W1. Women and Heart Disease

Women and Heart Disease

If you are a woman—or care for one—listen up!

Heart disease is the leading killer of women in America. Each year more women die of heart disease than men, yet heart disease and related risk factors are often missed in women. Symptoms of coronary artery disease and heart attack, for example, are often different in women than their male counterparts. Women are also less likely to receive optimal treatment for certain heart conditions.

If you’re like most women, you’re probably so busy taking care of everyone else, your own wellbeing and health tends to fall last. But you need to make your heart’s health a priority,and encourage other women to do the same. Even though heart disease tends to strike later in life, it can happen at any age. There are things about being a woman that can make you more prone to heart problems (for example, menopause and hormones).

Learn about your risk for heart disease and what makes it more likely. You can help protect your heart by adopting heart-healthy habits—for example, by exercising, eating right, getting enough rest, not smoking and paying attention to your health in general.

If you already have heart disease, you’re in good company—millions of women are living with some form of heart disease, and they can provide a wealth of advice, tips and information to help on your journey. Remember that prevention, early and accurate diagnosis, and treatment are critical.

Use this condition center to learn more about coronary artery disease in women. You can also chat online with other people like you, keep up with the latest research, and get tips to help you feel your best.


When it comes to heart disease, men and women are not created equal. In whatever way you look at heart disease—the way it is best diagnosed, the symptoms, the risk factors that contribute to its progression, as well as treatments or their application—clear differences emerge based on whether you are a woman or a man. While efforts are underway to better understand sex differences in heart disease, today’s research is just a start.

So, if you are a woman or care for one, listen up. Arming yourself with knowledge about your risk is important. Coronary heart disease is not just a “man’s disease,” and its effect on women tends to be riddled with misunderstandings. While deaths related to coronary artery disease—known as CAD for short—are declining overall, rates are increasing in young women. To put it into context, more women have died from heart disease than all cancers combined. All told, heart disease claims the lives of 1 out of 3 women in the U.S. each year. Yet, half of American women are still unaware that heart disease is their No. 1 killer.

So what is CAD, and how can you protect yourself and the women in your life? Read on, and share these tips.

What is Coronary Artery Disease?

Coronary artery disease is the most common type of heart disease. It develops when your coronary arteries, which act like fuel lines to supply blood and oxygen to the heart, become damaged or diseased. This often results when a waxy substance called plaque or atherosclerosis builds up in the walls of the arteries.

When your coronary arteries become narrowed or blocked, it means there is less blood flow to the heart; in some cases, plaque can rupture and blood flow is abruptly and completely blocked. CAD can lead to:

  • Chest pain (angina)
  • Heart attack
  • Heart failure
  • Heart rhythm problems

In women more often than men, these things can occur even without evidence of any obstructive coronary artery disease, which makes the diagnosis and treatment in women challenging.

Women are just as likely as men to develop CAD. In women, CAD usually develops seven to 10 years later in life compared with men. Menopause seems to kick off a host of risk factors including:

  • Weight gain, especially carrying excess fat around your waist or midsection
  • Diabetes, which is the strongest risk factor in women; in fact, studies suggest diabetes more than triples the risk of CAD in women, compared with doubling the risk for men
  • High blood pressure
  • Change in cholesterol profile (rise in LDL and triglycerides, fall in HDL)

Women tend to:

  • Have different and more subtle symptoms
  • Have no overt signs of blockages in the three major coronary arteries on tests, although blood flow to the heart muscle is reduced
  • Have blockages or dysfunction in smaller arteries (men are more likely to have plaque buildup in the large arteries around the heart)
  • Be treated less aggressively than men
  • Be less likely to dial 112

What Increases Your Risk

Most women—9 out of 10—have at least one risk factor for heart disease or stroke. The good news is 80% of heart disease and stroke can be prevented through lifestyle change.

Cardiologists say one of the best things you can do for your heart health is to understand your personal risk of developing heart disease. That means you should know:

  1. What increases your risk for heart disease.
  2. What you can do to lower your risk.

For women, it’s especially important to talk with your health care provider about traditional risk factors linked to heart disease, as well as those that are specific to being a woman.

The usual suspects for heart disease include:

  • Smoking
  • Having high blood pressure, cholesterol or diabetes
  • Not exercising or sitting for long periods of time
  • Eating a diet high in salt, saturated fats, cholesterol and added sugars
  • Being overweight or obese
  • Family history of early heart disease
  • Older age

Diabetes, mental stress/depression, obesity and smoking tend to play a bigger role in the development of CAD in women compared with men.

