You prob­a­bly know some­one who’s had a heart attack. Maybe it was a col­league who seemed healthy one day and was in the hos­pi­tal the next. Or maybe you’ve noticed your chest tight­en dur­ing stress­ful moments and won­dered whether you should be concerned. 

Here’s what catch­es many women off guard: heart dis­ease is the lead­ing cause of death for women in the Unit­ed States. Over 60 mil­lion women (44%) in the Unit­ed States are liv­ing with some form of heart dis­ease. Yet only about half (56%) of US women rec­og­nize that heart dis­ease is their #1 killer. The myth per­sists that heart attacks are main­ly a ​“man’s prob­lem.” They’re not. And the dif­fer­ences in how heart dis­ease affects women go way beyond statistics. 

At a Glance

Women face unique risks: Preg­nan­cy com­pli­ca­tions, menopause, and inflam­ma­to­ry dis­eases can all increase heart dis­ease risk in ways that don’t affect men.

Symp­toms look dif­fer­ent: Wom­en’s heart attack symp­toms often show up as fatigue, nau­sea, or jaw pain rather than the ​“clas­sic” chest-clutch­ing pain por­trayed in movies. Women also expe­ri­ence symp­toms dur­ing rou­tine dai­ly activ­i­ties, not just dur­ing exer­cise.

Treat­ment gaps exist: Women are less like­ly to receive cru­cial treat­ments like car­diac catheter­i­za­tion and stent­ing, and women are sig­nif­i­cant­ly less like­ly to be pre­scribed statins than men (odds ratio 0.79), even when they’d ben­e­fit equally.

Pre­ven­tion works: Dai­ly exer­cise, stress man­age­ment, and reg­u­lar check­ups with your provider can dra­mat­i­cal­ly reduce your risk, no mat­ter your age. 

Com­mon Types of Heart Dis­ease in Women

Coro­nary Artery Dis­ease (CAD)

This is the most com­mon type of heart dis­ease. About 1 in 17 women aged 20 years and old­er (5.8%) have coro­nary artery dis­ease. It hap­pens when fat­ty deposits and cho­les­terol build up as plaque inside your arter­ies. When too much plaque accu­mu­lates, blood flow to your heart gets blocked, and you can have a heart attack.

What makes CAD tricky for women is that symp­toms can appear dur­ing rest, not just dur­ing phys­i­cal activ­i­ty. Women are more like­ly to have angi­na while doing rou­tine dai­ly activ­i­ties rather than dur­ing exer­cise. You might feel chest dis­com­fort while sit­ting on the couch or lying in bed. Because of this, many women dis­miss what’s hap­pen­ing as heart­burn, anx­i­ety, or just being tired. 

Peri­par­tum Car­diomy­opa­thy (PPCM)

If you’re preg­nant or recent­ly gave birth, this con­di­tion can devel­op in the final month of preg­nan­cy or dur­ing the first five months post­par­tum. PPCM weak­ens your heart mus­cle, lead­ing to left ven­tric­u­lar enlarge­ment and reduced blood-pump­ing effi­cien­cy. Some women recov­er com­plete­ly with treat­ment from their provider. But PPCM can affect whether it’s safe to have future preg­nan­cies, so it’s some­thing to dis­cuss thor­ough­ly with your care team if you’re diagnosed. 

What Puts Women at High­er Risk 

Beyond the com­mon risk fac­tors every­one faces — high cho­les­terol, high blood pres­sure, obe­si­ty — women have unique vulnerabilities:

• Dia­betes: Affects heart dis­ease risk more severe­ly in women than in men.
• Smok­ing: Espe­cial­ly dan­ger­ous when com­bined with birth con­trol pills.
• Preg­nan­cy com­pli­ca­tions: Preeclamp­sia, ges­ta­tion­al dia­betes, or high blood pres­sure sig­nal a high­er future risk. About 1 in 10 women with exist­ing heart dis­ease will have heart com­pli­ca­tions dur­ing preg­nan­cy or with­in a year after birth.
• Menopause: Estro­gen loss sig­nif­i­cant­ly increas­es heart dis­ease risk.
• Stress and depres­sion: Trig­ger inflam­ma­tion and plaque buildup dif­fer­ent­ly in women.
• Inflam­ma­to­ry dis­eases: Lupus or rheuma­toid arthri­tis dam­age blood ves­sels over time.
• Fam­i­ly his­to­ry: Ear­ly heart dis­ease in rel­a­tives increas­es your risk.

