Heart disease is the leading cause of death among American women. According t  Centers for Disease Control and Prevention (CDC), one in four women in the United States in 2013 died from cardiovascular disease, which was 289,758 women. Since the first medical reports about heart disease, the condition has been associated with men more than women even though women struggle with this condition in huge numbers. In fact, only 54 percent of women recognize that heart disease is one of their leading risks; many women believe that breast cancer is a bigger risk, although that condition kills one in 31 women annually.  

About 5.8 percent of white women, 7.6 percent of African American women, and 5.6 percent of Mexican American women have coronary heart disease. In addition, 64 percent of women, or nearly two-thirds, have no previous symptoms before they experience their first heart attack. In the first year after a heart attack, 23 percent of women will die.

One in eight women between the ages of 45 and 64 have some form of heart disease. Because initial medical research focused on men’s heart attack symptoms and disease risks, many physicians fail to properly diagnose coronary disease, including a heart attack, in women before it is too late. Since this is still a problem with physicians, many women also fail to recognize their risk factors and symptoms, so they fail to report the problem until they must be hospitalized. Symptoms of a heart attack and heart disease in women are different, so it is important to know what to look for.

Signs of a Heart Attack in Women

The most common symptom of a heart attack in anyone, male or female, is pain. In men, this pain tends to center around the heart area, like a tightening in the chest or sternum. Pain can radiate down one or both arms, or the left arm may become numb. Shortness of breath and dizziness are also common symptoms in both genders.

Women are more likely to have heart attack symptoms that do not include pain or do not match up with those associated with men. These additional symptoms may include:  

  • Pain in the neck, jaw, shoulder, or upper back 
  • Abdominal pain or discomfort, including nausea and vomiting 
  • Pain in one or both arms 
  • Sweating 
  • Lightheadedness  
  • Unusual fatigue, often for one week before the heart attack 

Women may experience less chest pain than men (often reporting more pressure or tightness but not pain) because women are more likely to have arterial blockages that do not impact the main arteries, but the smaller ones that also supply blood to the heart. This is called small vessel heart disease or coronary microvascular disease.

  • One month before a heart attack, women are likely to report these symptoms:
    • 71% report unusual fatigue
    • 48% report sleep disturbances
    • 42% report shortness of breath
    • 39% report indigestion
    • 36% report anxiety
    • 27% report feeling their heart race
    • 25% report weak or heavy arms
  • During a heart attack, women these symptoms:
    • 58% report shortness of breath
    • 55% report general weakness
    • 43% report unusual fatigue
    • 39% report cold sweat
    • 39% report dizziness
    • 36% report nausea
    • 35% report heavy or weak arms

Preventing Heart Disease in Women

High cholesterol, high blood pressure, and obesity are risk factors for both men and women when it comes to heart disease. Abusing drugs and alcohol also increases the risk of coronary disease as well as other chronic health problems. Family history, lack of exercise, and poor diet all contribute to increased risk of heart disease regardless of gender.

Risk factors for coronary disease that are unique to women or more prevalent among women include:
    • Diabetes
    • Blood lipids (fats) and how they react to estrogen
    • Metabolic syndrome
    • Smoking
    • Early menopause or a hysterectomy
    • Mental and emotional stress

While some of these risk factors may be present in men, they are deadlier when they are present in women. For women with a family history or underlying condition that contributes to heart disease, controlling other lifestyle factors is very important. Work with a physician to assess all risk factors and learn which can be managed.

For example, eating a healthy, plant-based diet that is low in fats and refined sugars will reduce the risk of heart disease, both directly and by keeping the body at a healthy weight. Regular exercise improves heart health, reducing the risk of heart disease. Getting regular check ups at the doctor to monitor blood pressure and cholesterol will be important because if lifestyle factors are controlled for, a physician can prescribe medication to get these problems under control. A physician can also help with smoking cessation.

Drinking too much alcohol or abusing drugs puts the body under a great deal of stress, which increases the risk of heart disease. If alcohol or drug addiction is present, medically supervised detox is needed, so it’s important to enter a professional rehabilitation program as soon as possible.

Drugs and Alcohol Damage the Heart

There are many drugs that can lead to coronary disease or even a sudden heart attack if abused. These include 

    • Cocaine and crack cocaine
    • Crystal meth
    • Ritalin or Adderall
    • Alcohol
    • Opioid drugs like heroin or OxyContin
    • DMT
    • GHB
    • Inhalants
    • Ketamine
    • LSD
    • Marijuana
    • Ecstasy or MDMA
    • Mescaline
    • PCP
    • Synthetic cannabinoids or cathinones (e.g., Spice, bath salts)
    • Tobacco

Manage Lifestyle Choices to Reduce Heart Disease Risk

Heart disease is a confluence of family history, genetics, and lifestyle factors; these may include weight, eating habits, exercise, life stressors, and drug addiction. It is important for everyone, including women, to make healthier choices to manage lifestyle-related heart disease risks. If a woman struggles with drinking too much, abusing prescription or illegal drugs, or other lifestyle factors, she must get help from a physician. In the case of drugs and alcohol, this may mean entering a detox and rehabilitation program.