Also, be certain to discuss risk factors that are unique to women. These conditions are known to up the likelihood of heart disease. For example:

  • Menopause — Heart disease can happen at any age, but it tends to increase in women around or after menopause.
  • Having started menstruating before 10 or after 17 years of age.
  • Gestational hypertension/preeclampsia — Any elevation in blood pressure increases the risk for heart disease in women.
  • Gestational diabetes during any pregnancy.
  • Preterm delivery (before 37 weeks of gestation).
  • Polycystic ovarian syndrome.

Women are also more likely to have less common conditions linked to CAD. These include:

  • Heart disease that affects the smaller arteries supplying the heart (microvascular): These are typically due to dysfunction of the arteries and not complete blockages. Standard tests aren’t designed to diagnose microvascular endothelial dysfunction.
  • Spontaneous coronary artery dissection (SCAD).
  • Autoimmune diseases, such as lupus (SLE) or rheumatoid arthritis (RA).
  • Broken heart syndrome, also called Takotsubo Syndrome or stress cardiomyopathy: Despite the name, it can occur with good or bad emotional excitement.
  • Breast cancer: Although not exclusive to women, it certainly occurs more often in women. The chemotherapy and radiation for breast cancer can damage the heart, both acutely and in the future. Knowing your risk for heart disease and controlling risk factors is important after breast cancer. It is now more likely you will die from heart disease than breast cancer because the treatment for breast cancer has gotten so good. Having breast cancer should be considered as a risk factor for heart disease.

Signs and Symptoms

Heart disease often looks and feels very different in men and women.

Although many women will have the classic crushing chest pain, which is often thought of as the hallmark sign of a heart attack, at least one-third of women will have atypical symptoms or no symptoms at all. Tragically, heart attack or sudden cardiac death can be the first symptom of CAD in younger women.

This underscores the importance of always knowing your risk factors for heart disease—you won’t know if you don’t get checked. High blood pressure, for example, is often called a “silent killer” because it has no symptoms. In other words, the only way to know if your blood pressure is high—or becoming too high—is to check your blood pressure readings over time. Uncontrolled high blood pressure is a leading cause of heart attack and stroke.

What a Heart Attack Feels Like

Typical Symptoms  Women Often Feel
· Chest pain or discomfort (fewer women than men feel this)

· Shortness of breath

· Arm, neck, jaw or back pain

· Cold sweat

· Unusual or extreme tiredness

· Feeling dizzy or lightheaded

· Nausea or vomiting

· Upper body discomfort or indigestion (back pain, jaw pain without any chest pain or pressure)

· Palpitations

· Trouble sleeping

· Sudden anxiety or confusion

There are many ways CAD can be diagnosed.

Listen to Your Body

Every 90 seconds in the United States, a woman suffers a heart attack. Keep in mind that that sudden, crushing chest pain, or pressure or tightness aren’t the only signs of a heart attack.

If you have a nagging feeling something is wrong, play it safe and call 112 right away. Let the health experts decide if you are having a heart attack. Treatment is most effective if it’s given within one hour of a heart attack starting.

Preventing CAD

The choices you make every day play a large role in determining your risk for CAD and how quickly it might progress. Positive lifestyle changes are very important and can help to prevent CAD and delay its progression.


There are a number of treatment options for CAD, including lifestyle changes, medications, surgery and/or medical procedures.

Lifestyle changes are the mainstay of therapy. Commit to putting your health first:

  • Make healthy food choices to eat more plant-based and less processed foods.
  • Lose weight if needed.
  • Quit smoking or don’t start.
  • Reduce stress.
  • Get enough sleep.
  • Limit alcohol intake to one drink a day or less.
  • Know your blood pressure, cholesterol levels and find out if you have or are at risk for diabetes.

Women often are the ones juggling and taking care of everyone else first. By making these heart-healthy choices every day, you can help protect your heart and help those around you live healthier, too.

