By Amy Harris 

Heart disease is widely reported to be the number one killer of women in the U.S., yet relatively little research has been done on women’s heart health. For every 10 studies on heart disease in men, only four focus on women, and consequently, women lack information that would help them take care of their heart.  

Coronary heart disease – various conditions that negatively impact how the heart works – is serious and can lead to severe illness and death, if left untreated. Heart disease causes one-half of all deaths in women after the age of 55, and women are more likely to die from heart disease after they reach menopause than before menopause.  

Immigrants and refugees often suffer disproportionately from heart disease. Recognizing the systemic, cultural, and linguistic barriers to heart health for Maine’s immigrant and refugee women, who frequently lack access to routine primary care and therefore to screening for heart disease, is the first step toward saving lives.  

Robbie Harrison is a Portland Department of Public Health Community Health Outreach Worker (CHOW) who works with Latinx families newly arrived from Nicaragua, Honduras, and Venezuela.  Harrison explained that refugees and immigrants often have “no room for worrying about taking care of their health…they are too busy trying to form this new life, doing what they need to do to survive right now.” Living in this “highly adrenalized state,” as Harrison calls the acculturation process, takes its toll on mental and physical health. 


Elements of a heart-healthy lifestyle 

Do not smoke or vape 

Limit alcohol to one drink (or less) per day 

Eat a nutritious diet  


Aerobic exercise: At least 30 minutes a day, at least five days a week.  

Resistance exercise: At least two nonconsecutive days per week  

Social scientist Dr. Arline Geronimus introduced the concept of “weathering” in 1992 to describe the cumulative toll of racism and discrimination on the health of young Black and Brown women in the U.S. Constant stress associated with a lifetime of exposure to traumatic events harms the health of people of color. In addition, the American Heart Association warns of “poor health behaviors linked to living with systemic racism” – the mix of these with constant stress is a recipe for heart disease. Poor health behaviors include smoking, overeating, lack of physical activity, poor sleep hygiene, an unhealthy diet, and not taking medications as prescribed. 

When immigrants first arrive in the U.S., heart health may be protected by what is known as the “healthy immigrant effect.” The healthy immigrant effect describes new immigrants as, on average, healthier than U.S.-born people of the same age, race, and ethnicity. The longer someone lives in the U.S., however, the less healthy people become. This is ascribed to the toxic effects of poverty, substandard housing, lack of access to medical care, adoption of the American diet, smoking, substance abuse, and a lack of physical activity. 

Maine’s immigrant women are mothers, wives, daughters, grandmothers, aunts, sisters, cousins. Many are overwhelmed with the burden of caring for family and community members while also holding full-time jobs. Dr. Lila Martin, a cardiologist at Maine Medical Partners Cardiology, believes that “gender disparities in caregiver responsibilities and financial constraints limit women’s access to care.” Immigrant women disproportionately work longer hours in stressful, labor-intensive jobs, some with overnight shifts. They are often unable to take sick days, report abuse or harassment, or advocate for safe or healthy work conditions because they are afraid of losing their job or jeopardizing their citizenship status. 

Heart disease causes one-half of all deaths in women over the age of 55, and women are more likely to die from heart disease after they reach menopause than earlier in life. Women with severe hot flashes, night sweats, or who stop having periods when they are younger than age 45 may be at increased risk for cardiovascular disease. For a small subset of these women, “Research shows that starting hormone replacement therapy (HRT) during perimenopause can lower their risk for heart disease.” 

— Susan Kamin, certified nurse midwife and menopause expert, LifeCycle Women’s Health, Brunswick 

Martin reports that women are “more likely to be misdiagnosed, have delays in access to urgent procedures, and are also likely to do worse after receiving treatment for heart disease.” This is especially true if they do not speak English well or have access to a primary care provider for preventive health screenings.  

Cultural differences in expressing pain, and trouble describing symptoms may further delay or complicate heart disease diagnoses. The gender “pain gap” describes the documented phenomenon that women suffering from acute or chronic pain are frequently underdiagnosed and undertreated – and that undertreatment and misdiagnosis occurs more often among women of color. 

Some of the symptoms of heart disease in women are “silent,” and women themselves – as well as practitioners – may overlook these. Heart disease in women can present as a confusing mix of subtle signs such as dull and heavy or sharp chest pain or discomfort; pain in the neck, jaw, throat, upper abdomen or back; nausea or vomiting; and feeling tired. Symptoms can come and go and some women have no symptoms at all.  

Prevention and Treatment 

Every second counts when someone is having a heart attack, so knowing and paying attention to the symptoms of heart attacks and heart disease in women can save lives. The faster someone receives emergency medical services, the greater their chances for survival. Cardiologists agree that heart attack prevention should begin early in life, starting with assessing risk factors for heart disease. At regular health care appointments, women should have blood sugar and cholesterol screenings, and weight and blood pressure measurements.