When you picture someone having a heart attack, a man might pop to mind first. That’s understandable. It’s a widely held belief that cardiovascular disease affects more men than women. But that’s a misconception.
Heart disease is just as common in women. However, it shows up in different ways that aren’t as well known. That means women frequently have undiagnosed heart conditions, and they don’t always know when they’re having a cardiac event like a heart attack.
Knowing how to identify the signs of a heart attack or other potential heart problems is vital to protecting your heart health and quality of life, says Shree Lata Radhakrishnan, MD, a cardiologist who specializes in women’s cardiovascular health with The Women’s Heart Center at The Christ Hospital Health Network. Here, she explains what to look for and when to seek help.
How common is heart disease in women?
According to the Centers for Disease Control & Prevention, more than 60 million women in the United States have some form of heart disease. It leads to roughly 310,000 deaths among women every year.
Heart disease is more common than other conditions frequently linked to women, Dr. Radhakrishnan says. That includes breast cancer.
“Heart disease is very common in women. Just like men, it’s the number one killer of women in the United States,” she says. “Most people think that breast cancer is the top killer of women. But heart disease causes one in five female deaths. Breast cancer causes one in eight deaths each year.”
What heart disease risk factors affect women?
Women experience many of the same risk factors for heart disease as men, including:
- Diabetes
- High blood pressure (hypertension)
- High cholesterol
- Lack of exercise
- Obesity
- Poor diet
- Stress
- Genetic history
- Tobacco use
But women also face some risk factors that are uniquely related to two specific phases of their lives—pregnancy and menopause. During pregnancy, complications like hypertensive disorders of pregnancy including pre-eclampsia, gestational diabetes or premature labor can lead to chronic high blood pressure, type 2 diabetes and even coronary artery disease or stroke.
Dr. Radhakrishnan says menopause also increases your vulnerability to heart disease later in life due to hormonal changes, leading to hypertension, diabetes, and a change in body fat distribution.
“Menopause is a very distinctive point of life where a woman’s risk factors for heart disease tend to accelerate,” she says. “You’re going to be at high risk of developing the individual risk factors that eventually lead to heart disease like hypertension, high cholesterol and diabetes. So, having specialized care that focuses on this stage of life in women is crucial.”
How do heart attack symptoms appear in women?
While chest pain and chest discomfort are common signs of a heart attack in women, women don’t always experience those extreme symptoms. So, don’t let those signs be your only litmus test for this cardiac event, Dr. Radhakrishnan says. Your symptoms may be subtle and mimic other problems like heartburn or acid reflux.
“Not having chest pain doesn’t necessarily mean you’re not having a heart attack,” she says. “While chest pain is still the most common presentation, women are more likely to have other symptoms like trouble breathing, jaw pain, indigestion, nausea or vomiting.”
Other common heart attack symptoms in women include:
- Anxiety
- Cold sweats
- Dizziness
- Fatigue
- Shortness of breath
Dr. Radhakrishnan recommends paying attention to when and how your symptoms appear. Mild pain that is reproducible to palpation or upper body movement is unlikely to be related to your heart. However, you should seek medical care if your chest pain is persistent and if it appears with any other pain in your upper body or shortness of breath.
Are women at greater risk for certain heart conditions?
Heart disease can affect anyone. But women experience some heart conditions more often, Dr. Radhakrishnan says.
There is a spectrum of conditions under the blanket term Non-Obstructive Coronary Artery Disease where your arteries are not blocked, yet they can be diseased. Some presentations in this category include:
Angina with non-obstructive coronary artery disease (ANOCA) that can cause severe chest pain despite seemingly normal coronary arteries.
Ischemia with non-obstructive coronary artery disease (INOCA) where your heart is deprived of oxygen or blood flow despite no significant blockages in the arteries.
Myocardial infarction with non-obstructive coronary artery disease (MINOCA) where you have a heart attack despite no blockages.
The specialists at The Christ Hospital Women’s Heart Center also treat women for:
Coronary Microvascular Disease and coronary vasospasm: These conditions can produce a range of cardiac symptoms without any blockages to your main arteries on imaging exams. In coronary microvascular disease, the disease process is in your smaller blood vessels. In coronary vasospasm, your arteries tend to temporarily narrow down for unknown reasons. To diagnose these conditions, we use specialized stress tests or coronary reactive testing, a procedure that uses special medications to narrow your blood vessels to see how they respond to these stressors.
Spontaneous Coronary Artery Dissection: This condition occurs when a tear causes blood to flow between the layers of one of your coronary arteries.
Myocarditis: An inflammation in the muscle of the heart
Takotsubo Cardiomyopathy: With this condition, also called “Broken Heart Syndrome,” the heart muscle temporarily weakens in response to physical or emotional stress.
Ways to prevent and treat heart disease
Practicing healthy lifestyle behaviors is one of the best ways to protect your heart and prevent heart disease, Dr. Radhakrishnan says. She recommends:
The Women’s Heart Center also offers a preventive cardiology program for women with risk factors who haven’t yet had a heart attack or stroke. But treating heart disease goes beyond prevention. That’s why the Women’s Heart Center offers several other specialized heart care programs. The programs focus on:
Coronary microvascular disease: Treatment for women who have blockages in their small arteries
Cardio-obstetrics: Heart care for women who have pregnancy-related or peri-partum complications linked to a heart condition or risk factors
Preventative cardiology: Focusing on primary or secondary prevention of atherosclerotic cardiovascular events like heart attacks and strokes
What should you ask your doctor about heart disease?
Dr. Radhakrishnan recommends talking to your primary care doctor about your heart health as early as possible—especially if heart disease runs in your family or you have risk factors. If you are between 40 and 75 years of age, your doctor can help you determine your atherosclerotic cardiovascular disease (ASCVD) score. This number estimates how likely you are to have a cardiac event in the next 10 years.
“Depending on where your score falls, your doctor may recommend lifestyle modifications or medications like statins to help treat your heart disease,” she says. “Knowing your risk is helpful to understanding the state of your health. So, if you have specific symptoms, don’t ignore them. It never hurts to ask your doctor about any problems you’re having.”
Ultimately, she says, women should remember one fundamental truth to protect their heart health.
“As mothers, daughters, caretakers, and members of the workforce, we tend to put others first and ourselves last,” she says. “As a woman, you are also at risk for developing heart disease. Advocate for yourself and make time to take care of yourself! Be sure to check with your doctor about any symptoms or risk factors you have.”