By Pamela Assid, DNP, RN 

 Medically reviewed by Jeffrey S. Lander, MD

Heart disease is the leading cause of death in women in the United States.1 Women experience heart disease differently than men. Understanding those differences can help women access the appropriate healthcare resources quickly. Reducing risk factors and focusing on prevention are important to decreasing the negative impact of heart disease in women.

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Verywell / Zoe Hansen

Causes of Heart Disease in Women

Heart disease encompasses different heart and blood vessel conditions, such as coronary artery disease, vascular disease, high blood pressure, and heart failure. The most common cause of heart disease is atherosclerosis.2 It is caused by plaque buildup, a collection of cholesterol and fatty deposits, on the walls of the arteries. Over time, atherosclerosis restricts blood flow to the heart.

As blood flow becomes more restricted, the heart lacks oxygen and nutrient-rich blood. This condition is called ischemia, and the heart becomes less effective. Ischemia causes some of the symptoms of heart disease, such as chest pain, or angina.2

 

Symptoms of Heart Disease

Women typically have symptoms of heart disease about 10 years later than men.2 For men, chest pain is a common symptom. In women, symptoms of a heart attack are more subtle and can include:

  • Pain or aching in the chest and upper arms or back

  • Unusually fast heartbeat

  • Shortness of breath

  • Nausea

  • Fatigue

Heart disease may not be as obvious as a heart attack. It may present with these symptoms:

  • Angina, usually felt in the chest, but also in the left shoulder, arms, neck, back, or jaw

  • Shortness of breath

  • Palpitations, or irregular heartbeats (arrhythmia)

  • Rapid heartbeat

  • Dizziness

  • Nausea

  • Extreme weakness

  • Unusual fatigue

  • Sudden sweating or a cold, clammy feeling

Any of these symptoms should be evaluated by a healthcare professional, especially if they are new, sudden, or worsening.

Risks of Heart Disease in Women

Certain factors can increase a woman's risk of developing heart disease, including:3

  • High blood pressure

  • High cholesterol

  • Diabetes (high blood sugar levels)

  • Sedentary lifestyle

  • Diet high in saturated fats and cholesterol

  • Tobacco use

  • Being overweight

  • Family history of heart disease, especially at an early age

  • Being 55 years old or older

  • Menopause (being without a menstrual period for at least 12 months)

Diagnosis and Treatment of Heart Disease

Your doctor will take a thorough history and perform a physical exam to begin the diagnostic process. The doctor will discuss your risk factors and symptoms.

Tests that will be conducted to diagnose cardiovascular disease include:

  • Blood tests: Various blood tests can help a healthcare professional determine if you have heart disease, such as a lipid panel, lipoprotein A, and C-reactive protein.

  • Electrocardiogram (ECG): An ECG is a picture of the heart's electrical activity. It can indicate if the heart has developed compensatory mechanisms for heart failure (when your heart makes up for poor output), such as by adding more heart muscle, or enlarging. The ECG can also show if there are abnormal heart rhythms.

  • Stress test: An exercise stress test is when a person walks or runs on a treadmill while connected to an ECG. An exercise echocardiogram stress test or an exercise nuclear stress test will take an image of the heart before exercise and then take another image after exercise. A pharmacologic stress test is one in which a medication is injected that stimulates the heart to respond as if it is undergoing exercise. This test is either done as a pharmacologic nuclear stress test (in which a radioisotope is used to help image the heart) or a pharmacologic echocardiogram stress test (in which pictures of the heart are captured before and after injection of the medication).

  • Coronary computed tomography (CT) angiogram: A coronary computed tomography angiogram is a procedure in which contrast dye is injected into a person's blood vessels to allow advanced CT technology to create a three-dimensional image of the heart and vessels. This allows your doctor to determine if there is any signs of atherosclerosis or calcium buildup in the coronary arteries.

  • Cardiac catheterization: This is an invasive procedure that allows your doctor to evaluate your heart function. It involves the insertion of a long, thin catheter into a blood vessel in your arm or leg. Once inserted, the catheter follows the vessel to the coronary arteries. Contrast dye is then injected into the catheter. Using a specialized X-ray machine, your doctor can determine if the coronary arteries show any signs of cardiovascular disease or atherosclerosis.

Managing Heart Disease

Eating a nutrient-rich diet low in saturated fats and cholesterol combined with an active lifestyle is important in managing heart disease.4 For some women, there may be additional considerations, such as:

  • Medications: Uncontrolled high blood pressure and diabetes raise the risk of heart disease. If diet and exercise are not enough to manage these conditions, medications may be needed.

  • Tobacco cessation: Tobacco products increase heart disease risk. Several options are available to successfully help you become tobacco free.

  • Alcohol intake: Drinking too much alcohol increases your heart disease risk. Limiting alcohol intake to one drink a day or less can reduce your risk of having heart disease.

  • Stress: Stress can contribute to the development of heart disease. Finding ways to manage stress in a healthy way can reduce your cardiovascular disease risk.

Preventing Heart Disease in Women

Certain risk factors, such as family history or pre-existing heart conditions, cannot be changed. However, some can be modified to reduce the risk of heart disease, including:3

  • Increasing physical activity

  • Eating a healthy diet

  • Getting plenty of sleep

  • Reducing stress

  • Quitting smoking

  • Maintaining a healthy weight

  • Managing chronic conditions, such as high blood pressure and diabetes

Summary

Heart disease is the number one killer of women in the United States. The symptoms of heart disease may present differently in women than in men. For example, signs are more subtle in women.

Certain factors may increase your risk of having heart disease, including older age, family history of heart disease, menopause, and other chronic conditions like high blood pressure. Besides medical treatment, maintaining a healthy lifestyle and managing other health conditions you have can go a long way toward lowering your heart disease risk.

 Sources

Centers for Disease Control and Prevention. Lower your risk for the number 1 killer of women.

Cleveland Clinic.  Women and cardiovascular disease.

National Heart, Lung and Blood Institute.  Listen to your heart: women and heart disease.

Centers for Disease Control and Prevention.  Women and heart disease.

Keteepe-Arachi T, Sharma S. Cardiovascular disease in women: understanding symptoms and risk factors. Eur Cardiol. 2017;12(1):10-13. doi:10.15420/ecr.2016:32:1

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By Pamela Assid, DNP, RN
Pamela Assid, DNP, RN, is a board-certified nursing specialist with over 25 years of expertise in emergency, pediatric, and leadership roles.