Women in the South are dying from heart disease at rates that are rapidly catching up to men’s, shocking researchers, as men historically have experienced more deaths from the condition.
While deaths are declining for everyone nationwide, women in the South are not seeing the same benefits as men, leading to a wide gap in their survival outcomes.
Men have a history of higher heart disease death rates largely because they lack estrogen’s protective effect and have higher rates of certain risk factors.
But a dramatic shift is underway as women’s rates in the South rapidly catch up.
Researchers partly attribute the rise to the ‘Southern dietary pattern,’ a diet high in unhealthy ultra-processed foods, which harms women’s heart health more than men’s due to a combination of biological differences.
Hormonal, metabolic and body composition factors make women uniquely vulnerable to this diet, which is high in processed meats and low in whole grains and fiber.
This is compounded by an epidemic of obesity, which afflicts more women than men, with more than 41 percent of women and 39 percent of men qualifying as obese.
Systemic issues such as poverty and poor healthcare access intensify this biological risk, preventing women from receiving the preventive care needed to manage conditions like diabetes and high blood pressure before they become fatal.
Together, these forces converge to make women biologically more at risk of suffering from heart disease, which afflicts 30 million Americans and is the leading cause of death in the world. Additionally, women typically get heart disease later in life than men, and when they do, they often face worse outcomes.
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A gender gap has always existed in heart disease, with case rates of 8.3 percent in men compared to 6.1 percent in women.
Researchers analyzed US heart health data collected between 2011 and 2021.
They found that the prevalence of heart disease declined by nine percent in women.
But deaths are declining at a dangerously slow pace in the Deep South. In states like Mississippi and Arkansas, women’s heart disease mortality is not improving fast enough.
The progress for women is so slow that the historical gap between men and women has closed, not because men are doing worse, but because women are not getting better.
A toxic convergence of the Southern diet, obesity, physical inactivity and chronic stress has created a perfect storm that causes an overall drop in fatal heart disease to slow down or stall.
Seven Southern states, including Arkansas, Florida, Kentucky, Louisiana, Missouri, Oklahoma and West Virginia, remained in the worst 10 percent nationally for case rates.
When Eve Walker, from Detroit, Michigan, was just 28 years old when she suffered a heart attack
Southern states are more at risk of high death rates from heart disease, data from the CDC showed
Arkansas and Mississippi were the epicenters of this crisis, standing alone as the only two states where women faced a higher death rate from heart disease than the healthiest state: Hawaii.
The Southern US region has become a heart disease epicenter, with women disproportionately being the victims.
For every 100 men who died from heart disease, 70 women died, where a more typical ratio representing national averages might have been a woman’s rate being only 50 percent of a man’s rate.
This dietary pattern has been replicated in other regions, too. A recent uptick in heart attacks among people under 50 has been attributed to a modern confluence of risk factors, including rising rates of obesity, pre-diabetes and high blood pressure, often linked to poor dietary habits and inactive lifestyles.
A widespread epidemic of metabolic problems, including high cholesterol, blood sugar and blood pressure, is driving high heart disease death rates among Southern women.
Southern women face more severe health consequences from obesity than men, as a high BMI is a far stronger predictor of fatal heart disease for women who store more dangerous visceral fat, making their risk at the same BMI level disproportionately higher.
Beyond diet, chronic stress, depression and caregiving duties create behavioral vulnerabilities for women.
While heart disease death rates fell more for women (19 percent) than men (12 percent) from 2011 to 2021, a stark reversal of this trend emerged in two states. By 2021, Arkansas and Mississippi were the only states where women with heart disease had significantly worse outcomes than men
These factors often lead to emotional eating and less capacity for healthy cooking, worsening dietary habits and deepening heart health disparities.
Lack of physical activity is another major, and often female-specific, risk.
A woman’s body is more vulnerable to the metabolic damage caused by an inactive lifestyle, such as increased visceral fat and inflammation, which compounds the natural loss of heart-protective estrogen after menopause.
The research team concluded that the convergence of these factors creates a perfect storm, compounding women’s vulnerability to heart disease, particularly in poorer regions.
Their findings were published in the Journal of the American Heart Association.
