Heart disease is still the leading cause of death for women in the United States, causing more deaths each year than all cancers combined. Yet many women don't recognize the risk, or the symptoms, until something serious happens.
"We often see patients who are surprised by their diagnosis," says Miret Ibrahim, MD, a cardiologist and Medical Director of Echocardiograms at Lowell General Hospital. "There's still a gap between perception and reality when it comes to heart disease in women."
The good news is that heart disease is often preventable. Prevention starts with understanding your risk and taking action early.
Why women are at risk
Your risk of heart disease increases with age, especially after menopause. But plaque buildup in the arteries—known as atherosclerosis—can begin much earlier.
"Atherosclerosis can begin in your 20s or even sooner," says Dr. Ibrahim. "It's a slow process, which means there's a real opportunity to prevent problems later in life."
Risk factors unique to women
- Postmenopause
- History of hysterectomy
- Use of oral contraceptives
- Pregnancy complications such as gestational diabetes, preeclampsia or eclampsia
Risk factors for everyone
- High blood pressure
- High LDL ("bad") cholesterol or low HDL ("good") cholesterol
- Type 1 or type 2 diabetes
- Chronic kidney disease
- Smoking (past or present)
- Little or no physical activity
- Obesity
- High-fat diet
- Chronic stress
- Family history of early heart disease
Know your numbers
Understanding your risk starts with a few key health metrics.
Talk with your clinician about checking:
- Total cholesterol
- LDL ("bad") cholesterol
- HDL ("good") cholesterol
- Triglycerides
- Blood pressure
"These numbers help us predict risk long before symptoms appear," says Dr. Ibrahim. "They give us the chance to prevent heart attacks instead of reacting to them."
What your numbers should be
General heart health targets for women include:
- Blood pressure: below 120/80 mm Hg
- LDL ("bad") cholesterol: under 100 mg/dL (lower if you're high risk)
- HDL ("good") cholesterol: 50 mg/dL or higher
- Triglycerides: under 150 mg/dL
- Total cholesterol: under 200 mg/dL
"We don't look at numbers in isolation," Dr. Ibrahim explains. "Your overall risk determines what goals are right for you."
When to get checked
- Blood pressure: at least once a year, more often if elevated
- Cholesterol: every 4 to 6 years starting in your 20s, more often with risk factors
- Blood sugar: every 3 years starting at age 35, or earlier if at higher risk
If you have high blood pressure, diabetes or a family history of heart disease, your doctor may recommend more frequent screening.
"Screening should be personalized," says Dr. Ibrahim. "Your risk factors guide how often you should be checked."
Heart disease myths women should know
Even with growing awareness, a few persistent myths still keep women from recognizing their risk.
Myth: Heart disease mostly affects men
Fact: Heart disease is the leading cause of death for women in the United States.
"Many women still think of heart disease as a 'man's disease,'" says Dr. Ibrahim. "That misconception can delay diagnosis and treatment."
Myth: You'll always have chest pain
Fact: Women often have different, more subtle symptoms.
These can include fatigue, shortness of breath, nausea, or pain in the jaw, back or arm.
Myth: You're not at risk if you're young
Fact: Heart disease can start developing early in life.
"Atherosclerosis can begin decades before symptoms appear," says Dr. Ibrahim. "That's why prevention should start early."
Myth: A healthy lifestyle means you don't need screenings
Fact: Even healthy people can have high cholesterol or high blood pressure.
"Screening helps us catch silent risk factors," Dr. Ibrahim explains. "You can feel fine and still be at risk."
Heart disease symptoms in women
Symptoms of heart disease in women aren't always obvious. While chest pain is common, women are more likely than men to have subtle or atypical symptoms.
Watch for:
- Chest discomfort or pressure
- Shortness of breath
- Unusual fatigue
- Nausea or lightheadedness
- Pain in the jaw, neck, back or arm
"Women's symptoms can be easier to overlook," says Dr. Ibrahim. "That's why it's important to pay attention to changes in how you feel."
How to lower your risk
There's no single fix for heart disease, but small, consistent changes can make a big difference.
Maintain a healthy weight
Excess weight increases your risk for high blood pressure, high cholesterol and diabetes. Even losing 5% to 10% of your body weight can improve heart health.
"You don't have to aim for perfection," says Dr. Ibrahim. "Even modest changes can have a real impact."
Quit smoking
Smoking more than doubles your risk of heart attack by damaging blood vessels and increasing clot risk.
Get regular physical activity
Aim for at least 150 minutes of moderate activity or 75 minutes of vigorous activity each week. Exercise helps raise HDL cholesterol, lower LDL cholesterol and improve circulation.
Choose healthier fats
Replace saturated fats with healthier options like olive oil or canola oil. Limit:
- Full-fat dairy
- Fatty meats
- Processed foods
Eat more fruits and vegetables
Aim for about 2 cups of fruit and 3 cups of vegetables daily. Diets rich in produce are linked to lower blood pressure and reduced heart disease risk.
Increase fiber intake
Soluble fiber helps lower LDL cholesterol. Good sources include oatmeal and whole grains.
Drink alcohol in moderation
For women, moderation means up to one drink per day.
The bottom line
Heart disease in women is common, but it's often preventable.
"The earlier you start focusing on heart health, the more control you have over your future," says Dr. Ibrahim.
Know your numbers. Recognize the symptoms. Make small, consistent changes. Those steps can make a lasting difference in your heart health.
Find expert heart care close to home. Schedule an appointment with a Tufts Medicine heart specialist today.
