Cardiovascular Disease in Women: A Growing Crisis

Heart disease accounted for one in five female deaths in the U.S. in 2023.

Current Impact and Projected Rise

The American Heart Association (AHA) projects that the percentage of women with at least one type of cardiovascular disease will rise from 10.7% in 2020 to 14.4% by 2050. This forecast is based on historical data from national health surveys and census population estimates.

The projected increases for specific conditions include:

• Coronary heart disease: 6.9% to 8.2%
• Heart failure: 2.5% to 3.6%
• Stroke: 4.1% to 6.7%
• Atrial fibrillation: 1.6% to 2.3%

Key Risk Factors

The projected rise in CVD is partly attributed to an aging population, as well as increasing rates of several key risk factors among women. The AHA projects the following increases in risk factors from 2020 to 2050:

These risk factors are increasing across all adult age groups, including women aged 20 to 40. While rates of poor diet and lack of exercise are expected to decline slightly, and smoking rates are projected to continue dropping, the number of women experiencing sleep problems is anticipated to rise.

These adverse trends are expected to be more pronounced among Black, Hispanic, Indigenous, and multiracial women.

Unique and Additional Risk Factors for Women

Beyond standard risk factors, experts identify several conditions and life stages that can increase a woman's risk of cardiovascular disease:

Pregnancy History

Complications such as preeclampsia, gestational diabetes, pregnancy-related hypertension, preterm birth, low birth weight, or pregnancy loss are recognized as lifelong risk markers.

Reproductive History

Early menopause (before age 40), irregular periods, and a first period before age 12 have been linked to higher risk.

Menopause

This period is described as a significant cardiovascular transition, during which cholesterol, blood pressure, and sleep patterns often change. Frequent hot flashes and night sweats have also been associated with increased risk.

Additional Conditions

• Autoimmune conditions: Lupus or rheumatoid arthritis cause inflammation that increases heart disease risk.
• Medical treatments: Certain breast cancer treatments are cited as risk factors.
• Other conditions: Fibroids, endometriosis, polycystic ovary syndrome (PCOS), and depression are also mentioned as contributing factors.

Heart Attack Symptoms in Women

Women can experience heart attack symptoms differently than men, which can lead to diagnostic delays. While chest pain or discomfort remains a common symptom, women are more likely to report a range of additional or less typical symptoms:

• Pain in the upper back, arms, neck, or jaw
• Shortness of breath
• Nausea, vomiting, or indigestion
• Extreme fatigue
• Cold sweats
• Lightheadedness or dizziness
• Anxiety or an "anxious feeling"

Women often delay seeking medical attention longer than men during a heart attack and are more frequently misinformed that their symptoms are not heart-related.

Experts advise anyone suspecting a heart attack to call 911 immediately.

Awareness and Prevention

Awareness of heart disease as the leading cause of death for women has declined. An AHA survey showed awareness fell from 65% in 2009 to 44% in 2019. Sources note a disparity in public health campaign effectiveness, with women's heart health awareness lagging behind other efforts.

The good news: approximately 80% of heart disease risk is considered preventable.

Recommendations for reducing risk include:

• Know your numbers: Blood pressure, cholesterol, and blood sugar
• Share your history: Full pregnancy and reproductive history with healthcare providers
• Follow "Life's Essential 8": Eat better, quit tobacco, get healthy sleep, be more active, control cholesterol, manage weight, manage blood sugar, and manage blood pressure
• Take symptoms seriously: Persistent or unusual symptoms should not be ignored
• Attend regular medical checkups

Emerging Therapies

GLP-1 medications, used for weight loss and Type 2 diabetes, are improving cardiovascular prevention by positively affecting blood pressure, cholesterol, and metabolic health. These drugs have shown potential in reducing the risk of heart attack and heart failure.

However, the AHA's projections did not account for the potential broad impact of these drugs, as their long-term effects and accessibility remain under study.