Women and Heart Health: 8 Essential Facts

A cardiologist shares what women should know about their heart disease risks and how to protect themselves.

Heart disease is the leading cause of death for women in the United States. “One in five women will die of it, and cardiovascular disease claims more women’s lives than all cancers combined,” says Dr. Jennifer Haythe, co-director of the Women’s Heart Center and director of the Cardio-Obstetrics Program at NewYork-Presbyterian/Columbia University Irving Medical Center. Yet women are much less likely than they were a decade ago to recognize their heart risks, and only about half of women are aware that cardiovascular disease is their greatest health threat.

Understanding your risks can help you prevent harmful heart problems. Dr. Haythe spoke with Health Matters about what women and gender non-conforming people need to know to protect their hearts.

Portrait of Dr. Jennifer Haythe

Dr. Jennifer Haythe

1. More younger women are developing heart disease.

There’s been a worrisome increase in heart attacks among women ages 35 to 54 over the past two decades.

“The reason isn’t clear, but it may be related to increased stress as women have gained ground in the workforce,” says Dr. Haythe. “There’s also a higher prevalence of risk factors like obesity, diabetes, hypertension, and high cholesterol in younger women now.”

2. Heart disease can look different in women.

“We now have a better understanding of the spectrum of cardiovascular disease in women,” says Dr. Haythe. While traditional coronary artery disease is the most common form of heart disease in women and men, women are more likely to have several other types of heart disease. These include microvascular dysfunction, which is damage to the tiny blood vessels feeding the heart; vasospasm, a sudden narrowing of blood vessels that can block blood flow to the heart; and SCAD (spontaneous coronary artery dissection), a tear that forms in a blood vessel in the heart, blocking blood flow. SCAD is life-threatening and can cause a heart attack.

3. Women can have different heart attack symptoms.

During a heart attack, both men and women may experience the classic chest pain symptom. But women tend to have less typical signs: shortness of breath, nausea or vomiting, severe fatigue, and back or jaw pain, says Dr. Haythe.

Even when women think they may be having a heart attack, they are slower to seek help, research shows. But it’s important to call 911 immediately and get care right away, Dr. Haythe says.

4. Women may need to self-advocate to get the care they need.

Research shows that women wait longer than men after arriving at the emergency department to have their chest pain assessed and are less likely to get an electrocardiogram (EKG) test to detect heart problems.

“Unfortunately, sometimes women need to make their voices heard when their needs aren’t getting met,” says Dr. Haythe. “You can say, ‘I’ve noticed that I’m more short of breath and I’m worried about my heart. I want my heart to be evaluated.’”

After a heart attack, “women are often not prescribed appropriate medications or cardiac rehabilitation,” says Dr. Haythe. “They’re not given implantable defibrillators to control irregular heartbeats at the same rate. They’re also less likely to get some treatments for heart failure or receive heart transplants.” Ask your doctor if you are getting the best treatments for your condition, she advises.

"Unfortunately, sometimes women need to make their voices heard when their needs aren’t getting met. You can say, 'I’ve noticed that I’m more short of breath and I’m worried about my heart. I want my heart to be evaluated.’"

— Dr. Jennifer Haythe

5. Women have unique causes of heart disease.

More women than men are affected by autoimmune disorders, such as lupus and rheumatoid arthritis, that are linked to a higher risk of heart problems. Treatment for breast, uterine, and ovarian cancer may also increase a woman’s heart disease risk. Certain conditions, like depression, are linked to heart disease more frequently in women, and using oral contraceptives increases one’s risk.

6. Pregnancy is a “stress test” for the heart.

Several pregnancy conditions can increase the risk for heart problems later in life. These include diabetes and high blood pressure developed during pregnancy (gestational diabetes and gestational hypertension), and preeclampsia, a serious type of hypertension. These conditions typically occur after 20 weeks of pregnancy.

Women who have experienced these conditions should let their doctors know and make sure their blood pressure, cholesterol, and blood sugar are checked every year.

7. Heart disease is the No. 1 cause of maternal deaths in the U.S.

Cardiovascular disease complicates a growing number of pregnancies. Though rare, peripartum cardiomyopathy, a type of heart failure, is of particular concern. It can occur anytime from the last month of pregnancy through the first five months after delivery and is more prevalent among African Americans, says Dr. Haythe. Older maternal age, high blood pressure, and pregnancy with twins are other risk factors.

“It’s really important for women who are pregnant and aren’t feeling well to speak up,” says Dr. Haythe. “If there’s something that you think is not right, check in with your doctor.”

The same advice goes after pregnancy. “A woman’s cardiovascular status doesn’t go back to normal for another three months, and that period after delivery is some of the highest risk time for heart disease,” Dr. Haythe says. Be sure to keep up with your postpartum checkups and see your doctor if you don’t feel well.

8. Heart disease rises after menopause.

Cardiac problems increase with age, accelerating after menopause. Entering menopause before age 40 also raises a woman’s risk of heart disease.

“When women lose the protective effects of estrogen, they start to develop more coronary disease and cardiovascular illnesses,” says Dr. Haythe.

Protect Your Heart

About 80% of cardiovascular diseases may be prevented with behavior change. Take these steps to lower your risk:

See a primary care doctor.
Get an annual checkup with a general practitioner. “Women often are very busy with their work and family lives for their middle years and they don’t don’t pay much attention to their health,” says Dr. Haythe. “But it’s really important to capture risk factors that they may not know they have and treat them.”

Exercise regularly.
The American Heart Association recommends at least 150 minutes a week of moderately intense activity, such as brisk walking, or 75 minutes a week of vigorous aerobic exercise like jogging, or a combination of both. Choose a routine that makes sense for you.

• Eat healthy.
“Eat a healthy, balanced diet without a lot of heavily processed foods,” says Dr. Haythe. A good bet is the Mediterranean diet, which emphasizes whole grains, fruits and vegetables, and lean protein like fish and poultry, along with nuts, seeds, and olive oil. Limit saturated fat, salt, and sugar.

• Manage weight.
If you’re overweight, losing 5% to 10% of your body weight can significantly improve cardiovascular risk factors like high blood pressure and cholesterol.

• Get enough sleep.
Women are more likely than men to have sleep problems. Poor sleep has been linked to weight gain and high blood pressure, which raise the risk for heart disease. Seven to nine hours a night is optimal for heart health.

• Reduce stress.
Stress has been linked to heart risk factors, such as high blood pressure. Seek ways to feel calmer, such as meditation, yoga, or regular exercise.

• Don’t smoke.
Women who smoke are more likely to have a heart attack than male smokers.

• Learn your family history.
Some people may not know that they have an inherited predisposition for heart problems. Ask about any health conditions your grandparents and other family members had. “Family history is very important for a doctor to know,” says Dr. Haythe.

Jennifer Haythe, M.D., is a cardiologist and co-director of the Women’s Heart Center, director of the Cardio-Obstetrics Program, and associate director of the Adult Pulmonary Hypertension Program at NewYork-Presbyterian/Columbia University Irving Medical Center. She also is the Irene and Sidney B. Silverman Associate Professor of Cardiology in the Department of Medicine at Columbia University Vagelos College of Physicians and Surgeons. Dr. Haythe specializes in cardiovascular disease in women and during pregnancy, heart failure, cardiac transplant, and pulmonary hypertension.

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