Heart disease is the leading cause of death for women in the United States, but research shows that 44% of women aren’t aware of their potential risk. Nandita Scott, MD, a Mass General Brigham cardiologist, describes how heart disease can be different for women than men, and how women can lower their risk of developing it. Dr. Scott is co-director of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital, where she treats patients with heart disease.
“Heart disease can affect women uniquely and at all ages,” explains Dr. Scott. “Both patients and their providers often have a lower suspicion for heart disease. It’s therefore important for women to advocate for themselves.”
Women are more likely than men to have symptoms of chest pain without having traditional obstructive disease, like coronary artery disease, where the arteries are blocked or narrowed from the buildup of plaque. Plaque is made up of cholesterol, fats, and other substances.
Instead, chest pain in women can be caused by heart attacks that aren’t caused by blocked arteries. Women also may have chest pain when the heart doesn’t receive enough blood flow, or when they have heart spasms due to emotional stress or from cold temperatures. For example, cold weather can affect heart health in winter.
Women are more likely than men to have problems with their arteries tearing, like spontaneous coronary artery dissection (SCAD). They’re also more likely to develop broken heart syndrome (Takotsubo cardiomyopathy). These forms of heart attack are more likely to occur in women and can occur in response to extreme stress.
Women may experience the common symptoms of heart disease, including:
Chest pain or discomfort (also known as angina)
Pain in the neck, jaw, arms, or back
Women also may have other symptoms that are less well-known as a sign of heart disease:
“Regardless of age, any time a woman has symptoms to support a heart event, such as chest pain or pressure that does not resolve, she should call 911. The emergency room is available to ensure you’re not having a serious cardiac event. It’s much better to find out nothing is wrong than to sit at home with a heart attack,” says Dr. Scott.
Certain medical conditions, personal or family health histories, and lifestyle factors can increase the risk of heart disease, including:
High blood pressure or hypertension
Rheumatoid arthritis (RA)
“There are conditions that are unique to women that can increase cardiac risk, including history of high blood pressure during pregnancy, diabetes during pregnancy, preeclampsia, as well as going into menopause before the age of 40,” says Dr. Scott. “Rheumatologic conditions, such as lupus and rheumatoid arthritis, are also more common in women and can increase your risk for heart disease.”
Starting menopause before age 40
Family history of early heart disease (mother or sister with a cardiac event before age 65, or father or brother before age 55)
High alcohol consumption or alcohol use disorder
Eating a diet high in saturated fats, cholesterol, trans fats, and salt
“Heart disease is truly preventable. There is so much data to support the benefits of healthy eating, exercise, stress management, and adequate sleep on reducing risk,” says Dr. Scott.
Women should familiarize themselves with the symptoms of heart disease, and reach out to their doctor if they are experiencing anything of concern. It’s also important that women try to keep an eye on their mental health, including anxiety and depression, and manage their stress levels.
“There is a definite connection between the brain and the heart. Taking care of your mental health and managing your stress can also reduce your risk for heart disease,” Dr. Scott says.