What women need to know about their heart health

By Nupur Shah, M.D.
Cardiology Fellow

Heart disease is the leading cause of death in women, exceeding all cancers combined. Unfortunately, only 44% of women are aware of this fact. More than 400,000 women (i.e. 1 in 3 women) die from heart disease every year, and one woman suffers from a heart attack every 90 seconds.

The two biggest challenges that women face when it comes to heart health are lack of awareness and symptom recognition. Women often present with chest pain associated with other non-cardiac symptoms. That leads to a delay in seeking care, and healthcare providers are more likely to attribute these symptoms to non-cardiac causes, thus delaying diagnosis and treatment for heart attack.

One public campaign to spread awareness is Go Red for Women by the American Heart Association. February is American Heart Month, and we celebrate National Wear Red Day during this month to spread awareness about heart health.

Traditional risk factors, including high blood pressure, diabetes, high cholesterol, smoking, and obesity, remain critical to manage, and they can affect both women and men. However, there are many women-specific and women-predominant risk factors that not many women are aware of.

For example, pregnancy-related complications like gestational hypertension, preeclampsia, gestational diabetes, and preterm delivery, can be associated with a two- to four-fold increase in the risk for developing heart disease.

A woman at age 60 can have heart disease due to the pregnancy-related complications that she experienced at the age of 20 or 30. Autoimmune diseases, such as lupus and rheumatoid arthritis, are more common in women, as is anxiety and depression, and these all can increase the risk of developing cardiovascular diseases.

A history of breast cancer, certain breast cancer treatments, early age of menstruation, and premature menopause all place a woman at high risk for developing heart disease.

There is a common misconception that women present with “atypical” symptoms; this is a misnomer that should be abandoned. Rather, women present with “women-specific presentation.” Studies have shown that 90% of women present with typical chest pain, but compared with men, they are more likely to report three or more additional symptoms such as abdominal pain, jaw pain, shortness of breath, excessive fatigue, nausea, and dizziness. Such varied presentation of a heart attack, especially in the presence of risk factors, should be taken seriously with timely diagnosis and treatment.

Spreading awareness will inform more women about women-specific risk factors and women-specific presentation of a heart attack. Both national and international data show that women are treated differently than men in these instances.

Women more often experience a delay in the diagnosis of a heart attack and are less likely to receive timely guideline-based treatment than are men. Women have been underrepresented in clinical studies, with only 38% participation in the year 2020, causing uncertainty about the gender-specific efficacy and safety of evidence-based treatments.

Thus, more women must participate and enroll in research studies and clinical trials. Women and healthcare providers must advocate for increased awareness, enhanced access, and equal delivery of care when it comes to women with heart disease.