Ask The Experts: Why Are Women At Higher Risk For Cardiovascular Disease?

Heart disease is the leading cause of death for both males and females, despite the myth that heart disease is a “man’s disease.” Marco Govel/Stocksy

• Most women are unaware of their heart disease risks. 
• The myth that heart disease is a ‘man’s disease’ is inaccurate as heart disease is the number one cause of death for both males and females.
• Sex-specific risk factors like menopause, diabetes, obesity, and stress disproportionately put many women at higher cardiovascular risk.
• Experts urge awareness, education, and prevention strategies around female risk factors for heart disease.

Historically, heart disease was thought to be a “man’s disease,” when in fact, it’s the top cause of death among both men and women.

Yet a general lack of awareness about female heart disease persists. 

According to the Centers for Disease Control and Prevention (CDC), only 56% of women were unaware of their cardiovascular risks, despite heart disease being responsible for 1 in 5 female deaths. 

Why then does the leading cause of female death remain ambiguous?

Jack Wolfson, MD, board certified cardiologist and “The Natural Heart Doctor,” cited historical bias in medicine as one factor.

“For decades, cardiovascular research, diagnostic criteria, and public messaging were centered on men, while women’s symptoms were labeled ‘atypical,’ rather than correctly recognized as different,” he said. 

“The myth persists because men tend to have heart attacks earlier, while women often develop cardiovascular disease later and in more subtle ways. Heart disease is a human disease, not a gendered one,” Wolfson said.

Heart disease often presents differently in women, explained Nissi Suppogu, MD, board certified cardiologist and Medical Director of the Women’s Heart Center at MemorialCare Heart & Vascular Institute at Long Beach Medical Center in Long Beach, CA. 

These nuances may sow confusion about symptom recognition, potentially delaying diagnoses. 

There’s also a misconception that women face higher risks from breast cancer than heart disease, said Jennifer Wong, MD, board certified cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA.

“This highlights the need for greater awareness, earlier risk factor screening, and recognition that women may present with more subtle or atypical symptoms,” Wong said.

Healthline spoke with these cardiologists to learn more about the risk of heart disease in women and what can be done to prevent it.

These interviews have been edited and condensed for clarity and length.

What are the ‘silent signs’ of heart disease in women?

Wolfson: Many women are told their symptoms are stress, anxiety, or hormonal rather than cardiovascular. When chest pain, shortness of breath, or palpitations are dismissed, awareness never develops.

Women are also more likely to die after a first heart attack, partly because diagnosis is delayed and symptoms are misunderstood.

Wong: Women tend to have more atypical heart attack symptoms, such as nausea, vomiting, neck or jaw pain, and fatigue.

Women may experience heart attacks from less traditional causes, such as spontaneous coronary artery dissection (SCAD) rather than classic atherosclerotic plaque rupture.

Suppogu: More than 50% of women presenting with chest pain or having a heart attack have smaller blood vessel disease called microvascular disease or vasospasm.

If not managed appropriately, it can cause early onset of coronary artery disease as well as heart failure.

Why does menopause increase cardiovascular risk?

Suppogu: Hormonal changes play a significant role in physiological changes. Pregnancy-related conditions like hypertension, preeclampsia, and gestational diabetes increase the risk for early onset coronary artery disease or heart failure in the future.  

Other diseases of pregnancy, like cardiomyopathy, spontaneous coronary artery disease, also affect women’s health and quality of life.

Heart disease also rises significantly after menopause because of increasing calcification of the atherosclerosis or blockage of the coronary arteries. There is an increase in “bad” cholesterol levels, thickening of the blood vessel wall, elevated blood pressure, increased fat deposition, and weight gain.

Wong: Menopause is a major cardiovascular risk factor, and early menopause in particular has been linked to a higher risk of cardiovascular events before age 60. 

However, this increased risk appears to lessen over time and becomes less significant after age 70.

How do diabetes, obesity impact female cardiovascular risk?

Wong: Diabetes and obesity appear to increase cardiovascular risk disproportionately more in women than in men. 

