Heart Disease Risk Factors All Women Should Know About

Menopause, PCOS and gestational diabetes could increase a woman’s risk for heart disease—but there are ways to lower the odds.

Doctor talking with patient

In the United States, one woman dies of heart disease and stroke every eighty seconds. Although grim, this statistic may not be surprising since 90 percent of women have at least one risk factor for heart disease.

Anyone can be affected. Heart disease—an equal opportunity killer—is the number one cause of death in both women and men. Still, there are certain risk factors that are unique to women, says Jennifer Yeh, MD, an interventional cardiologist at Memorial Health in Savannah, Georgia.

So, while it’s very important for everyone to be aware of general risk factors, such as being overweight, having a family history of heart disease, smoking or having high blood pressure, high cholesterol or diabetes, women should be aware of the following four risk factors that are unique to them:


For both men and women, the risk for heart disease increases with age. But heart attacks among women, in particular, also increase about 10 years after menopause, according to the American Heart Association. This may be at least partly due to the loss of estrogen, which is believed to have a protective effect on artery walls by keeping blood vessels flexible.

With the hormonal changes of menopause come certain metabolic changes, including weight gain. As a result, women are more likely to develop elevated blood pressure and diabetes. Their LDL, or “bad” cholesterol and triglyceride levels can also rise while their HDL, or “good” cholesterol level drops or remains unchanged. All of these things can increase heart disease risk, says Dr. Yeh.

But don’t assume that you’re in the clear just because you’re in your 30s or 40s.

“More women are being diagnosed with heart disease in this younger age group due in large part to an increasing prevalence of obesity and sedentary lifestyles, as well as an associated rise in diabetes and continued tobacco use,” explains Yeh.

Regardless of your age, it is important to maintain a healthy weight and eat a heart-healthy and well-balanced diet that’s rich in fresh fruit and vegetables, whole grains and healthy fats such as fatty fish, nuts and olive oil, says Yeh. The American Heart Association doesn’t recommend that women use hormone replacement therapy (HRT) as a way to reduce their risk of heart disease.

Poltcystic ovary syndrome (PCOS)

PCOS—a hormonal disorder in which your body produces too much of the male hormone testosterone and similar hormones—affects up to 12 percent of reproductive-aged women, according to the Centers for Disease Control and Prevention.

While many women with this condition are worried about possible side effects such as acne, facial hair and weight gain, PCOS also carries an increased risk of heart disease. Women with the condition are more likely to develop high blood pressure and to have elevated levels of LDL cholesterol and low levels of HDL cholesterol. They’re also more likely to have type 2 diabetes. In fact, more than half of women with PCOS develop this chronic disease by age 40.

If you have PCOS, it’s important that your doctor screen you for type 2 diabetes. It’s also important to maintain a healthy weight and stay physically active to help lower your risk of both diabetes and heart disease.

Pregnancy complications

If you’ve had gestational diabetes, pregnancy-induced hypertension or pre-eclampsia, make sure your primary care physician is aware. These conditions are associated with a higher risk for heart disease down the road so you should be closely monitored, stresses Yeh.

If you’ve had preeclampsia, your risk of high blood pressure may be up to four times higher and your risk for heart disease and stroke may be twice as high, according to the Preeclampsia Foundation. Research also suggests that women with high blood pressure during pregnancy are at higher risk for high blood pressure and diabetes years later, the American College of Cardiology reports.  

For some women, this early warning sign of heart disease later in life could help motivate them make some heart-healthy changes.

Another pregnancy complication that could affect women’s heart health: gestational diabetes. “If you have had gestational diabetes, you are much more likely to go on to develop full-blown type 2 diabetes, which increases your heart disease risk,” explains Yeh.

A 2017 study published in JAMA Internal Medicine found that women who’ve had gestational diabetes have a 43 percent increased risk of developing heart disease than those who didn’t have the condition. Keep in mind, this translates to a small absolute risk. The researchers also pointed out the increase in risk was diminished among those who did not develop type 2 diabetes and those who adopted heart-healthy lifestyle changes, including getting regular exercise, maintaining a healthy weight, following a healthy diet and not smoking.  


It’s well known that smoking increases the risk for heart disease. What is less well known is that smoking may be even more dangerous for women than it is for men, says Yeh.

Women older than 35 who smoke have a slightly higher risk of dying from heart disease than male smokers in this same age group. It’s unclear why women are more vulnerable but, in general, smoking damages the structure and function of the blood vessels, which can increase the risk for atherosclerosis, or “hardening of the arteries.”

Atherosclerosis develops when plaques made up of fat, cholesterol and other substances build up in the arteries, causing them to narrow. This reduces the flow of blood to the heart, increasing the risk for heart attack, heart failure, problems with the heart’s electrical system, or even death.

Smoking can also lead to peripheral artery disease, which occurs when plaque builds up in the arteries that supply blood to other vital organs. Peripheral artery disease also increases the risk for heart disease, heart attack, and stroke.

The good news is if you quit smoking today, you’ll see results quickly. Heart attack risk drops dramatically in the first year and within five years your stroke risk will have dropped to that of someone who has never smoked.

Managing your heart disease risk factors

It’s important to make sure that you’re up to date on all your heart-healthy screening tests. This includes having your blood pressure checked at every healthcare visit. You should also have your cholesterol levels tested every four to six years and have a blood glucose screening every three years after age 45. If these numbers are already elevated, or you have risk factors for heart disease, you should talk to your doctor about whether it makes sense to get screened more frequently.

You can help keep heart risk factors in check by maintaining a healthy weight (or losing weight if you are overweight or obese), eating a heart-healthy diet low in saturated fat and salt, exercising at least 30 minutes most days of the week and not smoking, adds Yeh. Depending on your individual needs and medical history, your doctor may also prescribe medication in addition to lifestyle changes to protect your heart health.

It’s also important to be aware that women who have coronary heart disease may not present with the typical “elephant sitting on the chest” symptoms, Yeh says.

“Instead,” she notes, “they may have a more atypical presentation, including extreme shortness of breath, profound fatigue, pain across the upper back and shoulders or even terrible indigestion.”

Nevertheless, a study published in February 2018 in the medical journal Circulation found that more than half of women reported that their doctors didn’t think these symptoms were heart related compared to just 37 percent of men.

If you have signs like these, get medical attention right away. Don’t hesitate to be persistent and make sure any concerns about your heart health are addressed.

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