Did you know heart disease is the number one killer of women? It’s true—one in three women die from a heart-related problem, according to the American Heart Association (AHA). In fact, heart disease leads to more deaths among women than all cancers combined.
According to the Centers for Disease Control and Prevention, heart disease is extremely common. The agency estimates more than 60 million American women (nearly 45 percent) have some form of heart disease. And more than 310,000 will die from their condition every year.
Despite these numbers, the AHA says only 44 percent of women know that cardiovascular disease is the biggest threat to their health. Many women dismiss uncomfortable and dangerous symptoms that could point to a heart attack or stroke. As a result, they receive less treatment and experience worse outcomes.
In a recent webinar, cardiologist and medical director of the Women’s Heart Center at The Christ Hospital Odayme Quesada, MD, preventive cardiologist Shree Lata Radhakrishnan, MD, and interventional cardiologist Timothy D. Henry, MD, discussed the different ways heart disease presents in women and important ways you can protect your heart health.
If you’ve been diagnosed with heart disease or have a family history of heart-related problems, here’s what experts from the Women’s Heart Center want you to know.
1. Heart disease in women isn’t well understood
Even though heart disease affects millions of women, we still don’t know as much as we know about how it impacts men. The National Institutes of Health only began funding studies to examine cardiovascular disease in women in 1991. Even today, just 38 percent of heart disease investigations include women, Dr. Quesada says.
“When it comes to heart disease and women, we have a lot of gaps in our knowledge,” she says. “We can’t really take care of women appropriately unless we’re moving forward in the field.”
That’s why The Christ Hospital Health Network established its Women’s Heart Center in 2020. This Center of Excellence delivers sophisticated cardiovascular care through specialized programs and conducts research on heart disease in women.
2. Women experience different heart disease symptoms
Like men, women can feel chest pain and chest discomfort during a heart attack. But that isn’t always the case. In addition, women may experience a different set of symptoms. These signs can include:
Anxiety
Back pain
Cold sweats
Dizziness
Fatigue
Indigestion
Jaw pain
Nausea
Shortness of breath
Vomiting
Stroke symptoms may also look differently in women. In addition to common signs like face drooping, speech and vision problems, difficulty walking, severe headache and arm weakness, women may also experience:
Confusion
Disorientation
Fatigue
General weakness
Nausea
Vomiting
3. Women have heart attacks without blockages in major arteries
Obstructive coronary artery disease—blocked arteries—is a major cause of heart attacks and the chest pain associated with these events. Between 50 percent and 70 percent of men who experience chest pain have blocked arteries that show up on an angiogram, an X-ray that lets doctors examine your blood flow and blood vessels.
But the exact opposite is true for women. For women who experience chest pain with heart attack, angiograms reveal that 50 percent to 70 percent have no blocked arteries. Instead, they often have a lesser-known condition called coronary microvascular disease (CMD), Dr. Quesada says. With CMD, blockages exist in the heart’s smaller arteries while the major blood vessels remain open.
“What we’re missing on angiograms is the very intricate system of little arteries,” she says. “The reality is that when those little arteries are diseased, you can have chest pain when your larger arteries are open.”
Experts at the Women’s Heart Center use coronary reactive testing to determine if you have CMD. This procedure uses medication to narrow your blood vessels to see how they react to restricted blood flow.
Women are also more likely to develop a type of non-obstructive coronary artery disease, a condition that causes reduced blood flow. Specifically, they can experience myocardial infarction with non-obstructive coronary artery disease (MINOCA). This condition triggers severe heart attacks without any artery blockages.
4. Women face unique heart disease risk factors
Women face the same traditional risk factors for cardiovascular disease as men. These shared factors include:
But, according to Dr. Radhakrishnan, women have additional risk factors that men don’t encounter.
“Heart disease can affect a woman across her lifespan,” she says. “So, women face several unique risk factors.”
A woman’s risk for heart disease can increase due to:
Autoimmune diseases (such as lupus or multiple sclerosis) that occur more often in women
Exposure to oral contraceptives
Gestational diabetes (pregnancy-related diabetes)
Hormone replacement therapy
Preeclampsia (pregnancy-related high blood pressure)
Menopause
The impact of menopause
Your risk of heart disease rises during menopause because your estrogen level drops, Dr. Radhakrishnan says. As a result, your cholesterol level can increase, elevating your chances for atherosclerosis (the buildup of plaque in your arteries) and coronary artery disease.
5. Women can lower their heart disease risk
Dr. Radhakrishnan says that practicing healthy lifestyle behaviors—like those included in the American Heart Association’s Life’s Essential 8™ checklist—can reduce your heart disease risk.
“Each of these eight aspects can improve your health and lower your risk of developing heart disease,” she says. “They’re things that may seem intuitive, but delving deeper and paying close attention to each individual component is important to truly lower your risk.”
She says even focusing mainly on these four recommendations can improve your heart health:
Eating healthy—Choose a healthy diet like the Mediterranean or DASH diet. The goal is to eat fresh fruits and vegetables, healthy fats, lean proteins, fat-free or low-fat dairy, and whole grains. Limit salt, sugary snacks and alcohol. A healthy diet can help you lose weight and lower your blood pressure and cholesterol.
Exercise—Try getting at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise every week. Aim for your age-based target heart rate to get the most heart health benefits.
Manage your blood pressure—Normal blood pressure is 120/80 mmHg. Anything above that level is considered elevated and increases your heart disease risk. To lower your blood pressure, avoid alcohol, eat a healthy diet, exercise, get good sleep and quit tobacco.
Monitor your cholesterol—To reduce your heart disease risk, keep the level of your LDL—your bad cholesterol—to less than 100 mg/dL. If you have existing heart disease or have a family history of high cholesterol, try to get your level less than 55 mg/dL. A level less than 70 mg/dL is a good goal, Dr. Radhakrishnan says. A healthy diet, exercise, weight loss and quitting tobacco can help you lower your cholesterol level.
6. Tests can measure your heart disease risk
Understanding your heart disease risk is a big part of protecting your heart health. Dr. Radhakrishnan says knowing your risk can help your doctor determine your best treatment options or care plan.
Your provider can assess your likelihood of developing cardiovascular disease using several tests.
Atherosclerotic cardiovascular disease (ASCVD) risk score—If you’re between 40 and 75, this measurement estimates your risk of having a heart attack or stroke within the next 10 years. Your score will determine if you’re low, medium or high risk. If you’re at medium or high risk, your provider may recommend you start taking a statin to lower your cholesterol.
Coronary artery calcium (CAC) score—This CT scan measures the amount of calcium buildup in your coronary artery. The higher your score, the higher your risk of developing heart disease. This test works well for people who haven’t had previous cardiac events or aren’t experiencing heart disease symptoms.
Lipoprotein(a) (Lp(a)) level—This simple blood test measures the amount of lipoprotein(a) in your blood. Lipoprotein(a) is a specific type of cholesterol that boosts your risk of heart disease and stroke.
7. You can take steps to improve your heart health
Dr. Henry says being proactive is the best way to protect your heart health. To reach this goal, he recommends:
Connecting with a primary care provider
Discussing your ASCVD, CAC and lipoprotein(a) tests and scores during your appointment
Monitoring your blood pressure, cholesterol and weight
“It’s important that you know your risks and are doing whatever you can to prevent heart disease,” he says. “Above all else, it’s very important to advocate for yourself to get the cardiovascular care you need.”
If you’re experiencing chest pain or any symptoms of heart disease that get worse with exercise or activity, call the Women’s Heart Center at 515.585.2140 for an appointment.