Heart attacks in women: Learn how to lower the risks

Heart disease is the leading cause of death for women in the United States. Health care providers and patients can work together to help improve each patient’s care — and to help save more lives.

In this article:

What to know about heart attacks in women

Heart disease is the leading cause of death for both men and women in the United States. About one in five female deaths in 2021 was attributed to heart disease, according to the Centers for Disease Control and Prevention (CDC). What’s more, according to a 2020 study, women had an increased risk of developing heart failure or dying within five years of a heart attack when compared to men.

The state of women’s cardiac care

There’s still progress to be made to help both patients and health care professionals confront the fact that heart disease is not just a men’s health issue, as some used to believe not that long ago. Only 44 percent of women surveyed in 2019 realized that heart disease will kill more women than any other cause. According to a 2017 study from the Journal of the American College of Cardiology, weight issues and breast health were both cited as a top concern by 48 percent of primary care providers, while heart disease was cited as a top concern by only 39 percent.

According to JoAnn E. Manson, MD, chief of the division of preventive medicine at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School, “… women are less likely than men to get proper preventive care.” Although breast cancer screening should remain a high priority for women, says Dr. Manson, more women should also be talking to their health care providers about heart disease risk factors and prevention.

Women are less likely to survive a heart attack

It’s not just prevention that can be improved. “Women are more likely to have delays in getting care for heart attacks [they have], and those delays can mean they’re less likely to receive treatment in time to prevent damage to the heart,” says Dr. Manson.

For example, a 2018 study published in Circulation: Cardiovascular Quality and Outcomes found that only 39 percent of women received CPR from bystanders when they experienced cardiac arrest in public, compared to 45 percent of men. That difference increased men’s odds of survival by 29 percent. For every minute of delay in getting CPR, a sudden cardiac arrest victim’s chance of survival decreases by 7 to 10 percent.

Even after a woman arrives at the hospital with chest pain, her treatment may be delayed when compared to a man’s. According to a 2022 study published in the Journal of the American Heart Association, women in the emergency room complaining of chest pain waited about 11 minutes longer than men to be seen by a doctor. They were also less likely to have an electrocardiogram (EKG) or to be admitted to the hospital for treatment.

Heart attack symptoms in women

A potential reason women don’t always get prompt and effective treatment for a heart attack is that they — as well as emergency responders and doctors — often may not realize they are having one.

Women can exhibit a broader range of symptoms, some of which can be mistaken for common illnesses such as simple indigestion or nausea, which may help to explain why there is a higher rate of missed diagnoses for women. “Women’s heart attack symptoms can include the classic tightness and pressure in the chest, but they may also have other signs that are easily dismissed or misdiagnosed,” says Nieca Goldberg, MD, clinical associate professor of medicine at NYU Grossman School of Medicine and author of The Women’s Healthy Heart Program.

Both men and women may experience the chest pain and discomfort most often associated with a heart attack. But women may more frequently exhibit symptoms unrelated to chest pain, such as:

• Back or jaw pain 
• Nausea or vomiting 
• Shortness of breath 

“Don’t ignore these symptoms,” Dr. Goldberg stresses. “Call 911 or get to the hospital immediately, because rapid diagnosis and care can minimize damage to the heart muscle.”

Health factors that put people at risk of heart disease

Men and women with heart disease do have a number of risk factors in common. Cardiologists and the CDC have identified several key behaviors for lowering the risk of heart disease. The American Heart Association calls them “Life’s Essential 8”:

• Being active
• Controlling cholesterol
• Eating healthy
• Getting good sleep
• Managing blood pressure
• Managing diabetes
• Managing weight
• Not smoking or vaping

But certain health conditions matter more in terms of women’s risk, such as diabetes. Women with diabetes face twice the risk of heart disease compared to men with diabetes. Other risk factors associated with women include: 

• Autoimmune disease. Autoimmune diseases, such as rheumatoid arthritis and lupus, are diagnosed more commonly in women than in men. “These conditions are linked to chronic inflammation,” says Dr. Goldberg. “And that inflammation can stimulate a buildup of plaque in the arteries.”

• Early menopause. If someone stops getting their period before age 40, their risk of heart disease increases. During menopause, estrogen levels drop. “That can lead to weight gain and an increase in blood pressure and cholesterol,” says Dr. Goldberg. “Menopause doesn’t cause heart disease, but it can exacerbate certain risk factors.” Having ovaries removed between the ages of 35 and 45 can lead to similar increases in risk factors.

• Polycystic ovary syndrome. Women with this condition were once thought to be at increased risk for heart disease. But recent research suggests that the link may not be as strong as once thought.

• Pregnancy complications. “Pregnancy is considered a cardiometabolic stress test,” says Dr. Manson. If someone develops diabetes or high blood pressure for the first time during pregnancy, it can be an early warning sign that they have an increased risk of heart disease later in life.

Anyone who suspects they have any of the above conditions should seek medical care from a health care provider. And remember, it’s important that they know and understand the complete health history, says Dr. Manson. Sign up for regular screening services for diabetes at MinuteClinic^®. 

Dr. Goldberg concurs: “Finding a doctor you can communicate with and who listens to you is important. Be a health advocate and speak up for yourself — make sure your doctor has your full medical history and understands all your concerns.”

Heart-healthy moves

A person can take charge of their overall health to help reduce the risk of heart disease and heart attack. Even if someone doesn’t have any specific risk factors that increase their chance of having a heart attack, it’s important they take steps toward a more heart-healthy lifestyle.

First, make sure to get annual health checkups that include age-appropriate screenings such as blood tests for cholesterol levels and diabetes markers, blood pressure checks and EKGs or other heart-monitoring tests. (MinuteClinic offers these screening tests and more.) “There are several lifestyle factors you can control and that will help reduce risk factors such as high blood pressure, high cholesterol and obesity,” says Dr. Manson.

Other good-for-the-heart moves include:

• Getting regular aerobic exercise. Being physically active is highly beneficial for good health, says Dr. Manson. It might help with blood pressure, blood sugar regulation, cholesterol and weight control — plus, it can be good for mental health, too.
• Keeping an eye on weight. Being overweight is a risk factor for heart disease, but where a person carries that extra weight can be even more important than the number they see on the scale. “Abdominal fat is a stronger risk factor,” says Dr. Manson. Tracking waist size with a tape measure can be more helpful than monitoring weight on a scale.
• Limiting consumption of red meat, processed foods, fast foods and refined carbohydrates. In their place, consider eating more fish, fruits, healthy mono- and polyunsaturated fats, plant-based protein, vegetables and whole grains.
• Logging quality sleep. Getting too little sleep is a newly recognized risk factor for heart disease. Experts recommend that adults aim for seven to nine hours of shuteye every night.
• Managing stress and depression. According to the CDC, “… people experiencing anxiety, depression, stress and even post-traumatic stress disorder (PTSD) over a long period of time may experience… increased heart rate and blood pressure… reduced blood flow to the heart and heightened levels of cortisol. Over time, these physiologic effects can lead to calcium buildup in the arteries, heart disease and metabolic disease.” If they’re struggling with feelings of anxiety, being overwhelmed or sadness, talking to a mental health professional can help. People can find support at MinuteClinic mental health counseling services. MinuteClinic offers depression screening and management both in person and virtually.
• Quitting smoking. Dr. Manson says it’s important to remember that both cigarettes and vaping are bad for the heart.