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Why Women Are at Greater Risk Than Men for Heart Disease

Woman looking out the window in front of her computer

What’s the leading health risk for women? Many women are surprised to learn that it’s heart disease, not breast cancer.

“Women have a greater chance of dying from heart disease than men,” cardiologist Dina Sparano, MD, says.

In fact, more women in the United States die from heart disease than from all forms of cancer combined – nearly half a million women each year.

“Yet many women are not aware of this startling statistic, nor do they understand why,” she says.

Why Women Are at Greater Risk

“Women are at greater risk than men partly because heart disease is under-recognized and undertreated in women,” Dr. Sparano says. “And, although both genders are at risk when certain health conditions exist - including high cholesterol, high blood pressure, smoking and obesity – there are some unique reasons why heart disease in women may go undetected, untreated and lead to progressive disease.”

These reasons include:

Atypical symptoms. Although chest pain remains the most common symptom of a heart attack in women just as it is in men, it is possible for symptoms to be completely absent or more subtle, such as:

  • Neck, jaw, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Pain in one or both arms
  • Nausea or vomiting
  • Sweating
  • Unusual fatigue

Hormonal fluctuations. Women’s changing hormone levels can worsen heart rhythm disturbances and aggravate existing coronary artery disease -- particularly during menopause. Low levels of estrogen in post-menopausal women is a significant risk factor for developing cardiovascular disease in the smaller blood vessels. Blockages in these smaller arteries can restrict the blood supply to the heart but may not cause noticeable symptoms. Small vessel disease such as this is generally best treated by healthy lifestyle changes and medications, not surgery.

Mental stress and depression. Women’s hearts are more affected by stress and depression than men’s and both may trigger heart attack symptoms. In particular, a condition known as “broken heart syndrome” or stress cardiomyopathy, can be brought on by stressful situations and cause severe, but usually temporary, heart muscle failure. This condition occurs most commonly in women after menopause. Stress and depression can make it difficult for women to maintain a healthy lifestyle and follow recommended treatments, increasing their risk for heart attack and stroke.

Diabetes. Although it is not clear why, women with diabetes are at greater risk for heart disease than are men with diabetes. Inflammatory diseases, such as rheumatoid arthritis and lupus, may also pose an increased risk for women.

Women are under-represented in clinical studies. “We need more female representation in clinical studies to better understand prevention and women’s risk. We can only start to truly understand disease patterns related to women when we have data from large cohorts of women available for analysis,” Dr. Sparano says. “We must begin to embrace gender-specific approaches so we can better understand and address the health needs of women in our community.”

How to Lower Your Risk

Women (and men) can lower their risk of heart disease by knowing their numbers: blood pressure, ideal body weight and cholesterol. You can also lower your risk by making some simple lifestyle adjustments, including:

  • If you smoke, quit. This is the number one preventable risk of a heart attack. Female smokers have the highest incidence of sudden death and heart attacks.
  • Maintain a healthy body weight.
  • Get regular physical exercise (as approved by your doctor).
  • Eat a healthy, fiber-rich diet, low in fats and sugars.

Perhaps the most important advice, Dr. Sparano says: “Be your own best advocate when it comes to your health. Know your numbers, your risk factors and your family history. More importantly, learn from this and make the appropriate adjustments to your lifestyle.”

Related Links

Women's Cardiovascular Center