Cardiovascular Disease in Women

Heart disease in women refers to coronary artery disease (blockages in the heart’s arteries) or other heart conditions that affect females. Heart disease is the No. 1 cause of death both for women and men in the U.S. and around the world.

Image content: This image is available to view online.

View image online (https://assets.clevelandclinic.org/transform/a9060f41-efc7-4b75-a9f1-41b787e9b3cc/Heart-disease-in-women)

Women have many unique risk factors that can vary by their age and stage of life. These are in addition to the traditional risk factors that apply to everyone, like high blood pressure, high cholesterol, diabetes and tobacco use.

For a long time, common wisdom held that women were less likely to get heart disease or have a heart attack. Today, we know that’s simply not true, and there’s growing awareness of how heart disease can affect women.

Sex-specific differences that can affect the heart

Women and men share a lot in common when it comes to heart disease. But there are some key differences worth knowing about — including risk factors unique to women and certain symptoms that women are more likely to experience. These stem from sex-specific differences in the cardiovascular system, including:

• Anatomy: Females have smaller blood vessels and heart chambers. The walls of their ventricles (pumping chambers) are also thinner.
• Blood count: Females have fewer red blood cells. As a result, they can’t take in or carry as much oxygen at any given time.
• Cardiovascular adaptations: Changes in altitude or body position (like quickly standing up after lying down) are more likely to affect females. These changes can lead to sudden drops in blood pressure.
• Hormones: Estrogen and progesterone levels are typically higher in females, while testosterone is higher in males. These hormones can impact many aspects of your heart health and overall health.

Heart attack symptoms in women

A heart attack is a medical emergency in which blood flow to your heart suddenly drops. Chest pain or discomfort is the most common symptom of a heart attack for everyone. But women are more likely to have some other type of symptom, in addition to chest pain (or instead of it). They’re also more likely to have a silent heart attack.

A heart attack in women may feel like pain or discomfort in their:

• Chest (most common)
• Left breast
• Back or between their shoulder blades
• Neck or throat
• Jaw or teeth
• Arms (one or both)
• Shoulders

In addition to those symptoms, women experiencing a heart attack may also have:

• Unusual fatigue (most common)
• Shortness of breath
• Feeling dizzy or faint
• Feeling hot or flushed
• Indigestion
• Fast heart rate
• Numbness in their hands or fingers
• Nausea or vomiting
• Choking sensation

If you have any of these symptoms without another known cause — and especially if you have more than one symptom — call 911 or your local emergency number right away.

It’s also important to stay alert to early warning signs of a heart attack, which can affect both women and men. Some warning signs include unusual fatigue and fleeting episodes of chest pain.

What causes heart disease in women?

Women and men share many of the same cardiovascular disease causes. But there are some differences depending on the specific type of heart disease.

For example, a common cause of heart attacks for everyone is plaque buildup in the heart’s blood vessels. This plaque can rupture, leading to a blood clot that obstructs blood flow to your heart muscle. But women often have heart attacks even without severe coronary blockages. In those cases, common causes include:

• Coronary artery spasm: A severe, reversible tightening of your heart’s arteries
• Coronary microvascular disease: Problems with the small vessels that branch off from your coronary arteries
• Spontaneous coronary artery dissection: A separation or tear in a coronary artery wall that occurs without warning
• Broken heart syndrome: Rapid weakening of your heart muscle that happens after sudden physical or emotional stress

There are also sex-specific differences in the causes of heart failure. Some research shows that the risk of developing heart failure due to high blood pressure (hypertension) is greater for women than for men. This means diagnosing and treating high blood pressure in women is especially important for preventing long-term heart damage.

What heart disease risk factors are unique to women?

Women and men share many risk factors in common, like high blood pressure, high cholesterol and diabetes. But factors unique to females include:

• Menopause: Estrogen helps reduce your risk of heart disease. But natural menopause or surgical removal of your ovaries makes your estrogen levels drop. This raises your risk of blood clots, high cholesterol and atherosclerosis.
• Preeclampsia: Preeclampsia while pregnant greatly raises your risk of developing hypertension and/or diabetes later in life. It also raises your risk of having a stroke or dying from heart and blood vessel disease.
• Gestational diabetes: This common pregnancy condition raises your lifetime risk of developing diabetes or cardiovascular disease.
• Peripartum cardiomyopathy: This is a weakening of your heart that’s associated with pregnancy. It can lead to serious complications, like heart failure or death.
• Polyendocrine metabolic ovarian syndrome (PMOS): Having PMOS raises your heart disease risk. Women with this common condition often develop individual risk factors, like diabetes, high blood pressure, high cholesterol and sleep apnea.
• Use of hormone replacement therapy (HRT): HRT for the treatment of menopause may increase a woman’s cardiovascular risk, depending on her age and personal medical history. It’s best to discuss this risk with your physician.
• Use of oral contraceptive therapy: Taking “the pill” may raise your risk for heart disease if you have other risk factors, like obesity or tobacco use.

How are testing and treatment for heart disease different for women?

Some aspects of testing and treatment for cardiovascular disease are different for women. For example:

• Sometimes, rather than having a large piece of plaque, an artery contains a smooth layer of plaque. This happens more often in females. A coronary angiogram can’t always catch this type of plaque. So, if you have symptoms and get tested, the results may come back fine. In this case, you need more tests to identify the cause of your symptoms.
• Females are more likely to have ACE inhibitor intolerance.
• Statins reduce cholesterol levels for everyone, but females may be more likely to develop side effects. However, true side effects due to statins remain very rare, including in females.

It’s important to talk with your provider about your risks, symptoms, test results and responses to medication. Sex-based differences are sometimes less important than individual differences due to our unique medical histories and social environments.

How can women prevent cardiovascular disease?

Many heart disease prevention tips apply to both women and men — but there are some unique to women. Here are some steps you can take:

• Visit your healthcare provider for yearly physical exams.
• Ask for a referral to a preventive cardiologist, even if you’re young and feel healthy. It’s never too early to start the conversation.
• Learn if you have any risk factors for heart disease and talk to your provider about ways to manage them.
• Ask your provider how sex-specific risk factors, like having preeclampsia while pregnant or going through menopause, might affect your heart.
• Talk to your provider about the form of contraception that’s right for you, including any risks to taking “the pill.”
• Make an exercise plan that works for you (after checking with your provider).
• Avoid tobacco products and limit alcohol.
• Follow a heart-healthy eating plan, like the Mediterranean diet.
• Take medications to manage high blood pressure, high cholesterol and other heart disease risk factors as your provider prescribes them.