Heart Disease in Women: Subtle Warning Signs You Need to Know

Tell-tale heart disease signs in women may surprise you.

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“Heart disease is the leading cause of death and disability in American women,” says cardiologist Nieca Goldberg, MD, medical director at NYU Langone Health in New York. This may be surprising, since heart disease is often thought of as a man’s disease (think of the classic movie heart attack, when a man suddenly clutches his chest and drops to the ground). Yet 90% of women have one or more risk factors for heart disease, according to the Go Red for Women heart disease awareness campaign. Even scarier: Fewer women compared to men survive their first heart attack.

“Women know their numbers—they know the number on the scale, and they know the number of the size clothing that they wear, but they don’t know their blood pressure or cholesterol numbers,” says Joan Pagano, an exercise physiologist in New York City.

Knowing your individual risk factors for heart disease is one of the most important steps you can take on the road to prevention. Each risk factor worsens other risk factors you might have. So, if you have two risk factors, your risk of heart disease increases fourfold, and if you have three or more risk factors, your risk increases more than tenfold.

The statistics about heart disease in women are chilling, but here’s one you can feel better about: 80% of heart disease events may be prevented by lifestyle changes and education. Protect yourself: Here’s what you need to know about women’s heart disease symptoms and heart disease risk factors.

Warning Signs of Heart Disease in Women

Heart attack symptoms can be different in women compared with men, and are often much more subtle. “It’s really important for a woman to recognize that she might not have the Hollywood heart attack,” says Dr. Goldberg. In fact, coronary heart disease is often called “silent CHD” because some women have no symptoms at all. For women who do have heart disease symptoms, they might feel:

  • Nausea
  • Fatigue
  • Dull chest pain or discomfort (angina)
  • Pain in the neck, abdomen, or back
  • Shortness of breath

These signs often mimic other not-as-serious health issues, so women might brush them off and not get the medical care they need. (If you feel any of these symptoms, call 9-1-1 right away.)

Heart Disease Risk Factors Unique to Women

Women share many of the same heart disease risk factors as men (such as family history or having high cholesterol, high blood pressure) but some seem to affect women disproportionately.

Such heart disease risk factors as diabetes, smoking, anxiety, and depression are more likely to cause cardiac events in women than in men, says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital. In fact, having diabetes actually doubles a woman’s risk of developing heart disease. (Learn more about the connection between diabetes and heart disease here.)

Other risk factors, like pregnancy, menopause, and taking birth control pills, are specific to women.

  • Pregnancy. Heart disease is the leading cause of pregnancy-related deaths. That’s because when you’re pregnant, the physiology of your heart changes significantly: your blood volume increases, your blood pressure levels fall and rise depending on the stage of pregnancy, and your cardiac output (how much blood your heart pumps per minute) increases by 50%. Women who’ve had preeclampsia (a dangerous pregnancy-related condition characterized by high blood pressure and protein in the urine) or gestational diabetes (high blood sugar during pregnancy) also have an increased risk of developing heart disease later in life. Women who have had preeclampsia have three to four times the risk of high blood pressure, and double the risk for heart disease.
  • Menopause. Before age 55, women have a lower risk of heart disease than men. The estrogen women’s body naturally creates actually protects their hearts, says Dr. Bond. “Once we go through menopause we no longer produce a large amount of that estrogen,” she says. The natural decline in hormones that occurs during menopause can increase women’s heart disease risk.
  • Birth control pills. The Pill is safe for most women, even if they have heart disease—except for women who smoke. Smoking while taking birth control is dangerous; it can increase a woman’s risk of heart disease by 20%, even among young women. Some birth control can increase blood pressure, too, so it’s important for women to talk to the doctor (and be honest about your less-than-healthy habits like smoking) before starting the Pill or changing to a different one.


There are many heart disease risk factors you can’t control, like age, ethnicity, or family history, but some you can. Smoking, high cholesterol, high blood pressure, diabetes, being overweight, stress, lack of physical activity and bad diet are all controllable heart disease risk factors.

The best way to prevent heart disease is to learn your risk factors, get your blood pressure, cholesterol, and sugar checked and keep them at healthy levels, quit smoking, exercise regularly, and follow a heart-healthy diet. If you’re armed with knowing your risk, you can lead a healthy life even if you’ve had a heart attack, says Dr. Goldberg.

For more preventive health advice, check out the critical health tests women need in their 40s and the important health tests women need in their 50s.