Matters of The Heart
From pregnancy to menopause, board-certified cardiologist Dr. Rachel Bond explores how heart health sits at the center of women’s health—and what that means for Black women across every stage of life.
Getty Images
Heart disease is the leading cause of death for Black women, yet it’s often missing from women’s health conversations. Why is that, and what are the consequences of that silence?
Heart disease is overlooked in Black women because our health has historically been fragmented. Reproductive health, mental health, and chronic disease are often treated as separate conversations—when in reality, the heart is at the center of all of them. There’s also a long-standing myth that heart disease is a “man’s disease” or something that only affects people later in life. For Black women, that myth is particularly dangerous.
The silence has real consequences. It leads to delayed diagnosis, symptoms being dismissed or minimized, and missed opportunities for early prevention. Many Black women are diagnosed only after a major event—like a heart attack, stroke, or heart failure—when disease has been developing quietly for years. Silence costs lives.
Many Black women experience fibroids, PCOS, preeclampsia, and pregnancy-related complications. How are these connected to long-term cardiovascular risk?
These conditions are not just reproductive issues—they are early warning signs for cardiovascular disease.
Pregnancy is essentially a cardiovascular stress test. When complications occur, they reveal underlying vulnerabilities in the heart and blood vessels. The problem is that once pregnancy ends, the cardiovascular risk is often forgotten—by both clinicians and patients. We need to treat these diagnoses as a call to long-term heart health monitoring, not isolated events.
Menopause is frequently misunderstood or dismissed. What changes occur during menopause that increase cardiovascular risk for Black women, and how should we advocate for better care?
During menopause, declining estrogen affects the blood vessels, cholesterol metabolism, insulin sensitivity, and body fat distribution. Blood pressure rises, LDL (“bad”) cholesterol increases, and visceral fat accumulates—all of which increase cardiovascular risk.
For Black women, menopause often occurs earlier and with more severe symptoms, yet we are less likely to receive counseling, screening, or treatment. Too often, symptoms like fatigue, palpitations, sleep disruption, or brain fog are brushed off as “stress” or “aging.”
Advocacy means demanding intentional screening during midlife: blood pressure checks, cholesterol, glucose testing, and discussions about symptoms. Menopause should be a cardiovascular checkpoint, not a missed opportunity.
Maternal mortality rates for Black women remain alarmingly high. From a cardiovascular perspective, what warning signs are most commonly missed, and what should women ask their doctors?
Many cardiovascular warning signs are dismissed as “normal pregnancy changes” when they are not. Red flags include:
The postpartum period is particularly dangerous—many deaths occur weeks to months after delivery, when care drops off.
Women should feel empowered to ask:
Being “heard” can be lifesaving.
For Black women balancing caregiving, careers, and chronic stress, prevention can feel overwhelming. What are the most impactful steps to protect heart health right now?
Prevention does not have to be perfect—it has to be practical.
Medically:
Practically:
The most powerful message is this: Black women are not broken. The system has failed to protect us early enough. When we shift the narrative from blame to biology, prevention becomes not only possible—but powerful.
About Dr. Rachel Bond
Rachel M. Bond, MD, is a board-certified cardiologist in Arizona who has devoted her career to treating heart disease through early detection, education, and prevention. She is a women’s heart health specialist and author of review papers on maternal health, sex and gender differences, and cardiovascular conditions affecting women, as well as opinion pieces on health equity and the professional development of women and minorities in health sciences. Dr. Bond has a passion for advocacy, education, and mentorship, and frequently serves as an expert for news and media outlets. She is a Fellow of the American College of Cardiology, serves on its national diversity and inclusion committee, is a board member and co-chair of the CVD in Women and Children’s committee at the Association of Black Cardiologists addressing the Black maternal health crisis, and is a member of the American Heart Association and national spokesperson for the “Go Red for Women” campaign and president of the Greater Phoenix board of directors. Dr. Bond received the Nanette Wenger award for her work in women’s heart health and was named one of the most influential women in Arizona in 2022. She also serves on the OWN Your Health medical advisory board and on the National Academies of Sciences, Engineering and Medicine initiative on clinical preventive services to address heart disease risk and reduce pregnancy-related mortalities.
