Heart Health in Women

The diagnosis and treatment of heart disease in women used to be modeled on men’s experiences. That was problematic, it turns out, as there are important differences in the ways women and men experience a heart attack, says cardiologist Dr. Nupoor Narula, an Assistant Professor of Medicine and Director of the Women’s Heart Program at Weill Cornell Medicine. 

Chest pain may signal a heart attack in both genders, but women experience that symptom less often than men do. Women also tend to experience additional heart attack symptoms, such as nausea, vomiting, shortness of breath and fatigue. As well, a slew of female-specific risk factors can increase a woman’s chances of developing cardiovascular disease at some point in her life. In short, heart disease in women looks somewhat different from the way it looks in men, from testing and diagnosis to prevention and treatment.   

Cardiovascular disase is the number-one cause of death among women. Based on recent data from the Centers for Disease Control and Prevention (CDC), it accounts for 1 in every 5 female deaths.  

Compared to men, women are less likely to call 911 when they’re experiencing symptoms. That lack of emergency intervention may contribute to the high number of female deaths from heart disease and stroke. 

Read on for answers to your FAQs from Dr. Narula, a specialist who is deeply familiar with the way heart disease affects the female half of the population.  

What are the most common risk factors for heart disease in women? 

There are modifiable and non-modifiable risk factors—those you can change and those you can’t.  

Modifiable risk factors include: 

  • High blood pressure 
  • Diabetes 
  • High cholesterol 
  • Smoking 
  • Poor diet 
  • Excess weight 
  • Lack of exercise 
  • Inadequate sleep 

Non-modifiable risk factors include: 

  • A family history of heart disease 
  • Age 
  • Certain autoimmune diseases, such as rheumatoid arthritis, lupus and antiphospholipid antibody syndrome (these are more common in women) 
  • Female-specific risk factors 

What are female-specific risk factors for cardiovascular disease? 

Pregnancy complications 

These include gestational diabetes, pre-eclampsia (high blood pressure during pregnancy in addition to problems with other organs) and eclampsia (a condition that causes pregnant women with pre-eclampsia to develop seizures). 

Premature menopause 

Women experiencing early-onset menopause lose the protective effects of estrogen on heart health at an earlier-than-average age. 

Polycystic ovarian syndrome (PCOS) 

PCOS stems from an imbalance in reproductive hormones, leading to irregular menstrual periods, an increased risk of infertility and cysts in the ovaries. It is also linked with obesity and insulin resistance. 

What about socioeconomic risk factors? 

Dr. Narula also underscores a special set of risk factors that stem from socioeconomic disparities. These include: 

  • limited access to health care 
  • limited ability to afford healthy food 
  • intimate partner violence 
  • cultural or language barriers that impede conversations with providers 
  • low health literacy 
  • racism and biases of all kinds, leading to poorer outcomes 

“We don’t talk about these as much as we should,” she says, “but some of them occur more frequently in women than in men, so they need to be included in the mix, and they demand our attention.” 

How do you diagnose heart disease? 

A variety of tests can be used to diagnose heart disease, depending on the clinical scenario, Dr. Narula says. In addition to a thorough history and physical exam by a physician or other provider, a woman might undergo an electrocardiogram (EKG) or an echocardiogram (an ultrasound of the heart). We also use specialized blood tests to understand the nuances of cholesterol metabolism.  

“We can check different fats in the blood along with markers of inflammation, and we also use CT scans to see if we can detect heart disease in higher-risk patients even before any symptoms appear. That test is called a cardiac calcium score,” she says. “It tells us if a patient has been living with plaque long enough to form calcium in the coronary arteries. We may also order a carotid ultrasound—an exam that identifies any blockages in your carotid arteries. Blocked carotid arteries are a major risk factor for stroke.” 

Heart disease, indigestion or something else? 

To help distinguish between the symptoms of heart disease vs. other conditions that present similarly, Dr. Narula reviews the different organs and structures in the chest. 

These include the esophagus (food pipe), lungs, ribs and, of course, the heart. All of these structures can cause chest discomfort.  

Therefore, she says, an accurate history is important. Where is the chest pain?  How long has it been present, and how has it changed with time? Is it worse with exertion and better with rest? Is it related to position? To meals? To stressful situations? Do you have risk factors for heart disease (both modifiable and non-modifiable)?   

“Whatever the context, it’s clear that chest pain is no small matter,” she says. Women experiencing such pain would be well advised to recognize that heart disease is a possibility and discuss their symptoms with their doctor.” 

Many roads to prevention 

If you’re exercising regularly and consuming whole grains, fruit, vegetables, low-fat or fat-free dairy and lean protein, you’re optimizing heart health, Dr. Narula says. Alcohol consumption in moderation may also have some cardiovascular health benefits. 

If red wine is part of your daily life, and you’ve discussed the quantity with your physician, she says, it may be fine to continue that practice. But she wouldn’t advise people who don’t drink to begin consuming alcohol. 

One preventive measure that is no longer recommended for every patient is the daily baby aspirin regimen. Speak to your provider about the risks and benefits of baby aspirin. Do you already have cardiovascular disease? What other health conditions do you have? How high is your bleeding risk? What other medications are you taking that may interact with aspirin? We individualize our recommendation based on your answers to these and other questions.” 

If you’re already taking an aspirin a day, discuss it with your doctors before you stop taking it because everyone’s risk profile may be different, Dr. Narula advises. 

The ultimate preventive strategy is high-quality sleep. Sleep health is helpful for our brain. We know that poor sleep is a risk factor for heart disease and can be linked to obesity, diabetes and high blood pressure. 

Finally, don’t forget to take care of yourself, she says. Integrate small amounts of exercise or activity into your daily routine. Make incremental, sustainable changes. And focus on downsizing your stress.  

Life’s Essential 8 

The American Heart Association (AHA) names 8 strategies that will help women and men alike in their pursuit of a heart-healthy future: 

  • Eat better. 
  • Be more active. 
  • Quit tobacco. 
  • Get healthy, adequate sleep. 
  • Manage your weight. 
  • Control cholesterol. 
  • Manage blood sugar. 
  • Manage blood pressure. 

Visit the AHA’s website for concrete suggestions that will help you make the above changes and control your modifiable risk factors. 

To make an appointment with a cardiologist at Weill Cornell Medicine, please visit here.