Heart disease in women: why it’s so often overlooked

Picture someone having a heart attack. Who do you see? Chances are, it’s a man. He grabs his chest, maybe he collapses. 

Movies and television have reinforced this image for decades, and it isn’t necessarily wrong—chest pain or discomfort is the most common heart attack symptom in both women and men. 

It’s just not the full story. 

For some women, a heart attack can also mean shortness of breath, nausea, lightheadedness, unusual fatigue, discomfort in the back, neck, jaw, shoulder, arm or stomach. 

Symptoms don’t always look like what you’d expect in a heart attack, which can make them easier to explain away as stress, indigestion, illness, aging. Maybe you think it’s one more change associated with perimenopause or menopause. 

When heart disease doesn’t look the way you expect, it can be harder to recognize when something is wrong. Heart disease isn’t just a men’s health issue; it’s the leading cause of death among women in the United States, claiming more women’s lives than cancer. According to the CDC, heart disease caused 304,970 deaths among women in 2023, which is about 1 in every 5 female deaths. Yet only 56% of women in the U.S. recognize heart disease as their number one killer.

Heart health is women’s health

Women have learned to be proactive about breast health by getting mammograms, learning about family history, and understanding that screening still matters even when nothing feels wrong. 

Heart health deserves the same attention.  

It’s not because women need another disease to worry about, but because cardiovascular disease can develop quietly over many years. Knowing your risk earlier creates more opportunities to do something about it. Emphasizing that statistically, the risk of suffering from heart disease is higher than from breast cancer.  

Blood pressure can change. Cholesterol can change. Metabolic health can change. And your cardiovascular risk at 50 may look different from your risk at 30. 

Menopause doesn’t suddenly cause heart disease, but this stage of life can coincide with changes in your body composition, metabolic health, and blood vessels. Knowing more gives you information you can act on, and you can know where you stand.

Heart attacks don’t always follow the script

There’s an important misconception worth clearing up: women do experience chest pain during heart attacks.

In fact, chest pain or discomfort remains the most common heart attack symptom in women and men.

But women may also experience:

• Shortness of breath
• Nausea or vomiting
• Lightheadedness
• Unusual fatigue or weakness
• Pain or discomfort in the back, neck, jaw, shoulder, arm or stomach

None of these symptoms belong exclusively to women. What matters is recognition. Symptoms may also be subtle or less obvious, particularly in people with diabetes, who are more likely to experience a silent or unrecognized heart attack.

It’s also important to understand your underlying cardiovascular risk. Factors that can increase the risk of atherosclerotic cardiovascular disease include diabetes, high blood pressure, high cholesterol, smoking or a history of smoking, overweight or obesity, physical inactivity, and a family history of premature cardiovascular disease.

If the only heart attack you know how to picture involves dramatic chest pain and collapse, something subtler may not immediately register as a heart problem.

And when life is already busy, it can be tempting to explain symptoms away.

“I’m stressed.”

“I didn’t sleep well.”

“It must be menopause.”

“I’m probably coming down with something.”

Often, there may be another explanation. But new, unexplained or concerning symptoms deserve attention.

If you think you may be having a heart attack, call 911. Don’t wait for symptoms to become dramatic before taking them seriously and seeking emergency care.

How did a medication tradition in the 1950s help shape women’s healthcare?

Part of the answer starts with a medical tragedy that initially had nothing to do with cardiology.

In the late 1950s and early 1960s, thalidomide was marketed in several countries, including as a treatment for nausea during pregnancy. Exposure during pregnancy was eventually linked to severe birth defects in thousands of babies worldwide. 

The tragedy changed medicine.

Regulators understandably became deeply concerned about exposing a developing fetus to experimental drugs. But efforts to protect women also had an unintended consequence.

In 1977, FDA guidance recommended excluding most women who could become pregnant from the earliest phases of drug trials. The definition was remarkably broad, encompassing women using contraception and women who were not sexually active.

For years, large numbers of women were left out of important medical research.

In 1993, the FDA reversed its earlier guidance restricting women of childbearing potential from participating in early clinical trials. That same year, the NIH Revitalization Act established requirements for the inclusion of women and minorities in NIH-funded clinical research. 

Medicine learns from data. When the data doesn’t adequately represent everyone, our understanding of health doesn’t adequately represent everyone either.

For decades, women were underrepresented in many areas of medical research, limiting what researchers knew about important differences in disease presentation, treatment and outcomes. 

We’ve learned a lot since.

And we’re still learning.

Watch “Turns Out, Women Are Different,” an episode of Looking Deeper, for the remarkable story of thalidomide, FDA reviewer Dr. Frances Kelsey and the research decisions that followed.

Women aren’t just smaller versions of men

Women and men don’t have completely different hearts.

Atherosclerosis, or the buildup of plaque in arteries, affects both. Women and men can both develop major coronary blockages. Both can experience classic chest pain. And familiar risk factors such as high blood pressure, diabetes, smoking and unhealthy cholesterol levels matter regardless of sex.

But heart disease is more complicated than a single clogged artery.

For example, women are more likely to experience coronary microvascular disease, which affects the heart’s smallest blood vessels.

