What all women should know about heart disease

Heart disease is the cause of one in three deaths among women in the United States each year — a rate that’s more than all forms of cancer combined. Yet most women don't see it coming.

When we picture a heart attack, we imagine crushing chest pain. For women, the warning signs are often more subtle: shortness of breath, flu-like nausea, or even jaw pain. Most heart disease is preventable, but first you need to know what you're up against.

High cholesterol and blood pressure matter for everyone. But women face unique risks that most doctors won't bring up unless you ask.

Had a complicated pregnancy? Conditions like preeclampsia and gestational diabetes significantly increase your heart disease risk later. Many women don't mention pregnancy complications from decades ago, and many doctors don't ask.

"It should come up every time," says Dr. Sharonne Hayes, M.D., professor of cardiovascular medicine at Mayo Clinic. "It should be recorded at least once in your medical history." Even miscarriage, preterm birth, and intrauterine growth restriction increase cardiovascular risk.

Other risk factors that hit women harder include PCOS, autoimmune diseases like lupus and rheumatoid arthritis, early menopause (before age 45), and mental health conditions. Research shows stress, depression, and anxiety affect women's hearts differently.

Conditions like PCOS and autoimmune diseases are often viewed as "reproductive" or "immune" issues rather than "heart" issues, says Dr. Ijeoma Eleazu, M.D., assistant professor of medicine (cardiology) at Emory University School of Medicine. "This is a dangerous disconnect." These conditions can trigger insulin resistance, inflammation, and adverse cholesterol patterns that raise heart disease risk.

Your race or ethnicity may also be a factor. "Cardiovascular disease disproportionately affects Black and Native American women," notes Dr. Ifeoma Onuorah Ezenekwe, M.D., associate professor of medicine at Emory University School of Medicine. Social factors like discrimination and limited healthcare access can accelerate heart disease.

Menopause changes everything for your heart. Estrogen has been protecting your cardiovascular system for decades. When it drops, blood pressure and cholesterol rise, and arteries become less elastic.

Hayes encourages women to "frame menopause as one of those life-track transitions, like puberty or pregnancy, where women often reflect on their health."

"It's very common for 'bad' LDL cholesterol to spike during menopause as estrogen levels drop," says Eleazu. "Estrogen naturally clears LDL from the blood, and with decreased levels, LDL can climb — increasing heart disease risk even if your diet hasn't changed." Make sure you get your cholesterol and blood pressure checked regularly as you approach menopause. 

Hormone replacement therapy (HRT), which helps replace the estrogen that your body is no longer producing, can be a good option for many women — with the obvious added advantage of helping with other difficult symptoms of menopause, like hot flashes and night sweats. Research has shown that women who start HRT within 10 years of their last period have fewer cardiovascular events than those who don’t.

A 2025 study found women get significantly more heart protection from exercise than men — and actually need less to see benefits.

The study tracked over 85,000 adults and found women who exercised 150 minutes per week had a 22% lower heart disease risk than those who did not adhere to the 150 minute guidelines, compared to 17% for men. For a 30% reduction, women needed about 250 minutes per week while men needed 530 minutes.

"The takeaway isn't that women should do less but that every bit of activity counts," says Eleazu. "Even modest, consistent exercise can make a measurable difference in women's heart health, and that is empowering!"

While chest pain is what people think about when they think about heart attack symptoms, almost 45% of people having a heart attack experience no chest pain (these are called silent heart attacks for this reason) — far more common in women.

Women experience symptoms that are less frequently linked to heart attack:

• Unusual fatigue (sometimes days or weeks before)

• Shortness of breath

• Nausea or vomiting

• Shoulder, back, or arm pain

• Anxiety

These often resemble the flu, heartburn, or an ulcer — making them easy to dismiss.

Women are more likely to have heart attacks that don't show up on traditional tests. While men typically experience blockages in major arteries, women are prone to problems in smaller blood vessels (coronary microvascular disease), artery spasms, or spontaneous coronary artery dissection — a tear in an artery wall especially common after childbirth.

"These vessels are extremely small and sometimes microscopic, so they are not visible during standard heart catheterization," explains Ezenekwe. When they don't function properly, they can't deliver adequate blood supply during stress, leading to chest pain and heart attacks.

Standard angiograms often miss these issues. If your ER test is normal but you had heart-attack symptoms, follow up with a cardiologist for specialized tests like a PET scan, heart MRI, or coronary function testing.

1. Get your numbers checked: Know your blood pressure, cholesterol, and blood sugar. If you're approaching menopause or have risk factors, monitor more frequently. Hypertension is particularly critical — it increases stroke, dementia, and heart failure risk.

2. Move your body: Aim for 150 minutes of moderate activity per week. A 2025 review found even 7,000 steps daily can reduce cardiovascular disease risk by 25% compared to 2,000 steps.

3. Eat for your heart: Focus on fruits, vegetables, whole grains, and omega-3s. Limit saturated fats and processed foods.

4. Quit smoking: Smoking increases the risk of coronary heart disease by 30 percent. 

5. Talk to your doctor: Bring up pregnancy complications, even from decades ago. Mention family history and discuss medications. 

"Be your own best advocate," Ezenekwe emphasizes. "Stay informed, speak up, and ask for necessary tests, especially when things don't feel right."

Call 911 immediately. Don't drive yourself or wait to see if symptoms improve.

"Better embarrassed than dead," says Hayes. "We women have to get over our trying to make it comfortable for everyone else." EMS can start care immediately, know which hospital has cardiac capabilities, and alert the cath lab.

Women often delay seeking help while managing family obligations or worrying about overreacting. But every minute counts. You deserve the same medical urgency as anyone else. If something feels wrong, trust your instinct.

Heart disease in women is common, deadly, and too often missed — but it’s also largely preventable. Women face unique risks tied to pregnancy, menopause, autoimmune conditions, and mental health that don’t always show up on standard tests or fit the “classic” heart attack picture. Knowing your personal risk factors, paying attention to atypical symptoms, and advocating for yourself in the exam room can save your life. Heart disease isn’t just a men’s problem — and women deserve to be taken just as seriously, every time.