It's time to get heart smart.

Women & Heart Disease

Heart disease is not a "man's disease." Heart disease is the leading cause of death in women, according to the American Heart Association. Every year, nearly half of all women who die, die from heart disease.

Most women begin to develop heart disease or experience heart complications ten years later than men. This is most likely due to the protective effects of estrogen hormones in pre-menopausal women.

However, women at any age can have heart disease or heart attacks. When other risk factors are present, the protective effects of estrogen are greatly decreased. Women with heart disease tend to be older than men with heart disease, but women have an increased frequency of all heart disease risk factors, except for smoking.

Risk factors for heart disease in women

The good news is that many of the risk factors for heart disease in women can be controlled with lifestyle changes and/or medication. 

Age and heredity

Increasing age and heredity (including race) are two major risk factors for heart disease and stroke that women can't control. As women age, their chance of developing heart disease increases. Approximately four of five people who die of heart disease are 65 or older.

If your family has a history of heart disease, you're more likely to develop heart disease. Risk is higher for African-American women, whose death rate is 69 percent higher than the rate for white women. Women who have had a previous heart attack, stroke, or transient ischemic attack (TIA) sometimes known as a temporary "mini-stroke", also face a greater risk.

Type 2 diabetes

Because women with Type 2 diabetes have high levels of insulin in their bloodstreams, they're more prone to blood clots. This may explain why 75 percent of people with Type 2 diabetes die of heart attacks or strokes. Women with diabetes are three times more likely to die of heart disease than women without diabetes. Type 2 diabetes doubles the risk for a second heart attack in women, but not in men.

Although there is no cure for Type 2 diabetes, women can help control this medical condition by maintaining a healthy weight and exercising regularly. A recent study published in the Journal of the American Medical Association (JAMA) found that women with Type 2 diabetes could reduce their risk for heart attack or stroke by exercising regularly. Based on findings from this long-term CVD risk study of 3,000 people, researchers believe that regular exercise may improve a person's ability to dissolve blood clots and possibly lower the risk for CVD. Exercise makes the body more receptive to the effects of insulin.


During menopause, women stop producing the sex hormone estrogen, which offers some protection against heart disease. In recent years, doctors used hormone replacement therapy (HRT) to restore estrogen to pre-menopausal levels and to reduce a woman's risk for cardiovascular disease (CVD). But because of recent clinical trials, the American Heart Association recommends that HRT should NOT be used to prevent a second heart attack to reduce a woman's risk for CVD.


If you smoke, you're two to six times more likely than a nonsmoker to have a heart attack. Consider these facts:

  • Studies show that the more cigarettes you smoke regularly, the greater your  risk for heart disease.
  • There's a direct link between smoking and atherosclerosis.
  • Smokers who take birth control pills are at the greatest risk for a heart attack  and stroke.
  • Constant exposure to secondhand smoke increases a woman's risk for heart  disease.
  • Smoking also boosts the risk for stroke.


Women with high levels of the chemical homocysteine in their blood may have an increased risk for developing heart disease, stroke, and poor circulation in their hands and feet. Researchers are not sure how high levels of homocysteine affect the heart, but they believe that it damages the arteries, which makes the blood more likely to clot and the blood vessels less flexible. Sometimes high levels of homocysteine run in families; other women may develop the problem after menopause.

If you have a high homocysteine level, ask your doctor for additional information.

A good way to keep your homocysteine levels in check is to eat plenty of foods rich in folic acid (citrus fruits, tomatoes, lentils, beans, and fortified cereals and grains), vitamin B6 (meat, poultry, fish, fruits, vegetables, and grain products), and vitamin B12 (meat, poultry, fish, and dairy products).

High blood pressure

Women with high blood pressure face a greater risk for stroke, heart attack, or heart failure. Although high blood pressure is more common in men, postmenopausal women also have a high risk for developing the condition. In many cases, women can help control their blood pressure by maintaining a healthy weight, limiting alcohol intake to one drink per day, exercising regularly, following a heart-healthy diet, and reducing stress. However, some people may require medications to lower their blood pressure.

Chronic stress

Chronic stress can possibly contribute to heart disease by prompting the body to produce "fight-or-flight" hormones, like adrenaline, that constrict coronary arteries and promote blood clots. The good news is you can help control the stress in your life by eating nutritious foods, getting enough sleep, and exercising on a regular basis. Many women have found relief by taking stress-management courses, as well.


Obesity not only doubles your risk for heart disease and stroke, but it also increases your likelihood for developing diabetes, hypertension and high cholesterol, which all contribute to heart disease. If you're overweight, talk to your doctor about sensible ways to lose weight and eat healthfully.

Body Mass Index

Body mass index, or BMI, is a measure of weight for height. It is used to gauge weight status in adults. Weight status categories include: underweight, normal, overweight and obese.

While the BMI calculator can give you a good indication of your body mass index, it's important to note that BMI varies with age, gender, race and physical build.

High triglyceride/cholesterol levels

Women can reduce their risk for heart disease by controlling their triglyceride levels (levels of the most common type of fat in our bodies). About 25 percent of American women have high cholesterol levels (240 mg/dL or above), and more than half of women over age 55 in the United States need to lower their blood cholesterol. This waxy substance can cause hardening of the arteries (atherosclerosis), the major cause of heart attacks.

Although excess weight tends to increase your blood cholesterol level, heredity and diet also contribute to the condition. High cholesterol can run in families, and a diet high in saturated fat and cholesterol can cause high blood cholesterol levels. The good news is that you can lower your blood cholesterol levels and, in turn, slow, stop, or even reverse buildup in the arteries by adopting a healthy lifestyle. (For more information, see the section on Cholesterol Management.)

The deadly quartet

Obesity, diabetes, high blood pressure, and high triglyceride levels are sometimes called "the deadly quartet." According to a recent study, women are more likely to die if they have only one of the four risk factors, but women with all four have 5 times the risk for death as men with the "deadly quartet." Additionally, women with this combination are up to 12 times more likely to die than men during the first 10 years following coronary bypass graft surgery.

Physical exercise

Because the heart is a muscle, its performance improves with exercise. Regular exercise helps prevent heart attack and stroke by lowering blood pressure and low-density lipoprotein cholesterol (LDL, the bad kind). Exercise also makes blood vessel walls more flexible and, in turn, helps prevent hardening of the arteries and may help raise HDL cholesterol (the good kind.)

Danger signals

Because many women don't even know that they have heart disease, it's important to know the warning signs and when it's time to see your doctor. If you know what symptoms to look for, you can work with your physician to treat them early.

Nausea, fatigue and shortness of breath are some symptoms of heart disease in women, but they can also signal anxiety or stress.

Warning signs in women

If you experience signs of a possible heart attack, call 911 immediately.

  • Uncomfortable pressure, fullness, squeezing or pain in the chest that lasts more than a few minutes, or goes away and comes back
  • Pain that spreads to the shoulders, neck, jaw or arms
  • Chest discomfort may also be experienced in the upper back between the shoulder blades
  • Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath

Less common signs in women:

  • Chest pain, stomach or abdominal pain
  • Unexplained weakness, fatigue or anxiety
  • Palpitations, cold sweat or paleness
  • Shortness of breath (often associated with the signs listed above)

Because women's symptoms are often misdiagnosed, they're far less likely to be treated with statins, aspirin, beta-blockers and other heart-attack prevention medications. Cardiac catheterization tests are ordered at a much lower rate for women than for men.

Your best defense is knowledge. Learn about your own heart health and take an active role in your health care and make an appointment with your physician to learn more about the care and treatment of your own unique heart. It's a move that quite simply could save your life.