8.1 min readPublished On: April 1, 2024

Heart Disease in Women: A Closer Look

From time immemorial, women have been keepers of the heart. Nurturing and tending the hearts of loved ones is what women do.

But when it comes to our own literal hearts, many women don’t realize the risks associated simply with being female. Women have risk factors that men don’t, including pregnancy-related complications and menopause.

Statistics from the American Heart Association (AHA) reveal that cardiovascular disease is the leading killer of women and responsible for one in three deaths each year.

According to the AHA:

Heart disease kills more women than all forms of cancer combined.
Approximately 57.5% of total stroke deaths are in women.
Nearly 45% of women aged 20 and older are living with some form of cardiovascular disease.
Over half the deaths caused by high blood pressure — hypertension — are in women.
Almost 58% of Black women have hypertension.
Cardiovascular disease accounts for over one-third of maternal deaths.
High blood pressure, preeclampsia and gestational diabetes during pregnancy greatly increase women’s risk for developing cardiovascular disease later in life.

Know the symptoms

Be aware of the following symptoms, which can indicate common types of heart disease in women:

Angina
Dull or heavy chest discomfort
Pain in neck or jaw
Pain in upper abdomen or back
Fatigue/weakness
Dizziness/feeling lightheaded
Fainting spells
Nausea
Vomiting
Cold sweat
Shortness of breath
Rapid/pounding heartbeat
“Fluttering” sensation in chest or neck
Alternating fast and slow heart rate

“Women usually have a constellation of symptoms, which is why heart disease can go undetected. Some women have non-specific symptoms for weeks, but if you have any of these symptoms, don’t wait to tell your doctor,” says Maria Baldasare, MD, FACC, FSCAI, a board-certified interventional cardiologist with Orlando Health Medical Group/FHV Health.

Treatment concerns

Many patients don’t realize that cardiovascular disease or plaque buildup in the arterial circulation is as common in women as in men, points out Asad U. Qamar, MD, a cardiologist, and internal medicine specialist at Lorven Heart and Vascular Institute in Ocala.

“Late 50s and early 60s is usually when we see women presenting with coronary artery disease. It’s more common postmenopausal because of the hormonal changes. As we age, we lose the protective benefits of estrogen,” explains Dr. Baldasare.

Common heart issues

Let’s consider some of the most common types of heart disease in women:

Coronary artery disease (CAD)

Coronary artery disease (CAD) is the buildup of cholesterol deposits (plaque) in the arteries that bring blood to the heart. Left untreated, this can result in a heart attack.

Congestive Heart Failure (CHF)

Congestive Heart Failure (CHF) is the long-term condition of a weakened heart that isn’t pumping normally for a variety of reasons. Blood can build up in the lungs, legs, and feet. Causes can include CAD, diabetes, hypertension, arrhythmia, heart attacks, and other conditions. Although often found in elderly people, CHF can occur in younger patients because of congenital heart disease.

Peripheral artery disease (PAD)

Peripheral artery disease (PAD) is when narrowed arteries reduce blood flow to the legs, and sometimes, arms. As with other arterial diseases, the narrowing is usually caused by atherosclerosis–the buildup of fatty deposits in the arteries.

Carotid arterial disease

Carotid arterial disease affects the carotid arteries, which are the main vessels carrying blood and oxygen to the brain. These arteries can be narrowed by the buildup of calcium and fat deposits. Stroke can occur when oxygen flow to the brain is reduced or blocked by narrowing of the arteries or a piece of plaque that breaks loose.

Arrhythmia

Arrhythmia is an irregular heartbeat, of which there two different types:

• Atrial fibrillation, often called “AFib,” is when the heart has an irregular, very rapid rhythm. The condition can lead to blood clots in the heart and increases the risk of stroke and heart attack.

• Atrial flutter also refers to a rapid heartbeat, but unlike AFib, it’s usually a regular rhythm. It’s possible to have both AFib and Atrial flutter.

Risk Factors

Lifestyle choices and genetics are contributing risk factors for developing heart disease. These include:

High blood pressure (hypertension)
Diabetes (Type 1 or 2)
Family history of heart disease (genetics)
Being overweight (a BMI of 25 or higher, depending on height and weight)
Diet high in red meat, sugar, sodium
High low-density lipoprotein, or LDL, “bad” cholesterol
Smoking/Vaping
Alcohol consumption
Sedentary lifestyle
Stress
Poor sleep routine/sleep apnea

“Almost 45% of people in the United States have high blood pressure, and a lot of those are women,” Dr. Baldasare says. “Under the current guidelines, a good normal blood pressure is less than 120/80. It’s now generally accepted that 130/80 is considered stage one hypertension.”

