Understanding Risk for Heart Attack and Stroke in Women

Heart disease is the leading cause of death among women, but it's also one of the most preventable. Here's what you need to know about heart attack and stroke.

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Updated on January 3, 2024.

Each year, over 800,000 Americans experience a heart attack, and about 12 percent of heart attacks are fatal. Stroke is also a major cause of death and disability, making it the third leading cause of death among women and men.

Despite how common heart attack and stroke are, some misconceptions about them endure, particularly the notion that they primarily happen among men. In reality, women are more likely than men to die as a result of a stroke, while heart disease is the number-one killer of women in the United States.

The difference between heart attack and stroke

In most instances, a heart attack is caused by a small blood clot that becomes lodged within a blood vessel leading to the heart. Clots that develop or travel to the blood vessels in the brain cause the most common form of stroke. Strokes can also occur if a blood vessel bleeds into the brain.

What increases risk for heart disease in women?

Traditional heart-disease risk factors—including high cholesterol, high blood pressure, and obesity—are not sex-specific. But the prevalence of other factors that contribute to heart disease may be different in people assigned female at birth:

  • Metabolic syndrome: a condition characterized by fat that accumulates around the abdomen, high blood pressure, high blood sugar, low levels of HDL (aka “good” cholesterol), and high triglycerides
  • Mental stress and depression
  • Smoking
  • Low levels of estrogen after menopause
  • Family history of heart disease

Lifestyle changes can reduce your risk

The number-one thing women can do to prevent heart disease is to reduce stress in their lives, says Marianne J. Legato, MD, the founder and director of The Foundation for Gender-Specific Medicine at Columbia University in New York City.

"Deal with your life head-on,” Dr. Legato advises. "If you have a nagging problem you can't solve, it's very important to talk to somebody. Not everything needs a therapist. Talking to a true friend may be the best therapy there is."

How can you tell if stress is becoming a factor? "Look at what you are doing in excess," Legato advises. "Are you overeating or not eating? Shopping? Drinking? Gambling? Any of these are indicators."

She also advises taking care of yourself and knowing your risk factors. She adds, "Trust yourself and take action when needed."

Legato notes that exercise is essential to reducing stress, even if it's just walking.

"Walk everywhere, as fast as you can," she says.

You can increase physical activity by taking the stairs instead of the elevator, walking or riding a bicycle to do errands, parking your car a good distance from the entrance of buildings to get some extra steps, or doing some sit-ups or push-ups while watching TV.

Other lifestyle changes you can make to reduce your risk of heart disease include not smoking, maintaining a healthy weight, and eating a heart-healthy diet. Legato suggests keeping a detailed food diary for two weeks. If you would like more guidance, a dietitian or nutritionist can help you find ways to work more healthy foods into your diet, such as:

  • Fruits and vegetables
  • Whole grains
  • Fat-free or low-fat dairy products
  • Lean protein, poultry, fish, beans, eggs, and nuts
  • Healthy fats like olive oil
  • Foods that are low in saturated fats, trans fats, cholesterol, salt, sodium, and added sugars

If you have a medical condition that is a risk factor for heart disease, such as high blood pressure, high cholesterol, or diabetes, follow the advice of your healthcare provider (HCP), including taking your medicines as prescribed.

Keep a close eye on your blood pressure and blood sugar. While it can take some trial and error to get them under control, monitoring your numbers and working with your HCP can help get you on track. Some people at high risk of heart disease might also benefit from supplements, such as omega-3 fatty acids. Check with your HCP before you starting any supplements to see if they are right for you.

Until recently, daily aspirin was advised as a preventive measure. But new guidelines from the American Heart Association no longer recommend routinely taking aspirin, based on research suggesting it doesn’t prevent heart attacks in women and can lead to major bleeding. Because aspirin may still be appropriate for certain groups of people, ask your HCP about it and about other preventive measures you can take to reduce your risk of heart disease.

Article sources open article sources

Krumholz HM, Normand ST, Wang Y. Twenty-Year Trends in Outcomes for Older Adults With Acute Myocardial Infarction in the United States. JAMA Netw Open. 2019;2(3):e191938. Published 2019 Mar 1.
Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008;7(10):915-926.
Johns Hopkins Medicine. Metabolic Syndrome. Accessed February 17, 2022.
Cleveland Clinic. Estrogen & Hormones. Reviewed April 29, 2019.
Johns Hopkins Medicine. Is Taking Aspirin Good for Your Heart? Accessed February 3, 2022.
Alyson Kelley-Hedgepeth. Omega-3 fatty acids and the heart: New evidence, more questions. Harvard Health Publishing. March 24, 2021.
Centers for Disease Control and Prevention. Heart Disease Facts. Page last reviewed September 27, 2021.
Centers for Disease Control and Prevention. Stroke Facts. Page last reviewed May 25, 2021.
National Institutes of Health Office of Dietary Supplements. Omega-3 Fatty Acids: Fact Sheet for Consumers. Updated August 4, 2021.
American Heart Association. Should you take aspirin to prevent heart attack? Last reviewed March 20, 2019.

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