9 Questions with Janet Wright, MD, FACC
Director, Division for Heart Disease and Stroke Prevention
National Center for Chronic Disease Prevention and Health Promotion
U.S. Centers for Disease Control and Prevention
Although heart disease is the leading cause of death among women, many women remain unaware of the potential health risk. Why do you think that is and what can be done to change it?
Let me take the opportunity offered by your question to repeat the fact: heart disease is the leading cause of death in women. It surprises many that a woman’s risk of dying of heart disease is almost seven times the risk of death from breast cancer. A recent survey showed that while in 2009, 65% of women knew that heart disease was the number one killer, by 2019 that percentage had dropped to just 44% of women. Awareness was lowest in women younger than 35 and in some racial and ethnic groups. This distressing lack of awareness is likely the result of a combination of factors, but this is a problem we all can solve. National campaigns such as AHA’s Go Red for Women, NHLBI’s The Heart Truth, and the HHS Office of Women’s Health Make the Call; Don’t Miss a Beat have been effective in raising levels of awareness. Improved screening and risk factor counseling of women by not just primary care clinicians, but also OB-GYNs and other specialists and by community-based programs such as WISEWOMAN and WomenHeart will send a strong signal that these risks are serious, deserving attention and action to ensure a long and healthy life for women across the country.
And as challenging as it is, women must prioritize their health – including their heart health, making time for regular check-ups that can help detect and gauge their risk of a heart attack or stroke. My advice to women is to ask their doctor or nurse practitioner, “What is my risk of heart attack or stroke and how can I best lower that risk?” Knowing your blood pressure and cholesterol levels is a good start; following a plan with your clinical team to lower your risk can add healthy years to your life.
People are so busy with careers and families; what small steps can women take each day to achieve and maintain a healthy blood pressure?
It’s a fact: small changes maintained over time make a huge difference in health. In blood pressure, lowering your numbers even a few millimeters reduces your risk of heart attack, kidney disease, stroke, and even dementia! Examples of small changes include adding 10 minutes of physical activity to your daily routine, home-cooking 1-2 additional times per week, or replacing one serving of processed food (high in sodium) with a fresh vegetable or fruit. I encourage every woman with or at risk of high blood pressure to get a blood pressure monitor and to check their readings regularly at home. Keeping a blood pressure diary and sharing those readings with your clinical team is the very best way to get and keep hypertension under safe control – and to live heart attack- and stroke-free. It takes less than 15 minutes to do this regularly. A small investment with huge returns in health.
And when it comes to overall cardiovascular health, the Million Hearts Start Small. Live Big campaign is a perfect tool for busy people. The campaign is designed to encourage adults, particularly those age 55 and older, to get back on track with the small steps—like scheduling their medical appointments, getting active, and eating healthy—so that people can get back to living big.
What advice do you have for women about blood pressure, including women of reproductive age?
Women of any age need to know their blood pressure patterns. While hypertension used to be predominantly found in older adults, the age at onset is dropping in both women and men and for years has occurred earlier in African American and Black adults. My advice, regardless of age, is to get and use a blood pressure monitor at home and share readings with your clinical team. Women can then gain insights into the unique triggers and behaviors that raise or lower their blood pressure. Whether a really salty dinner, a stressful time with teens or in-laws, or a few peaceful moments of re-connection with a friend, seeing these patterns can help women make the small changes that make a big difference. In doing so, they can avoid the highly preventable harm that comes from undetected or uncontrolled high blood pressure.
Home-monitoring of blood pressure is extremely important for anyone who has experienced high blood pressure during or following pregnancy. In the U.S., high blood pressure is noted in one in every 12 to 17 pregnancies among women aged 20 to 44. Staying in close communication with your clinical team about elevations in your readings will help avoid complications for you and ensure a healthy start for your baby.
Hypertensive disorders of pregnancy are a leading cause of maternal death and complications, putting both mother and baby at risk for problems during and following pregnancy. Importantly, hypertensive disorders of pregnancy are largely preventable and treatable. Hypertensive disorders of pregnancy have become more common in part because of advanced age at first pregnancy, as well as increasing prevalence of obesity and other risk factors. There are racial/ethnic disparities in both the burden and outcomes of hypertensive disorders of pregnancy.
