10 Heart Health Facts Specific to Women That Might Surprise You  

This Valentine’s Day, we want to help you take care of your heart – and that starts with recognizing that many aspects of heart disease (and treatment for heart disease) are unique to women. Read on for ten heart health facts that might surprise you.  

1.) Heart disease is the #1 cause of death for American women.

According to the Centers for Disease Control and Prevention (CDC), heart disease was responsible for the deaths of about 1 in every five women in 2021, yet “only about half (56%) of US women recognize that heart disease is their number 1 killer. [1] ”     

2.) Three common types of heart disease in women are coronary artery disease (#1 cause of death), arrhythmia, and heart failure.

Coronary artery disease refers to the build-up of plaque in the walls of the arteries. The risk for coronary artery disease increases after menopause. An arrhythmia occurs when a heart beats irregularly, too fast, or too slow. Heart failure happens when the heart is weakened and unable to pump a sufficient amount of blood throughout the body [1].      

3.) Some women with heart disease experience NO symptoms, while others experience multiple symptoms. 

Symptoms can include angina (dull or heavy chest discomfort/ache), pain in the neck, jaw, throat, upper abdomen, or back, nausea, vomiting, and tiredness that doesn’t go away. Possible signs of a heart attack include chest pain or discomfort, back and neck pain, indigestion, heartburn, nausea, vomiting, excessive tiredness, dizziness, shortness of breath, chest palpitations or a fluttering feeling in your chest, swelling of feet, ankles, legs, or abdomen, sweating, pain between shoulder blades, and unexplained sleep disturbances.1-2 This list is not exhaustive. Again, some women may not experience any symptoms or different symptoms than what is listed here. It’s also worth noting that heart disease symptoms may present differently in women than in men, which can result in misdiagnosis or delayed diagnosis [9]. Additionally, these symptoms can be ignored or dismissed by medical providers since they can mimic what women experience during and post-menopause. 

4.) High blood pressure (also known as hypertension) is a primary risk factor for heart disease.

High blood pressure is defined as 130/80 mm Hg or higher or if someone is taking blood pressure medication. High blood pressure is a risk factor for heart disease and stroke. The CDC documents that it is underdiagnosed in women (only about 1 in 4 are successfully managing their high blood pressure). Racial disparities for high blood pressure have been found, with Black women 60% more likely to have high blood pressure compared to White women. Women who experience high blood pressure while pregnant are 2x more likely to develop heart disease later in life [1].  

5.) Medical conditions and lifestyle choices can increase risk of heart disease.

Some of these include diabetes, excess weight, high low-density lipoprotein (LDL) cholesterol, smoking, drinking too much alcohol, stress, an unhealthy diet, and a sedentary lifestyle. Additional risk factors associated with menstruation and pregnancy include early menarche (first period before age 11), early menopause (before age 40), polycystic ovarian syndrome (PCOS), gestational diabetes, preterm delivery, and delivery of a low birth weight or high birth weight baby.1 Experts note that after menopause, women may be more vulnerable to cardiovascular disease (CVD) risk factors [10].

Modifiable risk factors involve monitoring your blood pressure and managing high blood pressure through diet, exercise, stress management, and/or medication; managing diabetes; quitting smoking; limiting your alcohol intake (1 drink or less per day); monitoring your cholesterol and triglycerides; engaging in at least 150 minutes of moderate physical activity per week; finding ways to manage stress, such as through mental health counseling, support groups, social engagement, meditation or other relaxation strategies, or exercise; and consuming a healthy diet [1].

6. Women with atherosclerotic cardiovascular disease (ASCVD) are more likely to report poorer patient-reported outcomes compared to men.

A study published in the Journal of the American Heart Association in 2018 found that women with ASCVD were more likely to report poor patient-provider communication, lower health care satisfaction, poor perception of health status, and lower health-related quality of life scores compared to men with ASCVD. The study also noted lower use of aspirin and statins in women with ASCVD compared to men with ASCVD [3].

7. Women experiencing a heart attack may be less likely to receive guideline-recommended medical care compared to men.

A study published in the Journal of the American College of Cardiology in 2022 found that women with acute myocardial infarction with cardiogenic shock (AMI-CS) were less likely to receive guideline-directed medical treatment within 24 hours and at discharge, less likely to undergo revascularization, and had worse in-hospital outcomes (e.g., mortality, major bleeding) compared to men with AMI-CS [4].

