March 8 is International Women’s Day and we decided to focus our newsletter on women’s heart health, an understudied, under-diagnosed and under-treated health concern for women. Though there have been incredible improvements in cardiovascular mortality rates in women, heart disease is still the leading cause of mortality in women. Regardless of age, women tend to die more frequently within 1 year of their first heart attack (at 26% vs men at 19%), and within 5 years, at 47% vs men at 36%, are more likely to suffer heart failure or a stroke.

How is heart disease different in women?

Obstructive atherosclerotic disease of the larger arteries of the heart is the most classic presentation of obstructive coronary disease and remains the basic cause of acute myocardial infarction (AMI or heart attack) however, atherosclerosis manifests differently in women, usually affecting the microvasculature of the heart more so than the large vessels. EKG readings for women also do not present the same way as they do for men, providing a challenge to accurate diagnostics when a woman presents with suspected AMI.

Most of the risk factors for developing heart disease are the same between women and men, though the more common factors (cigarette smoking, diabetes mellitus , hypertension, obesity, alcohol consumption and depression and other psycho-social factors) they tend to be more potent in women. In one study, it was found that women who’d had an AMI had poorer health scores over all, and higher scores on the perceived stress scale; they had higher rates of depression, were more likely to report significant stress events within the previous year and significantly higher rates of diabetes mellitus. These risk factors were associated with poorer outcomes post AMI. Depression alone had the potential to increase a woman’s risk factors for AMI by 2-fold.

Does a heart attack feel different in women?

YES! Traditionally, people imagine a heart attack in the classic way, a burning pain in the middle of the chest that sometimes radiates to the arm. Women tend to have a cluster of symptoms including:

Pain in upper back, arm, neck and jaw

Unusual fatigue, weakness

Dyspnea (shortness of breath)

Indigestion, nausea/vomiting


Sense of dread

While the chest pain is a very classic symptom common to both sexes, women tended to present with a greater variety of symptoms, with somewhat less chest pain. Women 45 years and younger can even present without chest pain. These symptoms could come on suddenly, but some women report they come and go over days, weeks and even months before the AMI.

While so much more could be said about heart disease and heart health in women, for the scope of this article it is enough to begin with educating the public. One of the biggest barriers to women getting the help they needed was themselves; not knowing, or fearing stigmatization were two of the largest barriers immediately in front of a woman. Thus, educating the public on recognizing how heart disease can be different for a woman can be one of the most important steps to reducing the mortality rates globally.

Love the women and their hearts in your life. Print this out, share it with your friends and colleagues, you may just save a life.


Acute Myocardial Infarction in Women: A scientific statement from the American Heart Association, Circulation 2016; 133:916-947.