What Every Woman Should Know About Heart Disease

Although heart disease is the leading cause of death among women, it’s often misunderstood, underdiagnosed, and even dismissed.

“Women are often the heartbeat of their families, caring for everyone but themselves. But your heart health isn’t a luxury, it’s a necessity,” says Maria Delgado-Lelievre, M.D., a cardiologist and founder and director of the Comprehensive Hypertension Center at the University of Miami Health System.

Women often can have vague symptoms, like stomach discomfort, caused by a lack of enough oxygen in the heart. These symptoms can get overlooked, especially in women who appear fit and healthy.

Your health begins before you’re born.

Prenatal health and your childhood environment and habits shape your future heart health. These environmental factors are referred to as epigenetics, which alter how your body functions and have lasting effects on the heart.

“How you’re raised in a family, like your upbringing, diet, physical activity, and exposure to toxins, shapes how your body responds in the future,” says Dr. Delgado.

Before menopause, estrogen provides some protection against heart and blood pressure concerns.

“Even those with a family history of heart disease have a subtle protection,” says Dr. Delgado.

But when that hormone starts declining in perimenopause, this hormone shift loses its protective effects. Suddenly, women in their 50s and 60s can find themselves with high blood pressure and high cholesterol.

“One of the triggers of heart disease in women, besides cumulative environmental damage, is the decline of hormonal protection,” says Dr. Delgado.

Pregnancy-related red flags

Pregnancy is a time when your risk of high blood pressure can increase, known as gestational hypertension. High blood pressure while pregnant can increase your risk of preeclampsia, which is when someone with gestational hypertension also has protein in the urine.

“If a patient had preeclampsia in her 20s and is told her blood pressure is now fine, she’s still likely to become hypertensive later in life,” says Dr. Delgado.

Gender bias in medical treatment

In the past, most research was done on male lab animals and white men of European descent. That means cardiovascular studies may not always be applicable to women. Research has expanded to include other ethnicities and women, but gender bias still exists.

It’s not unusual for Dr. Delgado to see siblings in their 30s with high blood pressure concerns. “The sister’s been told by other providers that her high blood pressure is just because she’s anxious, so she should check back in a year. The brother with the same high blood pressure gets follow-up questions about smoking and family history,” says Dr. Delgado.

The hidden danger of hypertension in women

High blood pressure, or hypertension, is the leading risk factor for heart disease in the United States. It often goes undiagnosed because symptoms typically do not appear until the condition is severe.

“You need to measure your blood pressure to know if something is wrong,” says Dr. Delgado. It’s essential to catch high blood pressure early so treatment can begin.

“Clean arteries” can still mean heart disease.

Both men and women can have heart attacks when the large vessels of the heart become blocked. In women, however, major arteries can appear “clean” or unblocked on a CT scan, but there may still be heart damage due to dysfunction in the tiny blood vessels that supply the heart muscle. “This doesn’t show up in standard testing but still requires aggressive treatment just like traditional heart attacks,” says Dr. Delgado.

It’s not enough to appear healthy.

Tell your healthcare provider about anyone in your family with a history of high blood pressure or heart conditions. “If one parent or grandparent has a history of hypertension, you should be monitored for high blood pressure,” says Dr. Delgado.

A CT calcium score is a screening tool that could help diagnose more people, especially those with a family history of early heart disease. It detects hardened plaque in the arteries that would otherwise go undiagnosed. Sometimes, early changes aren’t found on standard tests.

Preventing heart disease starts by prioritizing your own health.

“Even when women care deeply about symptoms in their family members, they often ignore their own,” says Dr. Delgado.

Model healthy lifestyle choices for your family by incorporating nutritious foods and regular physical activity.

“Children of parents with high blood pressure have a 50–70% increased risk themselves,” says Dr. Delgado.

Two final tips to ensure your continued good health

Get screened: Ask your provider for a CT scan to examine your calcium score and a lipid panel if you have a family history of heart disease.

Trust your gut: Navigating the health care system isn’t always easy. If you know something isn’t right, don’t settle. Ask for referrals, second opinions or specialists.

“I see women who knew something was wrong for years but were never taken seriously,” says Dr. Delgado. “Don’t wait for symptoms. Start the conversation, monitor your health and demand the care you deserve.”

Written by Wendy Margolin for UHealth.

Tags: Dr. Maria Delgado, Health screenings for women, Heart disease symptoms in women, Hypertension in women, Preventing heart disease