Heart disease, hypertension take toll on Alabama women

Sherron Simmons was leaving a gym in 2010 when she started feeling chest pain and heartburn.

By the time she got home, the pain was so bad she could barely get out of her car. She knew that heart disease ran in her family, but she always thought it ran on the male side. Her husband encouraged her to get medical attention.

 “I made the statement to him: ‘If I could just lie down, I probably feel a whole lot better,’” said Simmons, a Birmingham resident who was a senior benefit analyst for Blue Cross Blue Shield for 36 years. “But because of his first aid training, he recognized my symptoms as being heart related.”

By the time she got to the hospital, she had already had her first heart attack. A few days later, as her husband walked her around the building, she again had searing pain in her chest.

“I had the second heart attack at the hospital and this time this heart attack caused my heart to stop,” she said. “I actually died in my hospital room and was revived.”

She had surgery again and her kidneys started failing as a side effect of her heart disease. She was in bed for so long that she dropped to 87 pounds and had to relearn to walk.

Simmons ended up on a heart transplant list. Eventually she received a heart from a young woman on May 22, 2011. Her donor was a 32-year-old and her mother’s only child.

A leading killer

Heart disease is the leading cause of death for women, both nationally and in Alabama. Alabama had the third-highest rate of death from heart disease in 2021, according to the Centers for Disease Control and Prevention, only trailing Oklahoma and Mississippi. That year, the death rate from heart disease for Alabama women was 193.7 per 100,000, compared to 135.6 for women nationwide. 

“Heart disease is both preventable and treatable,” said Dr. Wes Stubblefield, district medical officer for the Alabama Department of Public Health.  “The best prevention is to do the things that we’ve already outlined and knowing how important it is to to do these things for your long-term health. And I think that’s the major thing is just to making people aware of how these seemingly small life changes can make major impacts on their overall and long-term health.”

But risk factors and a lack of access to medical care continue to make it deadly. 

Stubblefield said that 44% of women have high blood pressure and only 23% of women have high blood pressure that is under control. According to ADPH, white women had a higher-than average rate of death from hypertensive heart disease in 2021, at 31.5 per 100,000 deaths, compared to a state average of 26.7. Black Alabamians have higher rates of death from heart disease.

KFF reports a little over 47% of Alabama women in 2021 said they had been told by a doctor they had hypertension, compared to 34% nationwide. Only Mississippi had a higher percentage. 

Dr. Kathryn Vindley at Vanderbilt University Medical School said that hypertension, which contributes to cardiovascular problems, is present in about half of women by the time they reach menopause. In many cases, it is asymptomatic. 

“We’re starting to see these things sort of showing up earlier and earlier in women’s lives,” she said. “Women do tend to sort of be a little bit protected until they reach menopause. And then we really kind of see an acceleration in these underlying risk factors and over cardiovascular diseases themselves, but we are starting to see these symptoms occurring more frequently in younger women.”

The American Heart Association connects heart disease to menopause as a result of less estrogen and more abdominal fat. Arteries also become stiffer.

Vindley said that younger women often have worse outcomes, in part because doctors are not quickly recognizing their problems.

Rural risk

The Southern United States is known as the “Stroke Belt,” due to the high rates of stroke mortality. The region has high rates of obesity, high blood pressure, diabetes and cholesterol.

Alabama ranks third in stroke mortality in the United States, trailing only Mississippi and Delaware. 

Vindley also said that people living in rural areas, where health care is often hard to access, are often at risk. Patients of color also statistically have worse outcomes in deaths by heart disease.

“I suspect a lot of it really comes down to those social determinants of health that are really limiting patients from getting really routine preventive care, that can help keep them healthier for the long term,” she said.

A 2019 news release from the American College of Obstetricians and Gynecologists said that cardiovascular disease is the leading cause of death in pregnancy and postpartum period. She said that blood pressure is tied to the outcomes, as is race and rural status.

“Rural minority patients have a much higher risk of having a major adverse cardiac event with pregnancy than a non-minority patient living in a city and probably a lot of that ultimately comes down to their ability to access routine care,” she said.

Unlike for men, she said that reproductive history is important for women seeking help with heart disease. Along with pregnancy complications, menopause is a high risk factor for women. She also said that women are often placed in a “caretaker” role in the family, which makes it more difficult for them to access care. 

“Thinking about how we can provide care in a way that is feasible for her to coordinate her appointments and get her appointments and take her medications and still be able to balance all the other roles that she has in her life,” she said. “That’s super important.”

Vindley said that heart disease is also often comorbid with mental health disorders, and the outcomes of both tend to be better when mental health is treated.

Contraception access is also important for patients to access. Unplanned pregnancies can lead to increased rates of blood clots and heart disease.

“There certainly are many places where it’s difficult to access contraception, or when those patients become pregnant, certainly, it’s difficult to access pregnancy terminations, which can certainly lead to life threatening conditions for the patients,” she said.

Self-advocacy

Since receiving her heart, Simmons has worked to advocate for and teach other women about heart disease.

Simmons tells women that they need to advocate for themselves at the doctor, and they need to see a cardiologist. She says that women often think they are “super people” and overlook the symptoms they, personally, are having, especially as wives and mothers.

“So a lot of women, you know, we take care of everybody but ourselves, and we overlook symptoms that we’re having,” she said. 

According to the Alabama Board of Medical Examiners, there are 376 M.D. and seven D.O. (doctor of osteopathic medicine) licensed cardiologists in Alabama. They also provided the numbers for all states, 495 M.D. and 12 D.O., with active licenses because they said that, sometimes, doctors have out of state addresses but practice in the state. 

According to the Bureau of Labor Statistics, Alabama employs slightly fewer cardiologists than the nation as a whole. There are 0.103 cardiologists per 1,000 jobs in Alabama, compared to 0.114 per 1,000 jobs nationwide. Cardiologists also make up a lower percentage of the workforce in Alabama than the nation as a whole, though they are more prevalent than in states like Georgia and South Carolina.   

Simmons said she always tells women to ensure they are sharing their family history with their doctors. Her doctor’s knowledge of her family’s heart disease helped him diagnose her condition more quickly.

Working with women in Alabama, one of the things Simmons hears most often is that they don’t have health insurance. Alabama is one of 10 states that has not expanded Medicaid, according to KFF. About 300,000 people in Alabama live in a “coverage gap,” being unable to qualify for insurance or subsidies for Affordable Care Act plans.  

She often reads about women going to the doctor but not doing anything afterwards because they don’t have the money or insurance.

“So, you know, that’s a main pet peeve for me, in living in Alabama, you know, about the expansion of Medicaid,” she said. “You know, for women who are the head of the household can’t afford it, or families who can’t even afford insurance, can’t even go to the doctor.”