Heart Disease Remains the Leading Cause of Death — Here’s Why Women Are at Special Risk

heart disease

Photo illustration by Katie Couric Media

Wondering if you could be at risk? We turned to two cardiologists to give us some insights. 

Even as the coronavirus continues to take hundreds of thousands of lives, heart disease is still the number one cause of death in the U.S., according to the Centers for Disease Control. One in four Americans die of it each year, and yet many women are still dangerously unaware of the risk factors. 

This could have something to do with the fact that awareness has been dropping steadily over the past 10 years — or the fact that it’s commonly thought of as a “man’s disease.” But nothing could be further from the truth: 1 in 3 women die of heart disease every year, almost one woman every minute. 

But two cardiologists are committed to encouraging women to be proactive about their heart health: Lisa Freed, director of the Women’s Heart and Vascular Program at Yale New Haven Hospital, and Jennifer Haythe, co-director of the Columbia Women’s Heart Center. 

“Women need to know that their longevity is crucial for their families,” Dr. Haythe says, “and to teach their own daughters that it’s important to take care of yourself and not just everyone else.”

First, what is heart disease? 

Heart disease refers to a range of conditions, but the most common is coronary artery disease, which affects the blood flow to the heart. In addition to heart attacks, there are also heart rhythm problems like arrhythmias, heart defects you’re born with (also known as congenital heart defects), heart valve disease, and the list goes on. 

“We have to remember that heart disease isn’t just having a heart attack,” Dr. Haythe told us. “There are so many different forms of heart disease.”

What are the common risk factors? 

Almost half of all Americans have at least 1 of 3 key risk factors for heart disease: high blood pressure, high cholesterol, and smoking, according to the CDC. However, some of these risks can’t be controlled because of factors such as your age and family history.

Dr. Freed warned that women, in particular, now have “more they need to worry about.” 

In May 2020, the American College of Cardiology updated its guidelines for preventing cardiovascular disease in women. While traditional risk factors like hypertension and diabetes still apply, there are a number of others that have been added that are unique to women. For instance, pregnancy-associated conditions, such as gestational diabetes and preeclampsia increase the future risk of heart disease. This is also true for women who suffer from miscarriages and stillbirths, who are two times more likely to develop heart disease. “Even if you get through your pregnancy and your diabetes gets better once you deliver, it’s still an extra risk later on in life,” Dr. Freed explained to us.

Other newly identified risk factors include menopause, premature menopause, and Polycystic Ovarian Syndrome (or PCOS). “We’ve been saying this for women for a while, but now the guidelines actually support it,” she said.

What are the symptoms?

Symptoms can vary depending on which kind of heart disease you have and whether you’re a man or a woman. For instance, with a heart attack, men are more likely to have chest pain, while women tend to have additional symptoms along with chest discomfort, such as shortness of breath, nausea, and extreme fatigue.

But Dr. Freed told us that chest pains remain the biggest red flag for everyone. “It is absolutely true that women have more atypical symptoms than men,” Freed said. “But — and this is the big but — chest pain is still the number one symptom for men and women.”

Sometimes heart disease may even be “silent,” as it was in Kerri Bryles’s case. The 45-year-old mother of three told KCM she unexpectedly ended up in the ICU at a St. Louis-area hospital after she couldn’t stop coughing, which she mistook at first for Covid-19. She was later diagnosed with torrential mitral regurgitation, which is caused when the heart’s mitral valve doesn’t close tightly, allowing blood to flow backward in your heart. Bryles ended up having major heart surgery where an Impella Heart Pump was used to keep her heart beating, and even now, she is in shock about her experience given that she didn’t have any underlying health conditions or family history that would make her more at risk. 

That’s why Dr. Haythe emphasizes that if you think something might be wrong, take it seriously because when it comes to the heart, “time is muscle.”

What are some steps women can take to decrease their risk or prevent heart disease?

The good news is that most forms of heart disease are very treatable today. There’s some evidence that being proactive about keeping your blood pressure and cholesterol low can at least partially reverse plaques in the coronary arteries. “Common sense is very much at play when it comes to heart disease and that’s not true of other diseases like certain cancers,” Dr. Haythe told us. 

But prevention is key: Bryles said the “biggest” thing she did to protect herself was to get vaccinated, along with her family. In fact, a growing number of studies suggest many Covid-19 survivors experience some type of heart damage, even if they didn’t have an underlying heart condition.

Then there’s making sure you go to your primary care doctor at least once a year for a regular check-up, even if you don’t think anything’s amiss. And if you haven’t already, start incorporating healthy eating and some regular exercise. But how much is enough? The American Heart Association recommends adults get at least 150 minutes per week of moderate-intensity aerobic activity like a brisk walk or 75 minutes per week of vigorous aerobic activity like running or cycling. You should also avoid smoking at all costs because Dr. Freed says it’s “definitely more potent for women.” 

Lastly, women shouldn’t neglect their mental health. Depression, anxiety, and acute or chronic emotional stress are typically more prevalent among women compared to men. Dr. Haythe says the key is learning to unplug — literally. She recommends putting down your phone especially before bedtime and trying some yoga instead of scrolling through social media. But she acknowledged that this is no easy task: “We’re in the midst of a huge mental health crisis not just in this country, but the world.” So, scrolling might be soothing to some. We get it.

But, to protect your heart, anything’s worth a try, right?