Why women need to focus on heart health 

Women experience unique life events, such as pregnancy and menopause, which can impact their risk of cardiovascular disease. Fortunately, through regular office visits with a primary care physician, patient education, simple lifestyle changes, and advocacy, many risk factors can be reduced.  

Disclaimer: The term “women or female” is used here broadly to include all people assigned female at birth.  

How stress impacts heart health in women 

Stress becomes chronic when it lasts at least 6 months, and it causes sustained elevations in cortisol levels. This leads to widespread inflammation and decreased insulin sensitivity. Consequently, chronic stress directly affects the heart through plaque accumulation in blood vessels and vascular damage triggered by high blood sugar levels.  

Women are more likely to experience specific life stressors that contribute to chronic stress and heart disease. Intimate partner violence impacts 1 in 3 women globally, and 60% of US women hold caregiving responsibilities. Childhood trauma and PTSD can affect chronic stress later in life. Hormonal fluctuations make women more likely to experience anxiety and depression, which can contribute to cardiovascular disease. By understanding the impact of stress on the mind and body, women can work to improve their physical and mental health. 

Implicit bias and its effect on women 

Despite increasing awareness, certain unconscious biases and stereotypes within the health care system can negatively impact patients—particularly among minority women. This is known as implicit bias, and it’s a well-proven phenomenon in health care. Implicit bias is experienced by any patient presenting, regardless of educational background. Studies have shown that implicit biases result in: 

• Disparities in pain management between Black or Hispanic patients versus white patients  

• Less accurate diagnoses for women compared to men 

• Less thorough explanations of medications for patients from perceived less privileged socio-economic backgrounds or perceived low health literacy  

Heart disease symptoms differ in women 

When experiencing a cardiac event or heart attack, women are more likely to experience back pain, jaw pain, abdominal discomfort and dizziness or lightheadedness rather than chest pain. These vague symptoms can often lead to both a delay in seeking care, as well as missed diagnoses and delayed interventions. Knowing your family history of cardiovascular disease, including age of onset, can be crucial. Risk factors for heart disease include nicotine use (cigarettes/vaping), high cholesterol, diabetes, obesity, sedentary lifestyle and excessive alcohol consumption. Diet and exercise isn't just something doctors say just to say it; it's a way to prevent disease.  

Untreated high blood pressure, also called hypertension, carries the greatest risk of heart disease. People often experience no symptoms for many years, which is why it's known as the “silent killer”. Heart disease remains the leading cause of death in the United States and accounts for at least 1 in every 3 female deaths. Non-Hispanic Black women, beginning at age 20, carry a nearly 60% risk of having some form of cardiovascular disease. Hispanic women carry a 43% risk, and American Indian/Alaska Native women carry a 30% risk of heart disease. High blood pressure can affect a woman at any age, too. 

Pregnancy and heart health 

Protecting heart health during the childbearing years is critical to preventing heart disease; each stage of pregnancy carries its own risks.  

Before pregnancy (preconception) 

Healthy lifestyle choices before pregnancy can help reduce the risk of complications during and after pregnancy. This includes talking to your doctor and performing a baseline health assessment to ensure any pre-existing conditions and risk factors are addressed. A healthy pregnant person means a higher likelihood of a healthy baby. See your family physician at least once a year for an annual exam.  

During pregnancy (perinatal) 

Pregnancy can worsen or create new cardiovascular problems, causing life-threatening complications. Hypertensive disorder of pregnancy (high blood pressure, preeclampsia, eclampsia) or gestational diabetes during pregnancy can greatly increase the risk of heart disease later in life. These conditions affect women of color even more, subsequently heightening those risks.  

Hypertensive disorders of pregnancy  

• Non-Hispanic Black women are twice as likely to develop preeclampsia and 2.5 times higher risk of preterm preeclampsia  

• Non-Hispanic Black women are 5x risk of dying from preeclampsia/eclampsia 

• American Indian/Alaska Native women account for 13% of pregnancy-related deaths despite accounting for 3% of US population.  

After pregnancy (postpartum) 

Heart-related issues can happen immediately after pregnancy or even up to a year later. It is imperative that women keep follow-up appointments and remain in open communication with their doctor regarding any new symptoms or concerns. If it is easier to schedule appointments along with your newborn, your family doctor can likely accommodate. At the very least, having your blood pressure checked during those well-child checks at pediatric offices can help you stay mindful of your readings. Always keep your primary informed.  

Protecting women’s hearts 

Simple steps can help protect against cardiovascular disease. It’s important to understand individual risk factors that may contribute to heart disease and speak with your doctor about any concerns. The American Heart Association’s ‘Essential 8’ offers eight key lifestyle measures to maintain and improve cardiovascular health: 

1. Move more 

2. Eat healthy (lean protein, high fruits and vegetables, decrease processed/sugary foods) 

3. Nicotine cessation  

4. Managing blood pressure 

5. Average 8 hours of sleep per night  

6. Keep the bad cholesterol (LDL, triglycerides) low  

7. Know your A1c (average blood sugars over a 3-month period)   

8. Maintain a healthy weight 

Simply remembering how heart disease can affect women differently than men can help women advocate for themselves and others. Recognizing the importance of at least yearly primary care exams after age 18 can save lives!