Summary
Heart disease is the #1 killer of women—and many women don’t realize their risk can be shaped by female-specific factors like early menopause or pregnancy complications. Learn what to watch for, how heart disease can present differently in women, and how a coronary artery calcium (CAC) score may help clarify your personal risk.
Myth: Heart disease affects men more than women.
Truth: Heart disease is the #1 killer of women in the U.S. The rate of coronary heart disease is on the rise in younger women aged 35 to 54 years.
Heart disease in women is an underestimated threat to all women. Heart health awareness is increasing, but we have a long way to go.
As we approach American Heart Month in February 2026, this is an important time to highlight that heart disease remains the leading cause of death for women—and to ensure women understand their unique risk factors.
Women can be underdiagnosed and undertreated for cardiovascular disease compared to men, which can delay prevention and care—especially in midlife.
Heart Disease Risk in Women
Risk factors for heart disease in women include the traditional risk factors and female-specific risk factors. The American Heart Association now recognizes female-specific risk factors as “risk enhancers” that may warrant increased preventive measures.
Traditional risk factors include high blood pressure, diabetes, high cholesterol, obesity, smoking, physical inactivity, family history, and age.
Female risk factors include reproductive factors such as when a woman starts her menstrual cycle, age of menopause, and a history of polycystic ovarian syndrome. Pregnancy-related complications like preeclampsia, gestational diabetes or hypertension, preterm delivery, and pregnancy loss can increase the risk of heart disease.
Female-specific risk factors can be clues to underlying vascular and metabolic changes that may increase long-term cardiovascular risk, even years after pregnancy or menopause.
Early Menopause, Pregnancy Complications, and Heart Disease
Did you know that early menopause (before age 40) has a 1.5–1.9 fold increased risk of cardiovascular disease or that preeclampsia specifically increases heart failure risk fourfold and doubles the risk of heart attack and stroke?
Importantly, these risks can remain significant even after accounting for traditional risk factors like cholesterol, blood pressure, and diabetes—one reason reproductive history should be part of cardiovascular risk assessment for women.
How Heart Disease Can Look Different in Women
Heart disease does not always present the same way in women as it does in men. Women are more likely to have coronary microvascular disease or non-obstructive coronary disease, and symptoms may include fatigue, shortness of breath, nausea, jaw pain, or back pain rather than classic chest pain.
Protecting Your Heart
You can protect your heart! Cardiovascular disease is largely preventable through lifestyle changes and awareness. Be sure to check in regularly with your primary care provider. Make sure your cholesterol, blood pressure, and blood sugar are not elevated. Exercise and maintaining a good weight/BMI are also important. Coronary artery calcium scoring may help risk assessment and guide decisions.
A coronary artery calcium (CAC) score is a non-invasive CT scan that measures calcium buildup in the coronary arteries, which is a marker of atherosclerotic plaque. The test is quick, does not require contrast dye, and uses low-dose radiation. Results are reported as a numerical score that can help refine future cardiovascular risk.
For women with borderline or intermediate risk—especially those with female-specific “risk enhancers”—CAC scoring can provide additional clarity and help guide personalized prevention strategies (lifestyle changes and, when appropriate, medication).
We have a variety of lifestyle programs at the Couri Center that can get you on the right track! New patients are always welcome. To schedule an appointment, please use the below form.
Be Well,
Renee Alwan Percell, MMS, PA-C @couri center
About the Author
Renee Alwan Percell, MMS, PA-C, is a physician assistant at the Couri Center for Gynecology & Integrative Women’s Health and has been part of the Couri Center team since 2016, providing comprehensive gynecologic and preventive women’s health care. She has experience in routine gynecology, pelvic prolapse management, and adolescent health, and is passionate about integrative patient education and wellness.
CONTACT US-ARTICLE
Disclaimer: This article is for educational purposes only and is not intended as medical advice. Please consult your healthcare provider for personalized care.
References
CDC. About Women and Heart Disease. https://www.cdc.gov/heart-disease/about/women-and-heart-disease.html
American Heart Association. Promoting Risk Identification and Reduction of Cardiovascular Disease in Women Through Collaboration With Obstetricians and Gynecologists. https://www.ahajournals.org/doi/10.1161/cir.0000000000000582
PubMed. Cardiovascular Disease in Women: Clinical Perspectives. https://pubmed.ncbi.nlm.nih.gov/27081110/
PubMed. Adverse Pregnancy Outcomes and Cardiovascular Disease Risk. https://pubmed.ncbi.nlm.nih.gov/31315936/
PubMed. Reproductive Factors and Cardiovascular Disease in Women. https://pubmed.ncbi.nlm.nih.gov/37752027/
American Heart Association (Circulation). Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.036748
American College of Cardiology. Coronary Calcium Score and Cardiovascular Risk (Ten Points to Remember). https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/07/23/13/39/Coronary-Calcium-Score-and-Cardiovascular-Risk
Mayo Clinic. Coronary calcium scan. https://www.mayoclinic.org/tests-procedures/heart-scan/about/pac-20384686
NHLBI. Women and Heart Disease. https://www.nhlbi.nih.gov/health/coronary-heart-disease/women