Caring for Her Heart: How Cardiovascular Disease Looks Different in Women

Cardiovascular disease (CVD) is the leading cause of death among women in the United States, yet many aren’t aware of this sobering statistic. Despite the fact that about 44% of the female population (more than 60 million women) are living with some form of cardiovascular disease—only about half of U.S. women recognize heart disease as their number one health threat.

The Minneapolis Heart Institute Foundation (MHIF) established the Penny Anderson Women’s Cardiovascular Center to help raise awareness of heart health in women. Understanding how heart disease affects women—often in different ways than men—is essential for prevention, early detection, and effective care. Here are some important things to know about risks and symptoms of cardiovascular disease in women.

Let’s start by defining heart disease

It generally refers to problems that affect the heart and blood vessels. Heart disease encompasses many conditions, including stroke, heart attack, arrhythmias, heart failure, heart valve disease, coronary artery disease and more.

In the case of coronary artery disease, important differences between men and women emerge. Women often have smaller arteries, which can make blockages harder to treat. Women also commonly present with different patterns of plaque buildup. Men’s plaque calcifies or hardens over time, making it easier to see on imaging. On the other hand, women’s plaque is often softer and may not show up as clearly on standard imaging. Women also tend to have more diffuse disease, a subtype of coronary artery disease in which larger sections of coronary arteries have a high plaque buildup, throughout the smaller vessels in the heart instead of the major coronary arteries. This can complicate diagnosis and delay treatment. Even though the blockage may look less severe, the outcomes can be just as serious.

Symptoms

Chest pain is the number one symptom of heart attack in men and women. Women may also have additional symptoms of a heart attack. While classic heart attack symptoms—like severe chest pain; jaw, neck, or back pain; nausea and shortness of breath do occur in women, they may also experience:

Chest discomfort (not always severe)
Indigestion
Fainting
Extreme fatigue
A sense that “something isn’t right”

Because these symptoms can be subtle or associated with something else, women may delay seeking care. To make matters worse, research shows that women who arrive to the emergency room with heart symptoms are less likely to be treated as a medical emergency. They are less likely to receive an electrocardiogram, cardiac monitoring, cardiologist consultation or hospital admission when they do seek help. This makes self-advocating crucial.

Understanding Your Risk

One way women can better advocate for themselves is by understanding their related health risks. High blood pressure, high LDL (“bad”) cholesterol, diabetes, and obesity increase heart disease risk for everyone. However, studies show that women with these risk factors often have a higher likelihood of cardiovascular disease than men with the same conditions. For example, type-2 diabetes can double or even triple a woman’s risk of heart disease.

Certain conditions and life events specific to women are also linked to increased cardiovascular risk. These include starting menstruation before age 10, polycystic ovary syndrome (PCOS) and use of fertility treatments may all increase risk.

For women who experience pregnancy, certain complications—such as pre-eclampsia, gestational diabetes, gestational hypertension, preterm birth or delivering a baby that is small for its gestational age—are also associated with a higher risk for cardiovascular problems. While these issues may seem temporary, they can serve as early warning signs of increased heart disease risk in the future.

Finally, menopause plays a role in increasing CVD risk, especially if you experience early menopause (before age 50). Many shifts in the body occur during menopause related to declining estrogen levels, including shifts in body fat distribution, impaired blood sugar regulation, elevated LDL cholesterol and higher blood pressure.

Next Steps

If you, or a woman you care about, have any of these risk factors in your health history, it's important to share this information with your healthcare provider and ask about steps to reduce your cardiovascular risk. The more women understand their personal risk—and take actions to manage it—the better their chances of preventing serious events like heart attack and stroke.

Each year, the MHIF hosts Hope, Health, & Heart, an event to raise women’s heart health awareness that supports the Penny Anderson Women’s Cardiovascular Center. This year’s event features a panel of experts to share heart-healthy knowledge - tickets are still available for this evening of learning and inspiration on August 12th. It’s one more way MHIF is working to empower women with the vital information needed to prevent and manage heart disease.