Heart Disease: What women need to know

two women drinking coffee and talking at home


In this article:

  • Heart disease is the No. 1 killer of women in the United States.

  • A heart-healthy diet, exercise and regular check-ups can help lower your risk and catch problems early, when they are easier to treat.

  • Delaying medical treatment for a heart attack can lead to serious problems — even death.

Almost 700,000 Americans died from heart disease in 2020 — that’s one in every five deaths.  Though heart disease is thought of as a disease that primarily affects men, almost as many women as men die each year of heart disease in the United States. It's the leading cause of death in the nation for men and women.

To learn more about keeping our hearts healthy, we talked with Alexander L. Pan, M.D., a cardiologist at Swedish Heart & Vascular - Issaquah, about heart disease in women. Dr. Pan gave us some insight into symptoms women should never ignore, the importance of early diagnosis and treatment and important steps women can take to lower their risk.

We often think of heart disease as being more common in men than women. Why is that?

I suspect a lot of it has to do with the media. We have all seen movies where a middle-aged man experiences a heart attack — he clutches his heart and falls to the ground, and someone calls 911. Can you remember ever seeing a woman have a heart attack on a TV show or in a movie?

Between the ages of 45 and 65, one in nine women has some form of cardiovascular disease. In the over-65 age group, it’s one in three women. 

Society’s emphasis on breast cancer may have something to do with it as well. Breast cancer awareness is important, but the fact is heart disease is the most common cause of death and disability in women in the United States. Between the ages of 45 and 65, one in nine women has some form of cardiovascular disease. In the over-65 age group, it’s one in three women.

Do women and men experience heart disease differently?

There are a few key differences. Women who have blockages in their arteries are more likely than men to present with heart failure after a heart attack. Their heart muscles do not pump blood and relax as efficiently which can cause blood to back up. This may lead to symptoms such as difficulty breathing during activities, shortness of breath when lying down and swelling in the legs.

Another difference lies in how angina (heart blockage-related chest pain) can be triggered. While men and women are equally affected by physical exertion, women are more likely to have stressful emotions cause their symptoms. That’s important to keep in mind if you are experiencing pain and wondering if you might be having a heart attack.

What are three things women can do to minimize their risk for heart disease?

First, eat a healthy diet that emphasizes fruits and vegetables, whole grains, lean animal proteins and fish. Avoid processed meats (like salami and ham), trans fats, energy drinks, soda and artificial sweeteners.

Second, exercise regularly. The American Heart Association recommends at least 150 minutes per week of moderate exercise, such as walking two to four miles an hour. That evens out to an easy 20-25 minutes of activity per day. If you enjoy more intense exercise, like jogging, biking fast or swimming laps, do that for at least 75 minutes a week.

If you find that you feel winded or nauseous doing an activity that usually makes you feel pretty good, that might be a warning sign.

Exercise is good for your body and mental outlook. It also can help you monitor your heart health. If you find that you feel winded or nauseous doing an activity that usually makes you feel pretty good, that might be a warning sign.

Third, see your primary care doctor regularly for a check-up and routine blood work, especially if you have a family history of heart conditions. If you are experiencing symptoms of heart disease, don’t delay care.

What are the warning signs women should never ignore?

The most common warning signs are chest tightness, pain, pressure and heaviness in the chest. Many people also experience pain that is radiating from the chest to the arm, neck or back. Often these symptoms are accompanied by shortness of breath and extreme fatigue. The symptoms are similar in men and women.

When should women seek care if they think they are having a heart attack?

Immediately. Damage to the heart muscle can be permanent within 20 minutes. The longer you delay treatment, the worse the damage is. If delayed for too long, some patients may miss the opportunity for life-saving surgery to open up their arteries.

From what you’ve seen, are people still delaying care for heart attack symptoms due to COVID concerns, like they were earlier in the pandemic?

Yes. At the peak of the pandemic, California had up to a 50% reduction in hospitalizations for heart attacks. Of course, heart attacks were still happening. But a much larger than usual number of people were not going to the hospital for immediate care.

If you are experiencing symptoms of a heart attack, seek medical attention immediately. At Swedish, we are doing all we can to provide a safe environment for care.

Heart attacks kill almost 700,000 Americans every year. One person in the United States dies every four seconds from cardiovascular disease, so I can’t emphasize this enough: if you are experiencing symptoms of a heart attack, seek medical attention immediately. 

It’s natural to be concerned about getting COVID-19, though. Especially if you already have heart disease.

That's true, but people with underlying heart problems (and many other conditions) may be at higher risk of getting COVID-19 and may be more prone to complications if they get it. In addition, the virus can cause heart muscle or vessel damage, resulting in severe problems.

The message is the same for everyone: follow Centers for Disease Control guidelines for COVID-19 prevention. That means washing your hands often, wearing a mask in public, practicing social distancing and getting your COVID-19 vaccine as soon as you can.

Meanwhile, please be assured that we are going above and beyond to ensure patient safety at Swedish. We are doing all we can to provide a safe environment for care. It’s been a stressful year for everyone, but we will get through this pandemic together!

Find a doctor

If you have questions about heart disease or cardiovascular health, contact Primary Care or the Heart & Vascular Institute at Swedish. We can accommodate both in-person and virtual visits.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.

Join our Patient and Family Advisory Council.

Additional resources 

Heart Month raises awareness, promotes prevention to save lives 

Reduce your sodium intake one step at a time for better health

New Women’s Wellness Clinic meets need for specialized care

Protecting your heart is more important than ever during COVID-19

Understanding women’s heart health with Dr. Sarah Speck

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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About the Author

The Swedish Heart & Vascular Team is committed to bringing you many years of expertise and experience to help you understand how to prevent, treat and recover from cardiovascular diseases and conditions. From tips to eating better to exercise and everything in between, our clinical experts know how to help you help your heart.

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