Tell-tale heart disease signs in women may surprise you.
“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:
- 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.
Dr. Goldberg is a cardiologist and medical director of the NYU Langone Health Joan H. Tisch Center for Women’s Health.Rachel Bond
Dr. Bond is a cardiologist and associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital and an assistant professor of cardiology at Hofstra Northwell School of Medicine.Satjit Bhusri
Dr. Bhusri is an attending cardiologist at the Lenox Hill Heart & Vascular Institute and an assistant professor of cardiology at Hofstra Northwell School of Medicine.Joan Pagano
Joan Pagano is an exercise physiologist in New York City.
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Heart disease is the leading cause of
death, and disability in American women.
00:00:07,703 --> 00:00:12,470
00:00:12,470 --> 00:00:16,857
There are certain risk factors that
actually are more likely to cause effects
00:00:16,857 --> 00:00:18,620
in women when compared to men.
00:00:18,620 --> 00:00:23,519
So these risk factors include diabetes,
smoking, as well as anxiety or
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Having belly fat or central obesity,
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having low levels of HDL or
good cholesterol is a risk factor that's
00:00:32,190 --> 00:00:36,170
greater in women versus men.
Then there are particular risk factors
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that are very specific to women, and these
risk factors are mainly during pregnancy.
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If during pregnancy you are diagnosed
with high blood pressure.
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If you were diagnosed with high blood
sugar, like diabetes for example.
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Also if you were diagnosed
00:00:49,490 --> 00:00:54,100
Menopause affects heart disease risk
because there are fluctuations in
00:00:54,100 --> 00:00:54,710
00:00:54,710 --> 00:00:58,670
We know that the estrogen
our body naturally creates
00:00:58,670 --> 00:01:00,310
actually protects our heart.
00:01:00,310 --> 00:01:04,820
And once we go to menopause, we no longer
produce a large amount of that estrogen.
00:01:04,820 --> 00:01:06,530
So the classic symptoms,
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the textbook symptoms we talk about
are chest pain, chest pressure,
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an elephant sitting on your chest.
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Common presentations we see in
women more than men are fatigue,
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shortness of breath, nausea.
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And of course, we see numbness and
tingling down the left arm or numbness and
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tingling up the left side of the neck or
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even the back.
So it's really important, one, for
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a woman to recognize that she might
not have the Hollywood heart attack.
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In fact, it can be some of
these less common symptoms.
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About 30% of women that we see have
heart attacks, they have heart
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disease in the smaller blood vessels.
We know that these
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patients should be treated very similarly
to it as if they had blockages in
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the major arteries of the heart.
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So we should make sure
their cholesterol is lower.
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We should make they're on an aspirin,
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We should talk to them about maybe
being put on medications to lower their
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heart rate or lower their blood pressure.
Women are more worried about cancer
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than heart disease.
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And even though heart disease is
the number one killer of women in
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the United States, and
kills more women than men.
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Women know their numbers,
they know the number on the scale, and
00:02:21,830 --> 00:02:24,820
they know the number of the size
clothing that they wear.
00:02:24,820 --> 00:02:28,677
But they don't know their blood
pressure or cholesterol numbers, and
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this is really important
to get your screenings, and
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know those numbers.
The best way to prevent heart disease
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is to learn your risk factors,
such as get your cholesterol,
00:02:40,570 --> 00:02:45,140
and sugar checked, quit smoking, exercise.
00:02:45,140 --> 00:02:50,440
If you're armed with knowing your risk,
so that you can prevent heart disease or
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should you have a symptom,
getting early treatment.
00:02:53,980 --> 00:02:57,325
You can lead a healthy life even
if you've had a heart attack.
00:02:57,325 --> 00:03:02,779
- Preventing 1 Million Heart Attacks and Strokes. Atlanta, GA. CDC (Accessed on February 10, 2021 at https://www.cdc.gov/vitalsigns/million-hearts/)
- Birth Control and Heart Disease in Women. Dallas, Tx. American Heart Association ( Acessed on February 10, 2021 at https://www.heart.org/en/know-your-risk/risk-factors/birth-control-and-heart-disease)
- Gunderson EP, Sun B, Catov JM, Carnethon M, Lewis CE, Allen NB, Sidney S, Wellons M, Rana JS, Hou L, Carr JJ. Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study. Circulation. 2021 Feb 1. doi: 10.1161/CIRCULATIONAHA.120.047320
Heart Disease in Women. Bethesda, MD. National Heart, Blood, and Lung Institute. (Accessed on February 10, 2021 at https://www.nhlbi.nih.gov/health-topics/heart-disease-women)
Heart Disease Causes Pregnancy-Related Deaths. Dallas, Tx. Go Red for Women, American Heart Association. (Accessed on January 29, 2018 at https://www.goredforwomen.org/about-heart-disease/heart_disease_research-subcategory/heart-disease-causes-pregnancy-related-deaths)High-Risk Cardiac Disease in Pregnancy. Washington Dc. American College of Cardiology Foundation. (Accessed on January 29, 2018 at http://www.onlinejacc.org/content/68/4/396)