joinhin/index.asp 

• The National Institute on Minority Health and Health Disparities: 

http://www.nimhd.nih.gov/

• National Library of MedicineWomen’s Health Resources page: 

http://www.womenshealthresources.nlm.nih.gov/

• The CDC Heart Disease Page: http://www.cdc.gov/heartdisease/

• The HHS Office of Women’s Health, Heart Health and Stroke: 

http://www.womenshealth.gov/heart-health-stroke/

• The HHS Office of Minority Health, Heart Disease Section: 

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u.s. department of health and human services

national institutes of health

office of research on women’s health

http://orwh.od.nih.gov

february 2012

nih publication no. 12-7680