Rec­og­niz­ing Heart Attack Symptoms

The ​“Hol­ly­wood heart attack” — a man clutch­ing his chest and col­laps­ing — isn’t what most women expe­ri­ence. Wom­en’s symp­toms can be sub­tle and easy to explain away. Watch for: 

• Dis­com­fort in unex­pect­ed places: Neck, jaw, shoul­der, upper back, or abdomen — not just chest.
• Short­ness of breath: With or with­out chest dis­com­fort, dur­ing activ­i­ty or at rest.
• Unusu­al fatigue: Over­whelm­ing exhaus­tion that makes sim­ple tasks feel impossible.
• Diges­tive symp­toms: Nau­sea, vom­it­ing, or what feels like indigestion.
• Oth­er signs: Sweat­ing, light­head­ed­ness, dizzi­ness, or arm pain.

Women may delay seek­ing treat­ment for up to 3 hours or even up to 5 days. That delay hap­pens part­ly because women don’t rec­og­nize what’s hap­pen­ing. Many attribute their symp­toms to non-car­diac con­di­tions like indi­ges­tion or acid reflux. If some­thing feels seri­ous­ly wrong, don’t wait to see if it pass­es — call 911. 

How Heart Dis­ease Gets Diag­nosed and Treated 

Test­ing chal­lenges: Diag­nos­ing heart dis­ease in women can be tricky. Women are more like­ly to have heart dis­ease in tiny arter­ies (coro­nary microvas­cu­lar dis­ease), which makes it hard­er to iden­ti­fy and can cause delays in treat­ment. Your car­di­ol­o­gist might need addi­tion­al tests beyond a stan­dard coro­nary angiogram.

Treat­ment dis­par­i­ties: While angio­plas­ties, stent­ing, and coro­nary bypass surgery work for both women and men, hos­pi­tal­ized women are less like­ly to receive cru­cial treat­ments like car­diac catheter­i­za­tion, PCI, and CABG. Women also face high­er com­pli­ca­tion rates from bypass surgery.

The statin gap: Women are sig­nif­i­cant­ly less like­ly to be pre­scribed statins than men, even though statins can reduce cho­les­terol by up to 50% and low­er heart attack risk by 25% to 35%. If you have high cho­les­terol or oth­er risk fac­tors, ask your provider whether a statin makes sense for you. 

Pre­vent­ing Heart Disease

Most heart dis­ease is pre­ventable. Changes you make today can pro­tect your heart for years to come. Dai­ly habits that make a difference:

• Eat a bal­anced diet: Focus on veg­eta­bles, fruits, whole grains, and lean pro­teins. Lim­it processed foods and added sugars.
• Move your body: Aim for at least 150 min­utes of mod­er­ate exer­cise week­ly — walk­ing, swim­ming, cycling, or any­thing you enjoy.
• Man­age stress: Try deep breath­ing, med­i­ta­tion, yoga, or activ­i­ties that help you decompress.
• Quit smok­ing: One of the most pow­er­ful things you can do for your heart. Ask your provider about ces­sa­tion programs.
• Lim­it alco­hol: No more than one drink per day for women.
• Con­trol dia­betes and cho­les­terol: Work with your provider to keep lev­els in a healthy range.
• Talk to your provider: Reg­u­lar check­ups help catch prob­lems ear­ly. Your provider can assess your risk fac­tors, order appro­pri­ate screen­ing tests, and cre­ate a pre­ven­tion plan tai­lored to your sit­u­a­tion. If you have con­cerns about your heart health or unusu­al symp­toms, sched­ule an appointment. 

Learn more about your risk for heart dis­ease and how you can pre­vent it, or sched­ule an appoint­ment online with one of our car­di­ol­o­gists today.