One in three women dies of heart disease, which averages to one death each minute. Heart disease is not just a man’s disease, it is the No. 1 killer of both men and women in the United States. Surveys by the American Heart Association (AHA) have shown a lack of awareness in women when it comes to their risk of heart disease, yet most cases of heart disease are preventable.

“It is important to know your risk,” said Sarah Thordsen, MD, cardiologist with the Froedtert & the Medical College of Wisconsin health network. “Obesity, diabetes and family history are examples of traditional risk factors shared by men and women. However, there are some risk factors that apply specifically to women or that affect women differently. Regular screenings can help your provider identify heart disease early.”

Important heart disease risk factors for women:

  • Pregnancy complications — Preeclampsia, gestational diabetes and high blood pressure during pregnancy can affect your risk of heart disease after pregnancy.
  • Diabetes — Women with diabetes are more likely to have heart disease than men with diabetes because women are also more likely to have additional risk factors such as obesity, high blood pressure and high cholesterol.
  • Smoking status Female smokers have a 25 percent higher risk of developing heart disease than male smokers.
  • Anxiety and depression — Anxiety and depression are more common in women than in men and are significant contributors to heart attacks and heart disease.
  • Menopause — Physiological changes due to menopause put women at a higher risk for heart disease, especially when combined with unhealthy habits.

The role of estrogen

Estrogen is a hormone produced by the ovaries in a woman. Before menopause, the levels of estrogen in a woman’s body provide some cardiac protection. Estrogen reduces inflammation and helps repair vascular injuries.

After a woman goes through menopause, there is a natural decline in estrogen. According to the AHA, there is an overall increase in heart attacks in women about 10 years after menopause. While estrogen protects the vascular system, few studies have demonstrated benefits of hormone replacement therapy in women post-menopause and most have mixed results, and it can have other non-cardiac risks. Other physiological changes after menopause, such as higher blood pressure and changes to a woman’s cholesterol profile, are important factors to consider.

Women can have different symptoms

A woman might not realize she is having a heart attack because she might not have typical symptoms or she may relate the symptoms to something else. The symptoms of heart disease in women can be variable, which can delay treatment and make it more difficult to obtain a diagnosis.

While the most common presentation for a heart attack in both men and women is chest pain, women may also present with symptoms unrelated to chest pain. Women may experience anxiety; shortness of breath; indigestion; sleep disturbances; fatigue; and pain in the neck, back, jaw or arms in the days leading up to a heart attack. In a study published in the medical journal Circulation, 53 percent of women reported their health care provider did not think these symptoms were heart-related.

“These are some of the symptoms we ask about in every history we take of a patient with chest pain,” Dr. Thordsen said. “As part of the Froedtert & MCW Women’s Heart Disease Program, we have a team of female cardiologists who are attuned to the female patient. We are constantly doing research to learn more about the best ways to prevent and treat heart disease in women.”

Tailoring prevention and treatment to women

Heart disease can be congenital or acquired. The risk is higher for women after menopause, but unhealthy choices, such as eating a diet high in fat or leading a sedentary lifestyle, can lead to heart disease at a younger age.

Preventing heart disease begins with annual wellness visits to your primary care provider. Routine screenings can identify risk factors for heart disease, such a high blood pressure, diabetes or cholesterol. Your first cholesterol check should be at age 20, or earlier.

“Many young people don’t go in to the doctor regularly,” Dr. Thordsen said. “But when it comes to heart disease, early and consistent screenings are so important.”