For years, organizations like the American Heart Association (AHA) have been producing awareness programs to warn women about heart disease. Still, many women are unaware of the dangers. In a 2000 national survey, only 34 percent of women correctly identified heart disease as a leading cause of death, and only 8 percent saw it as their biggest health threat. By 2008, six in ten women identified heart disease as the leading cause of death among women, and in 2010, the number rose to nearly seven in ten.

Even with this increased awareness, women are still finding it difficult to manage their risk factors. According to a 2007 survey by the Society for Women's Health Research, nine out of ten knew that cholesterol can cause damaging buildup in arteries, but less than a third knew their own cholesterol levels. More than a third was surprised to learn that high cholesterol produces no symptoms.

An additional survey by Women's Day found that over half of women reported difficulties in trying to exercise at least 30 minutes a day most days of the week, with the same amount struggling to maintain a healthy weight.

Women's biggest fears remain centered around breast cancer and other cancers. Yet, heart disease was responsible for 28.6 percent of all deaths in women in the United States in 2002, while all cancers combined represented only 21.6 percent of female deaths that year—with breast cancer responsible for less than 4 percent of all deaths.

Studies So Far Gender-Biased

It's not just a lack of awareness that has caused the gender disparity in heart disease. Though it's the number one killer of both women and men, the disease is under-recognized and under-treated in women. According to a 2010 report by the Society for Cardiovascular Angiography and Interventions (SCAI) in partnership with WomenHeart, only 20 to 25 percent of patients enrolled in most cardiovascular disease clinical trials are women. As a result, women are often treated according to data based on men, so their outcomes are often significantly worse men’s.

According to the survey, women were more likely to receive a delayed diagnosis because of atypical symptoms. Women with angina were less likely to: be prescribed aspirin or other lipid-lowering therapies, have an electrocardiogram done within 10 minutes of presentation, be cared for by a cardiologist, and be given high blood pressure medication.

Differences Between Men and Women

When it comes to risk factors for heart disease, women share most of them with men, such as:

  • high blood pressure
  • high cholesterol levels
  • smoking
  • overweight and obesity
  • lack of physical activity
  • poor diet

However, women do seem to be more affected by certain factors, like smoking, stress and depression, and diabetes. Studies conducted by Johns Hopkins cardiologists found that family history and body inflammation doubled a woman's risk for heart disease. Women with both a family history of heart disease and high C-reactive protein levels (which measures inflammation) had an increased risk of nearly four times.

Other differences between genders include the age of onset of heart disease, the symptoms of heart attack, and the outcomes of treatment. Women typically develop cardiovascular disease about ten years later than men, mostly because of the changes that occur during menopause, which leave women without the protection of estrogen.

Like men, women who have a heart attack are twice as likely to die within the first two weeks, but they’re typically not treated as aggressively as men. For example, within the first year after a heart attack, 39 percent of women die, compared with 31 percent of men.

Risk Factors for Heart Disease in Women

As heart disease can exist for years without any detectable outward symptoms, it's important to make regular appointments with your doctor and go over the following risk factors:

  • age (women over 50 or past menopause are at higher risk)
  • smoking
  • obesity/weight
  • cholesterol levels
  • blood pressure
  • triglyceride levels
  • diabetes risk
  • alcohol use
  • activity level
  • family history of the disease
  • body inflammation levels
  • metabolic syndrome (combination of belly fat, high blood pressure, high blood sugar, and high triglycerides)
  • other diseases, such as lupus and rheumatoid arthritis
  • taking oral contraceptives (when combined with other risk factors like smoking)
  • stress/depression

Other signs of potential heart disease in women may include chest pain (potentially due to angina), difficulty exercising (breathlessness), and peripheral artery disease, which causes leg pain.

Signs and Symptoms of Heart Disease

Unlike men, who usually have the standard symptoms of chest pain and shortness of breath, women have different heart disease symptoms. Unfortunately, these symptoms are less obvious and often ignored. As a woman, one of the best things you can do for your own health is to become more informed of typical signs of heart disease in women and learn to recognize when you should get to the emergency room.

In addition to understanding your risk factors, you should be aware of these potential symptoms of heart attack, which may be subtler than a man's symptoms:

  • unusual fatigue (one of the most often reported symptoms by women)
  • neck, shoulder, or upper back pain or discomfort
  • a burning sensation in the upper abdomen
  • nausea or vomiting and upset stomach
  • shortness of breath
  • sweating
  • lightheadedness or dizziness