In addition to lifestyle changes, you many need:

  • People who have or are at high risk for CAD are often advised to take one or more medications. Medicine can help the heart work better, lower blood pressure and cholesterol, manage symptoms including chest pain (angina) and/or prevent blood clots.
  • Coronary angioplasty and stenting(also called percutaneous coronary intervention). This procedure opens narrowed or blocked blood vessels that supply blood to the heart. A stent is a small, metal mesh tube that expands inside a coronary artery to keep it propped open. Angioplasty is a balloon procedure to open blocked arteries. Your doctor will decide which procedure is right for you based on your test results.
  • Heart surgery or coronary bypass grafting (CABG).Surgeons will open the chest to place grafts that restore blood flow to blocked or damaged arteries that supply the heart.
  • Cardiac rehabilitation.Cardiac rehab is a 12-week program that includes a mix of supervised exercise, nutrition counseling, stress management, assistance to quit smoking and education about the disease process, including how you can better take control of your health and improve outcomes. Studies show that people who attend cardiac rehab have fewer returns to the hospital and better quality of life.

Historically, treatments have been based on clinical studies that included mostly men. In fact, less than 25% of participants in heart-related studies have been women. The good news is that as research continues to evolve and include more women of all races and ethnicities, researchers are beginning to find diagnostic approaches and therapies that are better matched to women with CAD.

Make sure you are getting the best possible treatment. If you have CAD or are at high risk for developing it, take the time to talk with your doctor about whether you are getting the guideline-indicated therapies. Women are less likely to get them. This includes aspirin and referrals to cardiologists as well as cardiac rehab.

Living With Heart Disease

Women are natural caretakers—whether it’s as a mother, sister, daughter and/or partner. More often than not, women are so busy caring for everyone else that their own health and well-being slips to the bottom of the list. Sound familiar? If so, for your loved ones and your heart, commit to making you and your health a priority.

Take time to understand how likely you are to develop heart disease and what you can do to prevent it. This way, you’ll be taking steps to be here and healthy for the people who mean the most to you.

“My advice to women is to do one good thing for your heart every day. Protect your heart by making healthy choices that are right for you.”—Martha Gulati, MD, FACC

Tips for Staying Healthy

  1. Take stock of your heart disease risk at every age.We change as we age, and so do our risk factors! If you are approaching menopause or have had a pregnancy with a preterm delivery, gestational hypertension/preeclampsia or gestational diabetes, ask how these events can affect your chance of having heart problems in the future.2. Schedule routine health checkups and mark the dates on your calendar.Important numbers are measured at these visits: your weight, body mass index (BMI), waist measurement, blood pressure, blood sugar and cholesterol levels.

    3. Know and keep tabs on your numbers. Keep a notepad or use an app to track your numbers over time. For example, do you know your blood sugar, blood pressure, blood cholesterol levels and weight? Are they under control or within a healthy range?

    4. Start or step up your exercise program. Aim to get 30-45 minutes of exercise most days. Pick activities that get your heart pumping and that you enjoy. Walking, riding a bike, swimming—even gardening or heavy housework—count. Talk with your health care provider about what exercise routine is best for you.

    5. Maintain a healthy weight. Ask your provider what that number is, and pay attention to the fat around your waist. Women with more of an apple-shaped body and too much fat around their waists appear to be at higher risk of serious heart issues. Know your BMI and waist circumference.

    6. Eat a healthy diet. Make healthy food choices every day. Learn which foods have hidden fats, empty calories and added sugars. The Mediterranean and the DASH diets are two examples of heart-healthy plans.

    7. Quit or don’t start smoking. Ask your doctor for information to help you quit smoking.

    8. Reduce your stress. Too much stress can affect your health, so it’s important to figure out ways to cope with stress. Find time for yourself and to connect with what’s important to you. Listen to your favorite music, meditate, try out a fun exercise or yoga class, or go for a walk with a friend. If you feel overwhelmed at work or home, ask for help and only say “yes” to what you can handle.

    9. Get enough sleep. Insufficient sleep is bad for the heart—not to mention for your overall health. Not getting enough quality shuteye is linked to a higher risk of high blood pressure. A good rule of thumb for adults is to clock at least seven hours of restful sleep a night. Talk with your health care provider about sleep habits, especially if you often wake up feeling unrested.

    10. Limit alcohol to one drink a day or less. Too much alcohol can lead to weight gain, raise your blood pressure and disrupt how your heart beats.

    11. Listen to your body. If you have a feeling that something is wrong, get it checked out. If you think you are having a heart attack, call 112. Early diagnosis and treatment are critical, and may even save your life!