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. Malissa J. Wood, 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. Wood 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 at all ages, including younger women,” explains Dr. Wood. “Women are often the glue of their families, and they may not prioritize their own health. If they’re caring for young children or a sick relative, they often wait to get their chest pain checked out.”
Women are more likely 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 cold temperatures.
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 also can have the more traditional forms of heart disease found in men, especially if they have certain risk factors like:
Women may experience the common symptoms of heart disease, including:
Women also may have other symptoms that are less well-known as a sign of heart disease:
“Regardless of age, anytime a woman feels new onset of pressure or squeezing tightness that isn’t going away, they need to call 911,” Dr. Wood says.
Certain medical conditions and lifestyle factors can increase the risk of heart disease, including:
“If a woman has a history of preeclampsia, gestational diabetes, or hypertension during pregnancy, those are all associated with an increased risk of early heart disease,” says Dr. Wood.
Early-onset menopause, occurring before age 42, is also associated with a higher risk of heart disease. “It’s important to tell your doctor if you’ve had any of those conditions, even if they don’t ask,” Dr. Wood explains.
“Patients often don’t realize what a difference lifestyle changes can make in preventing heart disease,” says Dr. Wood. “Exercising, taking your medications, controlling your blood pressure and your blood sugar, watching your cholesterol, getting adequate sleep—all can decrease the risk significantly.”
Women should also 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 and manage their stress levels. “Behavioral health strongly interacts with cardiovascular health,” Dr. Wood says. “The links between stress, depression, anxiety, and cardiac disease are very strong in women. Don’t be ashamed to ask for help when you need it.”