Understanding women's heart health with Dr. Sarah Speck

Our heart-to-heart with Dr. Sarah Speck from the Swedish Heart and Vascular Institute helps answer some of your most pressing questions

  • Can chronic stress affect your heart as much as high blood pressure or obesity?
  • Do women experience different heart attack warning signs than men?
  • Can a high-risk pregnancy or menopause increase a woman’s risk of developing heart disease?


The statistics are staggering.

The biggest threat to women’s health in the United States is heart disease, which is responsible for one in every three female deaths every year. That averages out to about one woman every minute, according to the American Heart Association.

Luckily, those numbers are not set in stone. Educating yourself, knowing your risk factors and making healthy lifestyle choices can improve the odds that your heart will keep beating steadily well past menopause and into your senior years.

We talked to Dr. Sarah Speck, medical director of the health and wellness rehabilitation programs at the Swedish Heart and Vascular Institute in Seattle to get answers for some of your most common questions about this deadly disease and how it affects women’s health. Here’s what we learned.

What types of heart disease affect women?

The term “heart disease” refers to several problems that affect your heart health. It is often thought to affect men more than women, but that is a dangerous misconception that can often lead women to ignore warning signs that their health is at risk.

Heart disease is often thought to affect men more than women, but that is a dangerous misconception that can often lead women to ignore warning signs that their health is at risk.

Women may experience all forms of heart disease including:

  • Coronary artery disease, or CAD, is the most common type of heart disease in both men and women. It occurs when plaque builds up on the artery walls that transport blood to your heart muscle. The buildup narrows and hardens your arteries in a condition called atherosclerosis, which makes it difficult for your heart to get the blood it needs.
  • Congestive heart failure is a serious medical problem that occurs when your heart is unable to pump as efficiently and effectively as it should.
  • Arrhythmia is a condition that causes your heart to beat too slowly, too fast or with an irregular rhythm, like in atrial fibrillation.
  • Angina is chest pain and discomfort that happens during periods of high stress or physical activity but then stops with rest. Women are more likely than men to experience angina.
  • Coronary microvascular disease (MVD) affects the walls and lining of the tiny blood vessels that stem from the coronary arteries, which can decrease the blood flow to your heart and cause permanent damage. Women develop MVD more frequently than men.

How does heart disease vary for women and men?

Heart disease is very different for women than it is for men even though the “big five” risk factors for both are the same, including:

  • Smoking
  • High blood pressure
  • Diabetes
  • High cholesterol levels
  • Obesity

In addition to these, several female-only conditions can increase a woman’s risk of developing heart disease, including:

  • Polycystic ovarian syndrome (PCOS) can cause insulin resistance, obesity, metabolic syndrome and other hormonal changes that can damage the heart.
  • Turner syndrome affects only females and may cause narrowing of the heart vessels causing increased blood pressure.
  • High-risk pregnancies with high blood pressure, preeclampsia or gestational diabetes and the hormonal and physical changes that accompany them may be a factor in developing heart disease later in life.
  • Menopause alters hormone levels, metabolism, cholesterol levels and weight and can often increase the risk of heart disease.

The timing is often different for women as well. “Women are far more likely to develop heart disease later in life than men,” said Dr. Speck, who explains the stats:

  • At age 45, one in nine women have some type of heart disease compared to one in five men.
  • At age 65, one in three women have heart disease compared to one in two men.
  • By age 80, the same number of women and men have heart disease.

For many women, high stress levels can also be a risk factor. Research shows that not only do women process stress differently than men, chronic stress may have a greater effect on their mental and physical health than it does for men. And that can be dangerous.

“Chronic stress is as significant a risk to your heart as if you have high blood pressure or diabetes,” said Dr. Speck.

How are the signs of a heart attack different for women than men?

The most common sign of a heart attack, for both women and men, is chest pain. However, women often describe the feeling as pressure or a heavy ache in their chest rather than the crushing or stabbing pain that is commonly associated with the onset of a heart attack.

Other signs experienced by women include:

  • Nausea or lightheadedness
  • Unusual shortness of breath
  • Unusual palpitations or heartbeats
  • Extreme unexplained fatigue
  • Breaking into a cold sweat
  • Pain or heaviness that radiates through your left arm, neck or jaw
  • Feelings of doom or a sense that “things just aren’t right”

Women tend to delay treatment longer than men, which increases the chance they’ll experience more serious consequences.

“After 20 minutes you have permanent damage,” said Dr. Speck who explained that knowing what to look for and reacting quickly are vital components in achieving a positive outcome before, during and after a heart attack.

“Women typically don’t go to the hospital as early as they tell their husbands to go. They should be more aware and be even more proactive when it comes to their health,” said Dr. Speck. “Get help soon enough. Get treated early enough.”

How does pregnancy affect my risk of heart disease?

Research indicates that women who experience complications like high blood pressure or gestational diabetes during pregnancy could be at higher risk for heart disease in the future. According to Dr. Speck, women who experience these health issues during pregnancy should monitor their health carefully—especially once they begin menopause and the natural protection provided by estrogen fades.

How does menopause affect my risk of heart disease?

Menopause plays a prominent role in women’s health as natural estrogen, which offers some protection against heart disease, is no longer produced. For many women, the hormone fluctuations and metabolism changes that accompany this stage of life can lead to unhealthy cholesterol levels, weight gain, increased inflammation and high blood pressure. All increase the risk of heart disease.

What can women do to reduce their risk of developing heart disease?

Making healthy lifestyle choices is one of the most effective ways to lower your chance of heart disease or heart attack, according to Dr. Speck. Also, if you have health issues that can affect your heart, like high blood pressure or cholesterol, it’s important to take your medication exactly as prescribed to minimize the impact those conditions have on your heart, she said.

Women—especially those at higher risk—can:

  • Lower their salt intake
  • Exercise at least 30 minutes a day
  • Have an annual physical exam
  • Maintain a healthy weight

 “Women are very good at taking care of other people and less good at taking care of themselves. As much as 80 percent of your risk is under your own control.”

“It’s a matter of putting yourself first,” said Dr. Speck. “Women are very good at taking care of other people and less good at taking care of themselves. As much as 80 percent of your risk is under your own control.”

Sarah Speck, MD, MPH, FACC

Dr. Sarah Speck has practiced cardiology and internal medicine in the greater Seattle area for more than two decades. She is the  medical director of the cardiac wellness and rehabilitation program at the Swedish Heart and Vascular Institute in Seattle. In 2009, Dr. Speck assembled a team of preventative and rehabilitative health experts to co-found POTENTRX, a company that develops individualized, comprehensive exercise and nutrition plans that are carried out under medical supervision for improved health.


Find a doctor

The cardiologists at Swedish understand that women experience heart disease differently than men. They use advanced technology to evaluate your risk factors and develop a strategy to help you strengthen your heart and prevent future cardiac events. Find a doctor you can trust in our provider directory.

Are you a woman living with #heartdisease or the aftermath of a #heartattack? Share your experiences with readers @swedish.

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


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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