A lot of people believe that heart disease primarily affects men. Many also believe that cancer is the top cause of U.S. deaths and that heart attacks always involve crushing chest pain.
They are wrong.
Heart disease is the leading cause of death in the U.S., yet fewer than half of women recognize it as their greatest health threat. Among the most alarming trends: The number of women 35 to 54 experiencing heart disease and heart attacks is increasing.
For decades, heart attack death rates declined sharply, thanks to improved research, standardized treatment guidelines and widespread use of effective medications and procedures. While heart attack deaths are still much lower than they once were, the increase in heart problems among younger adults is worrying.
Multiple factors are driving this shift. Low levels of physical activity and high levels of sedentary behavior are major contributors, along with the growing diabetes and obesity epidemic, socioeconomic stressors, and environmental factors such as poor air quality, natural disasters and other influences.
Still, there is good news: Heart disease is largely preventable. And for women in particular—who may not experience obvious symptoms or whose symptoms are subtle—knowledge is a powerful prevention tool.
Here are five things every woman needs to know to protect her heart.
More women die of cardiovascular disease than all cancers combined
Heart disease is the No. 1 killer of women in the U.S., causing one in three deaths each year. While men tend to develop cardiovascular disease earlier, women are more likely to experience poorer outcomes.
Historically, younger women with heart disease were less likely to receive evidence-based treatments such as statins and more likely to be told they were “too young” to have heart disease—or simply advised to lose weight. These delays and dismissals have had serious consequences.
Landmark research, including the Women’s Ischemia Syndrome Evaluation (WISE) study, which I led for the National Institutes of Health/National Heart, Lung, and Blood Institute, helped reveal how heart disease often presents differently in women and prompted important changes in diagnostic and treatment guidelines. Despite these advances, women with heart disease are still more likely to be misdiagnosed, underdiagnosed or undertreated—sometimes delaying care that could save their lives. Knowledge can help women advocate for themselves.
Women often experience different heart attack symptoms than men
The so-called “Hollywood heart attack”—tingling in the left arm that leads to sudden, crushing chest pain—is common in men and can occur in women as well. But many women experience subtler symptoms, including shortness of breath, nausea, unusual fatigue, back or jaw pain, or chest discomfort that doesn’t feel severe or dramatic.
Because these symptoms don’t match common expectations of a heart attack, they also have historically been overlooked or minimized. If you experience any of these symptoms, seek medical attention immediately.
Heart attacks can occur even if your arteries are clear
An increasing number of heart attacks are occurring in people without significant blockages in the major coronary arteries, a pattern seen more often in women. While men’s heart disease more commonly involves blockage of large arteries, women are more likely to experience dysfunction of the heart’s smaller blood vessels. This condition can lead to ischemia—a critical reduction in blood flow to tissues or organs—with no obstructive coronary artery disease, or INOCA.
Even women who are physically fit can develop INOCA. In the past, if a woman had heart attack symptoms but a “normal” angiogram that showed clear major arteries, her condition might not have been recognized. Continued awareness and ongoing education around INOCA are helping clinicians better diagnose and treat these patients.
Heart disease develops silently over time
By the time someone has a heart attack, the disease process may have been underway for a decade or more. While heart disease can be managed with highly effective treatments, the most powerful strategy is prevention.
An estimated 80% of heart disease cases are preventable with lifestyle modifications. These include staying current with annual health screenings and knowing cholesterol, blood pressure and blood sugar levels, exercising at least 30 minutes daily, getting up from sitting throughout the day (a sedentary lifestyle is considered as strong a risk factor as smoking), managing stress, getting seven to nine hours of sleep, avoiding smoking and maintaining a nutritious diet.
Also, certain life stages and conditions unique to women, such as pregnancy and menopause, can affect long-term cardiovascular risk and should be discussed with a healthcare provider.
Prevention is about good habits, not deprivation
A Mediterranean, plant-based diet emphasizing fruits, vegetables, nuts, beans, whole grains, healthy fats such as olive oil and lean proteins is recommended for heart health. Think of it as a diet of freshness, abundance, color and beautiful foods. Parents are encouraged to help ensure their children make healthy food choices, too.
Heart health isn’t about deprivation—it’s about building habits early that can prevent disease down the road.
C. Noel Bairey Merz, M.D., is director of the Barbra Streisand Women’s Heart Center, the Linda Joy Pollin Women’s Heart Health Program, the Erika J. Glazer Women’s Heart Research Initiative and the Preventive Cardiac Center in the Smidt Heart Institute at Cedars-Sinai. She also is professor of Medicine and the Irwin and Sheila Allen Trust Chair in Women’s Health Research at Cedars-Sinai.