Women are also more likely to experience signs of reduced blood flow to the heart without a major obstruction in one of the large coronary arteries. You may hear this described as INOCA: ischemia with no obstructive coronary arteries.

The terminology sounds complicated.

The takeaway isn’t “Heart tests don’t work for women.”

It’s that heart disease can take more than one form.

And as research has included more women, medicine has gotten better at recognizing those forms. That’s progress worth paying attention to.

Don’t wait for your heart to get your attentio

For a long time, the story of heart disease focused heavily on what happened after symptoms appeared. Today, there is another important conversation at play: What can we learn before disease becomes apparent?

You don’t have to wait for symptoms to start asking questions about your heart.

Start with what you can know today:

• What is your blood pressure?
• What do your cholesterol numbers mean?
• How is your blood sugar and metabolic health?
• Do you smoke, or have you smoked in the past?
• Did a parent or sibling develop cardiovascular disease at an early age?
• Have you experienced pregnancy complications such as preeclampsia or gestational diabetes?
• How are your cardiovascular risk factors changing through menopause?
• Are you getting regular physical activity?
• How are your diet and sleep supporting your health?

Depending on your individual risk, a clinician may also consider biomarkers such as ApoB or lipoprotein(a), commonly called Lp(a).

You don’t need to become a cardiologist. You just need to start asking better questions.

“What do I know about my heart today?”

“What could I learn now that might help me protect it for the future?”

What if you could actually look at your coronary arteries?

Traditional risk factors help estimate your likelihood of developing cardiovascular disease based on how you compare with other people who have similar characteristics. Advanced imaging can add something different: a direct look at whether coronary artery disease is already present and what it looks like today.

A coronary CT angiogram (CCTA) is a noninvasive CT examination that creates detailed images of the coronary arteries. It can identify atherosclerosis, or “plaque,” in the arteries of the heart and help determine whether that plaque is narrowing the arteries and affecting blood flow.

In simple terms, rather than looking only at clues that suggest whether you might have coronary disease, CCTA can provide information about what is actually happening inside your coronary arteries.

AI-assisted plaque analysis can go a step further by helping quantify the amount of plaque and characterize different types and features of plaque, including features associated with higher cardiovascular risk.

More information doesn’t automatically mean more testing is better. Your symptoms, age, medical history, risk factors, previous testing and the benefits and downsides of imaging all matter. That’s a conversation to have with a qualified healthcare professional.

But today’s technology gives clinicians ways to see cardiovascular health with a level of detail that wasn’t available to previous generations. That information can create more opportunity for an informed, personalized conversation about what comes next.

Your mammogram may have something to say about your heart

There’s another connection between women’s health and cardiovascular health that may surprise you.

And it starts with an exam millions of women already know well.

A mammogram can sometimes reveal calcium deposits in the walls of arteries within the breast. This is called breast arterial calcification, or BAC.

BAC is not breast cancer.

It also doesn’t diagnose coronary artery disease.

But it may be useful information.

Research has found an association between BAC and cardiovascular risk. Scientists are still determining exactly how that information should be incorporated into routine cardiovascular care.

For now, there’s a simple takeaway:

If breast arterial calcification appears on your mammogram report, ask about it.

Talk with your healthcare provider about whether it adds anything meaningful to the bigger picture of your cardiovascular health.

Breast health or heart health doesn’t have to be an either/or decision.

We can pay attention to both.

What women can do differently today

We can’t rewrite the history of women’s medical research, but we can benefit from what medicine has learned since.

Know your numbers. Know your family history. Pay attention when something feels new or unexplained. Don’t dismiss a concerning symptom simply because it doesn’t resemble the heart attack you’ve seen in movies.

Ask questions about your cardiovascular risk before symptoms give you a reason to.

And remember that prevention doesn’t have to mean assuming something is wrong.

It can simply mean giving yourself more information while you have more choices about what to do with it.

That’s a different, more powerful way to think about longevity.

Not just adding years to life, but protecting more of the healthy, active years you want to live.

See more of your cardiovascular health

Your cardiovascular health isn’t defined by one cholesterol result, one blood pressure reading or one scan.

Your arteries, biomarkers, family history, lifestyle and personal risk factors all contribute to the bigger picture.

For women who want to understand their health story more clearly, SimonMed Cardiovascular Longevity brings multiple types of cardiovascular information together in one assessment.

The program combines:

• Coronary CT angiography
• AI plaque analysis
• More than 25 cardiovascular and metabolic biomarkers
• A one-on-one consultation with a preventive cardiologist

Together, those insights can provide a more comprehensive view of cardiovascular health and help inform a personalized conversation about prevention.

Advanced cardiovascular imaging isn’t right for everyone, and it doesn’t replace routine care with your healthcare provider.

But if you’re thinking:

“I feel healthy. I want to understand what I can do now to help stay that way.”

It may be time to take a closer look.

Understand more than your risk factors. Understand your heart.

SimonMed Cardiovascular Longevity combines advanced coronary imaging and AI plaque analysis with more than 25 cardiovascular and metabolic biomarkers and personalized guidance from a preventive cardiologist.

This article is for educational purposes and isn’t a substitute for individualized medical advice, diagnosis or treatment. If you believe you may be experiencing symptoms of a heart attack, call 911.