The cardiovascular protection women may have from endogenous estrogen is diminished or negated [with] diabetes and obesity, leading to a significantly higher risk of adverse cardiovascular events.

Suppogu: Diabetic women have a threefold increase in developing heart disease compared to men with diabetes. 

Women with diabetes tend to have more coronary atherosclerosis and lesser chance of having revascularization or being on appropriate medical therapy to achieve target cholesterol, blood pressure, and blood sugar numbers. 

Obesity is more prevalent in women compared to men, given their body composition and menopausal changes, causing them to store a higher percentage of body fat and abdominal fat, with easy weight gain. Obesity also confers a higher risk for developing coronary atherosclerosis in women.

Wolfson: Diabetes essentially erases the natural cardiovascular protection women once had before menopause. 

Elevated blood sugar damages blood vessels, disrupts nitric oxide signaling, worsens inflammation, and accelerates plaque instability. 

Obesity also affects women differently because fat distribution, hormones, and insulin sensitivity interact in complex ways. Visceral fat increases inflammation and estrogen disruption, driving higher triglycerides, lower HDL function, and greater vascular damage. 

Women are also more likely to develop metabolic dysfunction at lower body weights than men.

How does mental health impact a woman’s heart disease risk?

Wong: Depression is more prevalent in women and appears to be a stronger predictor of cardiovascular disease in women than in men. 

Women may also have greater biological susceptibility to stress, including heightened inflammatory responses and increased platelet aggregation. 

These factors may contribute to a disproportionate increase in cardiovascular risk associated with chronic stress in women.

Suppogu: When you look at the roles of men and women in a family setting, women tend to take on more things around the house for the children and for their partner, and juggle their work-related roles as well. 

All this tends to add to their level of stress, along with hormonal changes and aging, making it difficult to handle stress.

Stress and anxiety tend to double the risk of heart disease in women and is one of the risk factors, just like diabetes, hypertension, smoking, or obesity.

What can women do to lower their cardiovascular risk?

Wong: Preventive measures such as maintaining a heart-healthy diet, engaging in regular physical activity, and prioritizing consistent, restorative sleep can substantially lower a woman’s overall cardiovascular risk.

Wolfson: Women should prioritize real food nutrition, especially wild seafood, regeneratively raised meats, eggs, fermented foods, fruits, vegetables, and healthy fats like olive oil, avocado, and coconut. 

Ultra-processed foods and sugars are a major driver of inflammation and insulin resistance.

Movement matters. Daily walking, resistance training, and staying physically active throughout the day protect blood vessels and improve insulin sensitivity.

Sleep and circadian rhythm are critical. Poor sleep increases blood pressure, blood sugar, and inflammation. 

Stress management and emotional health are essential. Chronic stress, trauma, and lack of community directly impact cardiovascular risk through hormonal and inflammatory pathways.

Women should test, not guess, looking beyond basic labs to assess oxidative stress, insulin resistance, inflammation, nutrient status, and toxin burden allows intervention long before disease develops.

Suppogu: We need to teach women about the importance of prevention and advise them to see a primary care physician yearly to check blood pressure, cholesterol, blood glucose, and weight, counsel about smoking and alcohol intake, and discuss mental health.

We need to encourage women to advocate for their cardiac health. If they have symptoms concerning heart disease, then they must get checked sooner [rather] than later.

What can be done to help more women learn about heart disease risk?

Wong: Awareness of cardiovascular risk factors is essential for improving outcomes in women. 

Recognizing these risks early and taking proactive steps can significantly reduce the likelihood of future cardiovascular events. 

Suppogo: We need to educate women to recognize cardiac symptoms, that heart disease can present differently, and not just like chest pain. 

Education about additional risk factors that are more common in women like inflammatory conditions, depression anxiety, and pregnancy related issues [is important].

Wolfson: We need better education starting in primary care, honest conversations earlier in life, and a shift toward testing real risk factors like inflammation, insulin resistance, oxidative stress, toxins, and nutrient deficiencies instead of relying solely on cholesterol numbers or waiting for symptoms. 

Heart disease in women is not inevitable. With the right education, testing, and lifestyle strategies, it is largely preventable.