The bottom line is to learn your blood pressure patterns, share your readings with your team, and demand attention if you detect abnormal patterns. The CDC’s Hear Her campaign is helping to spread the word about the importance of listening to women’s health concerns during and following pregnancy.
When you think about high blood pressure prevention, what do you believe is often overlooked?
Because high blood pressure doesn’t have many – if any – symptoms, it can often be overlooked. The only way to really understand your blood pressure is to learn your patterns through home- or out-of-office readings. Discussing this pattern with your clinical team and sharing your insights into how physical activity, diet, stress, and medications change your readings can help you be in control!
Many risks for heart disease and stroke—including high blood pressure and high cholesterol—may not have any symptoms. Many of these risks—specifically high blood pressure, high cholesterol, smoking, and obesity—are preventable and controllable. Controlling these risks could reduce your risk for heart attack or stroke by more than 80%.
During the last year, what’s been learned about high blood pressure in women and have any specific studies or clinical trials caught your eye?
One extremely important study was released in April of 2022, providing practice-changing insights to protect women who experience high blood pressure during pregnancy. The Chronic Hypertension and Pregnancy (CHAP) trial of about 2400 women with mild chronic hypertension (less than 160/110, the previous threshold for treatment, but above 140/90) showed that treatment improved outcomes for women and their babies. There was no difference between the treatment and no-treatment groups in the rate of babies born small for gestational age, indicating that treating the mothers’ blood pressure at the level of 140/90 was safe for the fetus. This new evidence is supported widely and will help protect women and babies from the harm of uncontrolled high blood pressure.
How concerned should women be about the role environmental factors play in high blood pressure? What can they do to reduce these risks?
We have lots yet to learn about the role of environmental factors, including air quality, on cardiovascular health in general and high blood pressure in particular. I would encourage women to rely on trusted sources such as CDC’s National Center for Environmental Health and the Environmental Protection Agency. We do know that particle pollution contributes to heart attack, stroke, and other serious conditions. Learn more here and join the Million Hearts Climate Change and Cardiovascular Disease Collaborative kicking off on November 3, 2022.
What excites you about blood pressure control and heart health research and the direction the research is going? What should we look for on the horizon?
What excites me most is the public and private sector commitment to the equitable prevention, detection, and control of the number one cause of cardiovascular disease, the nation’s number one killer. Using an equity lens in this work will ensure that we improve health outcomes for everyone—and THAT is very exciting. I am also eager to learn and help spread newer approaches, such as artificial intelligence and machine learning as well as community-based models that make it easier for individuals with high blood pressure to get care and advice. The national network of community health centers is really leading the way by using self-measured or home-monitoring approaches with great success.
Research also shows pandemic-induced anxiety and eating disorders are on the rise. What is important for those affected to know in terms of heart health?
Although challenging to measure, anxiety and stress can have short- and long-term effects on heart and brain health. For example, adrenaline, secreted in times of emotional and physical stress, increases blood pressure and heart rate, interferes with sleep, and may change blood clotting. Stress can also affect our health habits. When a little physical activity might be just what we need to alleviate stress, it can feel hardest to make it happen. During times of stress and strain, it’s important to go back to the tried-and-true recipe for heart health: healthy food with treats in moderation, a daily dose of activity, and a connection with others.
It’s natural to feel stress, anxiety, grief, and worry during the pandemic. You can help yourself, others, and your community manage stress by taking breaks from news stories, including those on social media; taking care of your body; making time to unwind; connecting with others; and connecting with your community- or faith-based organizations.
We notice one of your profile pictures shows you proudly holding up a fish. Can you tell us how often you fish and what you love about it?
Although catching a fish is always a thrill, I have realized that the best part of fishing for me is to be in the places where fish live. I love and am nourished by nature. The rhythm of casting a line, focusing on a fly, and being ready to “take ‘em” are soul food for me.