Understanding Women’s Risk for Heart Attack and Stroke

Heart disease is the leading cause of death among women, but it's also one of the most preventable. Here's how to know if you're in the danger zone.

smiling woman holding a book

Medically reviewed in February 2022

Updated on February 17, 2022

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

Despite how common heart attack and stroke are, some misconceptions about them endure, particularly the notion that they are primarily men’s problems. That isn’t true. 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 a heart attack and a 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 makes women susceptible to heart disease?
Traditional heart-disease risk factors—including high cholesterol, high blood pressure, and obesity—are not sex-specific. But other factors may be more important in the development of heart disease in women:

  • Metabolic syndrome: This is marked by a combination of 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

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

"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 shrink. 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 women to take care of themselves and to know their risk factors. And, she adds, "they need to trust themselves 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.

Increase physical activity, such as taking the stairs instead of the elevator, walking or riding a bicycle to do errands, parking your car a good distance from the entrance 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 of the following foods into your diet:

  • Fruits and vegetables
  • Whole grains
  • Fat-free or low-fat dairy products
  • Lean protein, poultry, fish, beans, eggs, and nuts
  • Healthy fats
  • 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, try to be extra meticulous. 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. It can take some time and trial and error to get them under control, so don’t despair about or ignore an abnormal number. Some women at high risk of heart disease might also benefit from supplements, such as omega-3 fatty acids. Check with your HCP before you start any supplements to see if they would make sense for you.

Until recently, many women were once advised to take a daily aspirin as a preventive measure. But new guidelines from the American Heart Association no longer recommend this routine practice after research found it doesn’t prevent heart attacks in women. In addition, aspirin can lead to major bleeding. It’s still appropriate for some groups of people, though. Your HCP will advise you on this and other preventive measures to take to help you reduce your risk of heart disease as much as possible.

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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