8. Women and racially and ethnically diverse populations are underrepresented in cardiovascular clinical trials.

For instance, a study that analyzed 10-year trends in enrollment of women and minorities in randomized clinical trials used to support approval of 35 new cardiometabolic drugs reported that women only accounted for 36% of trial participants. [5] In this analysis, women were underrepresented in trials of coronary heart disease, heart failure, and acute coronary syndrome. [5] Furthermore, 81% of trial participants were White, and only 4% were Black. Enrollment of more women and racially and ethnically diverse populations is critical to understanding heart disease, medications, [6] and other treatment options.

9. Income level appears to impact access to/use of cardiovascular disease (CVD) prevention services.

A study that included 185,081 participants without CVD and 32,862 participants with CVD found that very low (VL)-income adults were less likely than high-income adults to have blood pressure or cholesterol checked in the past two years and five years, respectively, and receive counseling about exercise or smoking cessation [7].

10. Substance use in pregnancy is associated with cardiovascular events.

A study published in 2023 found that substance use (e.g., amphetamine or methamphetamine, cocaine, opioid, cannabis, alcohol, polysubstance use) during pregnancy was associated with cardiovascular (CV) events such as acute myocardial infarction, stroke, arrhythmia, endocarditis, acute cardiomyopathy or heart failure, or cardiac arrest; major adverse cardiac events; and maternal death during delivery hospitalization. Amphetamine/methamphetamine use produced the strongest association with CV events. Amphetamine/methamphetamine, opioid, alcohol, and polysubstance use were associated with maternal death [8].

References

[1] Centers for Disease Control and Prevention. Women and heart disease. cdc.gov. Updated January 9, 2024. Accessed February 12, 2024. https://www.cdc.gov/heartdisease/women.htm.

[2] Edmundowicz D. Heart attack symptoms: Are they different for men and women? templehealth.org. Temple Health. Published July 6, 2020. Accessed February 12, 2024. https://www.templehealth.org/about/blog/heart-attack-symptoms-men-women-differences.

[3] Okunrintemi V, Valero-Elizondo J, Patrick B, et al. Gender differences in patient-reported outcomes among adults with atherosclerotic cardiovascular disease. JAHA. 2018;7:e010498. doi:10.1161/JAHA.118.010498.

[4] Elgendy IY, Wegermann ZK, Li S, Mahtta D, Grau-Sepulveda M, Smilowitz NR, Gulati M, Garratt KN, Wang TY, Jneid H. Sex differences in management and outcomes of acute myocardial infarction patients presenting with cardiogenic shock. JACC. 2022;15(6):642-652. doi:10.1016/j.jcin.2021.12.033. 

[5] Khan MS, Shahid I, Siddiqi TJ, Khan SU, Warraich HJ, Greene SJ, Butler J, Michos ED. Ten-year trends in enrollment of women and minorities in pivotal trials supporting recent US Food and Drug Administration approval of novel cardiometabolic drugs. JAHA. 2020;9(11):e015594. doi:10.1161/JAHA.119.015594.

[6] Michos ED, Reddy TK, Gulati M, Brewer LC, Bond RM, Velarde GP, Bailey AL, Echols MR, Nasser SA, Bays HE, Navar AM, Ferdinand KC. Improving the enrollment of women and racially/ethnically diverse populations in cardiovascular clinical trials: An ASPC practice statement. Am J Prev Med. 2021;8:100250. doi:10.1016/j.ajpc.2021.100250.

[7] Shahu A, Okunrintemi V, Tibuakuu M, Khan SU, Gulati M, Marvel F, Blumenthal RS, Michos ED. Income disparity and utilization of cardiovascular preventive care services among U.S. adults. Am J Prev Cardiol. 2021;8:100286. doi:10.1016/j.ajpc.2021.100286.

[8] Evans K, Wu P, Mamas MA, Irwin C, Kang P, Perlow JH, Foley M, Gulati M. Substance use in pregnancy and its association with cardiovascular events. JACC Adv. 2023;2(8):100619. doi:10.1016/j.jacadv.2023.100619.

[9] Heart disease in women is not like heart disease in men. ColumbiaDoctors. (2023, July 28). https://www.columbiadoctors.org/news/heart-disease-women-not-heart-disease-men#:~:text=Women%20are%20more%20likely%20to,as%20gastrointestinal%20problems%20or%20anxiety.

[10] Williamson, L. (2023, February 21). The connection between Menopause and Cardiovascular Disease Risks. www.heart.org. https://www.heart.org/en/news/2023/02/20/the-connection-between-menopause-and-cardiovascular-disease-risks