More Resources
Heart disease is overlooked in Black women because our health has historically been fragmented. Reproductive health, mental health, and chronic disease are often treated as separate conversations—when in reality, the heart is at the center of all of them. There’s also a long-standing myth that heart disease is a “man’s disease” or something that only affects people later in life. For Black women, that myth is particularly dangerous.
The silence has real consequences. It leads to delayed diagnosis, symptoms being dismissed or minimized, and missed opportunities for early prevention. Many Black women are diagnosed only after a major event—like a heart attack, stroke, or heart failure—when disease has been developing quietly for years. Silence costs lives.
Many Black women experience fibroids, PCOS, preeclampsia, and pregnancy-related complications. How are these connected to long-term cardiovascular risk?
These conditions are not just reproductive issues—they are early warning signs for cardiovascular disease.
- PCOS is linked to insulin resistance, high blood pressure, and abnormal cholesterol.
- Fibroids are associated with chronic inflammation and higher rates of hypertension.
- Preeclampsia and gestational hypertension double to quadruple the risk of future heart disease and stroke.
- Gestational diabetes dramatically increases lifetime cardiometabolic risk.
Pregnancy is essentially a cardiovascular stress test. When complications occur, they reveal underlying vulnerabilities in the heart and blood vessels. The problem is that once pregnancy ends, the cardiovascular risk is often forgotten—by both clinicians and patients. We need to treat these diagnoses as a call to long-term heart health monitoring, not isolated events.
Menopause is frequently misunderstood or dismissed. What changes occur during menopause that increase cardiovascular risk for Black women, and how should we advocate for better care?
During menopause, declining estrogen affects the blood vessels, cholesterol metabolism, insulin sensitivity, and body fat distribution. Blood pressure rises, LDL (“bad”) cholesterol increases, and visceral fat accumulates—all of which increase cardiovascular risk.
For Black women, menopause often occurs earlier and with more severe symptoms, yet we are less likely to receive counseling, screening, or treatment. Too often, symptoms like fatigue, palpitations, sleep disruption, or brain fog are brushed off as “stress” or “aging.”
Advocacy means demanding intentional screening during midlife: blood pressure checks, cholesterol, glucose testing, and discussions about symptoms. Menopause should be a cardiovascular checkpoint, not a missed opportunity.
Maternal mortality rates for Black women remain alarmingly high. From a cardiovascular perspective, what warning signs are most commonly missed, and what should women ask their doctors?
Many cardiovascular warning signs are dismissed as “normal pregnancy changes” when they are not. Red flags include:
- Severe or persistent shortness of breath
- Chest pain or pressure
- New or worsening swelling, especially in the face or hands
- Severe headaches or vision changes
- Palpitations or fainting
- Elevated blood pressure postpartum
The postpartum period is particularly dangerous—many deaths occur weeks to months after delivery, when care drops off.
Women should feel empowered to ask:
- "Could this be related to my heart or blood pressure?"
- "Do I need cardiac testing or follow-up after delivery?"
- "How does my pregnancy complication affect my long-term heart health?"
Being “heard” can be lifesaving.
For Black women balancing caregiving, careers, and chronic stress, prevention can feel overwhelming. What are the most impactful steps to protect heart health right now?
Prevention does not have to be perfect—it has to be practical.
Medically:
- Know your numbers: blood pressure, cholesterol, glucose, weight trajectory.
- Take pregnancy history seriously—share it with every clinician.
- Don’t delay symptoms. Trust your body.
Practically:
- Prioritize sleep as a medical necessity, not a luxury.
- Build movement into daily life—walking counts.
- Reduce chronic stress where possible and name it when it can’t be reduced. Stress is not a personal failure; it is a biological risk factor.
- Establish care with a clinician who understands women’s cardiovascular risk across the lifespan.
The most powerful message is this: Black women are not broken. The system has failed to protect us early enough. When we shift the narrative from blame to biology, prevention becomes not only possible—but powerful.
About Dr. Rachel Bond
More Resources
