The American Heart Association estimates that 44 million women in the United States have cardiovascular disease. Heart disease is the No. 1 killer of women, causing one in four women’s deaths. The most common form of heart disease in both men and women is the narrowing or blockage of coronary arteries. This is called coronary artery disease, and it is the most common cause of heart attacks. 

In women, heart disease tends to occur about 10 years later in life than in men. It is thought that estrogen helps protect women. Estrogen in the body increases HDL (good) cholesterol, helps decrease LDL (bad) cholesterol, promotes blood flow and protects against free radicals that can damage cells. As women approach menopause, typically around age 50, estrogen levels drop. Declining estrogen contributes to an increase in blood pressure, increased blood glucose levels, and an increase in belly fat and fat deposits around the heart — all risk factors for heart disease.

Although half of all deaths from heart disease take women, the risk for women is frequently underestimated. Women are often diagnosed later in the course of their disease and have more widespread disease. Although chest pain is the most common sign of a heart attack in both men and women, more women than men present with subtle signs, such as neck, jaw or upper back soreness; nausea or vomiting; shortness of breath; lightheadedness; sweating; or unusual fatigue. Women might be more likely than men to have these symptoms because women are more likely than men to experience blockages in the small vessels and tiny arteries around the heart, rather than in their main arteries. This condition is called coronary microvascular disease. Standard tests for coronary heart disease are not designed to detect microvascular disease, so it often goes undiagnosed and untreated. 

Women also are more likely than men to have a condition called broken heart syndrome. Extreme emotional stress can lead to severe, but often short-term, heart muscle failure. Symptoms are similar to a heart attack, and test results may indicate a heart attack. However, there is no evidence of blocked arteries. Most people who experience this condition have a full and quick recovery.

Most women, nine out of 10 in fact, have at least one risk factor for heart disease. Some of these risk factors play a bigger role in women than in men.

Diabetes. Having diabetes doubles your risk for heart disease. Women with diabetes have an even greater risk for heart disease than men with diabetes.

Mental stress and depression. Stress increases your risk for heart attack. In general, emotional stress takes a greater toll on women’s health than on men’s health.

Smoking. Women who smoke have a greater risk for heart disease than men who smoke. In addition, women who smoke not only increase their risk for having a heart attack but for having a heart attack earlier in life.

Elevated blood pressure, cholesterol or blood sugars. Declining estrogen levels and menopause can impact all of these measures of heart health.

Sitting long periods of time or not exercising. Lack of exercise is a major risk factor for heart disease. Some research has found that older women tend to be more inactive than older men.

Diet. Diets high in salt, sugar or saturated fat put women and men at increased risk for heart disease.

Pregnancy complications. If a woman had gestational diabetes or high blood pressure while pregnant, or if she had a preterm delivery, she is at greater risk for heart disease later in life.

Overweight or obesity. Increased fat, especially belly fat, increases risk.

Women and men can reduce their risk for heart disease with the right lifestyle choices. Get started with the following tips.

Get routine checkups. Important numbers are measured at these visits, including weight, body mass index, blood pressure, blood sugar and cholesterol levels. You might learn you need to make changes to improve your heart health.

Know your numbers. Keep track of the results of your annual visits to monitor changes.

Quit smoking. This is the single most important thing you can do to improve your health.

Start or step up exercise. Aim to get 30 to 45 minutes of exercise most days. Pick activities that get your heart pumping and that you enjoy.

Measure your waist. Pay attention to fat around your waist, and lose weight if needed. Women with an apple-shaped body are at higher risk for heart disease.

Eat a heart healthy diet. Follow a Mediterranean or DASH diet with lots of fruits, vegetables, whole grains, lean meats and healthy fats.

Reduce your stress. Find ways to cope with stress. Meditate, practice yoga, listen to music, or distance yourself from things that cause your stress.

Get adequate sleep. Insufficient sleep is bad for you heart and your overall health. A good rule of thumb is to get at least seven hours of restful sleep each night.

Limit your alcohol. Women should not drink more than one alcoholic beverage a day; men, no more than two.

Listen to your body. If doing your daily activities becomes noticeably more difficult or if you experience other unusual symptoms, get checked out. Keep in mind that symptoms can occur weeks or even months leading up to a heart attack.

You are never too young or too old to have a heart attack. Now is the time to start taking care of your heart.

Anita Marlay, R.D., L.D., is a dietitian in the Cardiopulmonary Rehab department at Lake Regional Health System in Osage Beach, Mo.