Understanding Women’s Heart Disease: The Silent Threat We Need to Talk About

Heart Disease Is Women’s Number One Killer—Not Cancer

Here’s a sobering fact that might surprise you: heart disease, not breast cancer or any other form of cancer, is the leading cause of death for women in America. According to the Centers for Disease Control and Prevention, heart disease was responsible for one out of every five female deaths in 2023. Yet despite these alarming statistics, only about 56% of women recognize this danger. This gap in awareness represents a critical public health issue that deserves our immediate attention.

Dr. C. Noel Bairey-Merz, a cardiology professor and director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai, puts it bluntly: “It is the leading killer of women at all ages so, starting at the age of 18, more women will die of heart disease than breast cancer.” This statement should be a wake-up call for women of all ages. While breast cancer awareness campaigns have successfully educated women about that disease, heart disease has somehow remained in the shadows, quietly claiming more lives year after year. The disconnect between the actual risk and women’s perception of that risk creates a dangerous situation where women may not take the necessary preventive measures or recognize warning signs when they occur.

Women’s Heart Attack Symptoms Are Different—And That’s Not “Atypical”

For decades, medical professionals described women’s heart attack symptoms as “atypical,” a term that Dr. Bairey-Merz says is both outdated and misleading. “You’re not supposed to use that term anymore because it is misleading,” she explains. “It suggests that women, who are 51% of the population, are atypical compared to 49% of men. That doesn’t make sense.” This linguistic shift represents more than just political correctness—it reflects a fundamental problem in how we’ve approached cardiovascular research and treatment.

The issue stems from the fact that cardiovascular disease research has historically focused primarily on men. The symptoms we often think of as “classic” heart attack signs—crushing chest pain, profuse sweating, and pain shooting down the left arm—may be typical for men, but they don’t necessarily apply to women. When a woman experiences a heart attack, she’s more likely to feel pain in her upper back, arm, neck, or jaw, according to the American Heart Association. A comprehensive analysis of multiple studies published in the Journal of the American Heart Association in May 2020 found that women experiencing heart attacks had higher odds of pain between the shoulder blades, nausea and vomiting, and shortness of breath, while having lower odds of the chest pain and sweating typically associated with heart attacks in men.

Dr. Harmony Reynolds, who directs the center for women’s cardiovascular health at NYU Langone Health, emphasizes that these differences matter. “In fact, both women and men can present without a ‘typical pain’ feeling,” she notes. “You know the classic thing is that people say, ‘Oh it felt like an elephant was standing on my chest,’ or that the pain was so bad that they couldn’t stand it, and that’s not always the case with heart attacks, particularly for women.” Women are 30% less likely than men to report chest pain when having a heart attack. Instead, they may perceive more of a discomfort rather than outright pain, and they’re more likely to report experiencing multiple symptoms simultaneously compared to men.

The Dangerous Delay: Why Women Wait Too Long for Help

Even more concerning than the symptom differences is what happens when women experience these warning signs. Research published in The Lancet in May 2022 revealed that even while actively having a heart attack, many women wait longer to seek medical attention compared to men. And when they do seek help, more women are incorrectly told that their symptoms aren’t related to their heart. This double jeopardy—delayed help-seeking combined with medical dismissal—creates a perfect storm that can have devastating consequences.

Why do women wait? Part of the problem lies in societal expectations and internalized fears. The American Heart Association points out that women sometimes downplay their symptoms and experiences because they’re afraid of being viewed as overreacting or being labeled a “hypochondriac.” This fear of judgment, combined with women’s tendency to prioritize others’ needs over their own health, can lead to fatal delays. Women might convince themselves that what they’re feeling isn’t serious enough to warrant emergency care, or they might wait until they’ve taken care of their children, finished work tasks, or handled other responsibilities before addressing their own medical emergency. This tendency to self-minimize, while perhaps socially conditioned, can literally be deadly when it comes to heart attacks, where every minute counts.

Taking Control: What Women Can Do to Protect Themselves

Dr. Reynolds believes that improving and personalizing the medical evaluation process could save countless women’s lives. Her advice is practical and empowering: women should come to their medical checkups prepared with a list of questions, and if heart disease is among their concerns, they need to speak up assertively. She emphasizes that women should make sure to discuss every symptom they’re experiencing—no matter how minor it might seem—and ask about any available tests that will provide a thorough evaluation of their heart health.

This proactive approach requires women to advocate for themselves in medical settings, which isn’t always easy. It means not accepting dismissive responses, not minimizing your own symptoms to make doctors feel more comfortable, and insisting on answers that satisfy your concerns. If you feel chest discomfort, unusual fatigue, shortness of breath, or any combination of symptoms that doesn’t feel right, you have every right to request comprehensive cardiac testing. If a healthcare provider suggests your symptoms are just anxiety or stress without properly investigating cardiac causes, you have every right to seek a second opinion or insist on further testing.

Beyond individual doctor visits, both Dr. Bairey-Merz and Dr. Reynolds recommend that all people, regardless of sex, follow the American Heart Association’s Life’s Essential 8 checklist to protect their heart health. This evidence-based framework includes: eating a healthy diet rich in fruits, vegetables, whole grains, and lean proteins; getting regular physical exercise; quitting tobacco use in all forms; ensuring good quality sleep; managing a healthy weight; controlling cholesterol levels; keeping blood sugar in check; and monitoring other important health numbers like blood pressure. These lifestyle factors aren’t just suggestions—they’re proven strategies that can significantly reduce your risk of developing heart disease in the first place.

Education and Awareness: Changing the Narrative Around Women’s Heart Health

Dr. Reynolds emphasizes that women’s heart health education is absolutely crucial to turning the tide on this silent epidemic. “There is this sense that heart disease is a man’s disease and it’s just wrong,” she states firmly. “If you don’t look for it, you’re not gonna find it.” This statement captures the essence of the problem: both women and their healthcare providers need to actively consider heart disease as a possibility rather than overlooking it in favor of other diagnoses.

Changing this narrative requires effort on multiple fronts. Women need to educate themselves about their actual risk factors and the symptoms they might experience. Healthcare providers need continuing education to recognize and properly evaluate cardiac symptoms in women. Medical research needs to continue including women in cardiovascular studies and analyzing sex-based differences in disease presentation and treatment outcomes. And society as a whole needs to shift its understanding of heart disease from a “man’s disease” to what it actually is: the number one killer of both men and women, just with some important differences in how it manifests.

The good news is that awareness is growing, conversations are happening, and more resources are being dedicated to understanding women’s cardiovascular health. Organizations like the American Heart Association have launched initiatives specifically focused on women’s heart health. Medical centers are establishing women’s heart health programs. And doctors like Bairey-Merz and Reynolds are working to educate both their colleagues and the public about these critical differences. But there’s still a long way to go before heart disease awareness among women reaches the level it needs to be at—where every woman knows her risk and can recognize the warning signs that might save her life.

The bottom line is this: heart disease doesn’t discriminate by gender, but it does present differently in women than in men. By understanding these differences, advocating for ourselves in medical settings, adopting heart-healthy lifestyles, and spreading awareness to other women in our lives, we can begin to close the gap between women’s actual risk and their awareness of that risk—and ultimately save lives in the process.