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What You Need to Know About Heart Disease in Women

A diorama of heart health

By Vivian Mason


If you ask women what their biggest health threat is, they might answer “breast cancer.” But, they would be wrong.

Cardiovascular disease (or heart disease) is the leading cause of death for women in the United States, and it is at an alarming rate. In fact, according to the Centers for Disease Control and Prevention (CDC) and the American Heart Association, it is the leading cause of death in this country for both Caucasian and African American women. Of the 1.3 million active duty service members, more than 16% are currently women, so ensuring a healthy heart also helps ensure a healthy force.  

Cardiovascular disease is an umbrella term for all kinds of diseases that affect the heart or blood vessels, including coronary heart disease (known as clogged arteries or atherosclerosis), heart attacks, hypertension, stroke, congenital heart defects, and peripheral artery disease. 

“Heart disease” is a catch-all phrase that describes a variety of conditions that affect the heart’s structure and function, such as heart failure, angina, arrhythmia, valvular heart disease, and coronary artery disease. All heart diseases are cardiovascular diseases, but not all cardiovascular diseases are heart diseases. In general, most people use the term heart disease to refer to any of these conditions. 

Dr. Mark Haigney
According to Dr. Mark Haigney, director of the Military
Cardiovascular Outcomes Research program at USU,
the greatest danger that puts women at risk for heart
disease is the prejudice that it isn't a woman's problem.
(Uniformed Services University photo)
Why is heart disease still the number one cause of death? 

“Well, it’s largely due to our habits,” says Dr. Mark Haigney, director of cardiology, professor of medicine and pharmacology, and director of the Military Cardiovascular Outcomes Research (MiCOR) program at the Uniformed Services University of the Health Sciences (USU). “The Western diet that we eat is high in fat, high in salt, and high in cholesterol. A substantial number of people still smoke -- nearly a quarter of the population still. There’s also been an epidemic of obesity. Certain forms of heart disease are strongly associated with obesity and that’s something we don’t have a good answer for.  We know how to deal with high blood pressure and high cholesterol. We know women should eat five servings of fruits and vegetables every day. We know they should exercise for at least 30 minutes a day five times per week. However, we don’t have the slightest idea of how to keep people from gaining weight. It’s the mystery of our age.”

Because heart disease is so common and often silent until it strikes, it’s important to recognize the various controllable and uncontrollable factors that put women at risk. Key controllable risk factors include smoking, poor diet, high cholesterol, high blood pressure, obesity, diabetes, physical inactivity, alcohol use, and stress/depression/anger. Early-onset heart disease, before the age of 60, is largely preventable with lifestyle interventions and medications as needed.

Uncontrollable risk factors include increasing age, family history of heart disease, race, ethnicity, and being postmenopausal.

Women can reduce their risk of heart disease in a number ways, including smoking cessation, getting a checkup, improving cholesterol levels, controlling high blood pressure and cholesterol, exercising regularly, eating a heart-healthy diet, maintaining a healthy weight, limiting alcohol use, managing stress, watching blood their pressure, and controlling their blood sugar. 

Women often experience different signs and symptoms of heart disease than men. A 2003 study published in Circulation, a journal of the American Heart Association, reviewed the symptoms most often seen in women who had experienced a heart attack. The major symptoms did not include classic heart attack symptoms like chest pain, tingling, etc. Instead, women were found to have experienced anxiety, sleep disturbances, and unexplained fatigue at least one month before the actual heart attack occurred.  

Four pilots walking with F-15 planes in the background.
Heart disease is the leading cause of death among women. More than 16% of the 1.3 million active duty service members are women, so ensuring a healthy
heart also helps ensure a healthy force.  (U.S. Air Force photo by Tech. Sgt. Keith Brown)

Silent heart attacks occur without the usual symptoms, and you may not even realize that you’ve had one. These attacks are more common in women with diabetes and in those women who’ve had prior heart attacks. Symptoms can include shortness of breath, fatigue, mild discomfort in the chest/arms/jaw that goes away after resting, nausea, palpitations, abdominal pain or heartburn, skin clamminess, and sleep disturbances. Many women often report experiencing some type of emotional stress prior to heart attacks. It’s been reported that 23% of women die within one year of having an attack.

“I’d say the greatest danger that puts women at risk for heart disease is the prejudice that it isn’t a woman’s problem. I think we’ve made progress in this area, though. There’s a lot of literature that says women get less aggressive treatment for their heart disease, and that bias leads to poor survival and worse outcomes,” said Haigney.  “Also, just think about what your heart’s been doing every second of every day for years.  We’re seeing far fewer heart attacks now, which is largely a function of better medications, statin drugs that lower cholesterol levels, improved food habits, much less smoking, and people just eating better food.”  

It’s important for women to take charge of their heart health. They can greatly reduce risk factors by making lifestyle changes. 

“I think if we figured out how to deal with weight gain, we’d see bigger improvements in blood pressure and other things that lead to heart disease in the long run.”  

An infographic about Women's Heart Attack Symptoms
(Image Credit: MC3 Brooks Smith, U.S. Navy)