When it comes to LDL, lower is better, as in below 100 mg/dL. However, if you have other risk factors, or already have heart disease, your doctor will probably want to see your LDL at 70 mg/dL or lower.

Dr. Qamar notes that diabetes, hypertension, high cholesterol, smoking and a family history of heart disease continue to be major risk factors.

“Inactivity and elevated body-mass-index (BMI) are risk factors, but a lot of times we take a very simplified approach and just assume that a person who is heavier has a higher risk than a person who is thin,” notes Dr. Qamar.

“We do see a lot of thin people who have extraordinary metabolic propensity for cardiovascular disease, and we do see heavier people who are metabolically healthier than thinner people. Weight alone can never be taken as the ‘be-all’ risk factor,” he adds.

Dr. Baldasare and Dr. Qamar both emphasize the importance of knowing your family history of heart disease, especially if immediate family members under age 50 have had cardiac events or cardiac disease.

“A family history of a cardiovascular event or a cardiovascular diagnosis, especially coronary artery disease, carotid arterial disease, and other vascular disease such as peripheral arterial disease involving the lower extremities in a first degree relative, and especially at a younger age, which we call ‘premature cardiovascular disease,’ is a very, very strong risk factor,” Qamar says.

If you have such a family history, aggressive, non-invasive diagnostic testing should be done early on.

Such testing includes evaluation of lipids (cholesterol), blood sugar and blood pressure. If you smoke, doctors strongly encourage you to stop.

Additional important testing includes having your coronary calcium measured.

“Those calcium scores should then be followed as therapy is delivered to make sure we are headed in the right direction,” Dr. Qamar says.

Be Proactive

You can’t change genetics, but there are practical things you can do to reduce your risk of heart disease:

Get at least 30 minutes of moderate exercise five days a week
Stop smoking/vaping
If you drink, limit alcohol to one or less drink per day
Avoid saturated and trans fats
Follow a Mediterranean or plant-based diet to lose weight, increase metabolism and lower cholesterol
Moderate sugar consumption
Drink more water
Schedule routine doctor visits and lab work
If on medication, follow doctor’s orders and take faithfully

Many of these recommendations seem simple, but following them will make a noticeable difference in your health.

Some patients only go to the doctor when something is wrong, but with routine doctor visits and lab work, risk factors can be identified and steps can be taken to prevent serious heart disease. So keep taking prescribed medication, unless instructed otherwise, for a risk factor like hypertension.

“The awareness of heart disease in women has gotten a lot better and the majority of women do seek medical attention if they have symptoms,” Dr. Baldasare says.

Breast Cancer & Heart Disease

There can be an overlap of breast cancer and heart disease. The disturbing truth is that older women who are breast cancer survivors have a greater risk of dying from heart disease than from a recurrence of cancer.

Dr. Baldasare explains that both diseases share some of the same risk factors, including smoking, lack of exercise and alcohol consumption, but cancer treatment is also a factor.

“Some of the therapies to treat breast cancer can affect your heart,” she notes. “Some of the drugs used for chemotherapy are cardio-toxic, so the woman may survive breast cancer but end up with cardiac disease in the future.”

Blood clots and high blood pressure are just two of the side effects women may experience after chemotherapy and other cancer treatments.

Radiation, especially to the left breast, can also have repercussions, including hardened or blocked arteries, heart valve problems and irregular heart rhythm.

There’s even a new medical field known as cardio-oncology focused on protecting the heart while treating cancer.

Your mammogram may help identify a higher risk for heart problems.

Breast arterial calcification is associated with a higher risk of developing cardiovascular disease. These white spots on imaging screens reveal calcium buildup in breast arteries.

Although breast arterial calcification isn’t considered an indicator of breast cancer, research shows that women whose breasts showed calcification were 51% more likely to develop heart disease or have a stroke than those whose breasts showed no arterial calcification.

Pandemic impact

We’re still feeling the effects of the pandemic.

Lockdowns, fear and uncertainty caused many people not to forgo diagnostic testing and preventive treatments.

Dr. Qamar says he’s seeing a significant number of patients who developed COVID and post COVID cardiomyopathy, and heart arrhythmias associated with cardiomyopathy.

“We are also seeing a lot of patients who, just because of COVID and because of the restrictions, which were directly or indirectly imposed because of COVID, were really not worked up and never went to their physicians,” he notes. “They never had their routine cardiovascular testing done and are now being diagnosed with cardiovascular disease.”