Women’s heart health deserves closer attention, particularly as risk factors can change with age and life stages. Hormonal changes, pregnancy-related complications, diabetes, high blood pressure and menopause can all affect cardiovascular risk. Yet symptoms may not always look the way we expect. Knowing the warning signs, getting health checks and addressing risk factors early can help women protect their heart health over time.
Know the warning signs
Heart disease is often thought of as predominantly a male problem, but cardiovascular disease is also an important health threat facing women.
“One challenge is that women may develop heart disease differently and may not always present with the classic picture of a heart attack,” says Dr Pradheep Krishnamohan Rachakonda, Consultant Cardiothoracic Surgery at Zulekha Hospital.
Chest pain remains the most common symptom, but women may also experience unusual tiredness, breathlessness, nausea, sweating, dizziness or pain in the back, shoulder, arm, neck or jaw.
“These symptoms are often mistaken for acidity, stress , anxiety or simple exhaustion,” says Dr Rachakonda. “This can result in women waiting too long before seeking medical attention.”
Dr Koshy Georgey, Consultant Cardiology & Interventional Cardiology, Burjeel Hospital, Abu Dhabi, says women are also more likely to have disease involving the small blood vessels, coronary spasm, or a heart attack without a major arterial blockage, rather than the classic pattern of a blocked large artery.
He says that sudden severe fatigue, breathlessness at rest, nausea or heartburn, and pain in the jaw, neck, back or upper abdomen are often dismissed as reflux, anxiety or a pulled muscle.
Dr Ahmed Ismail Al Jubouri, Consultant Cardiologist, PRIME Hospital, adds that the nature of heart disease in women can differ from the classic blockage pattern.
“Women are more likely than men to experience a heart attack without an obvious blockage in the arteries that supply blood to the heart,” he says.
The risk is also influenced by factors that may be particularly relevant to women, including smoking, psychological stress and depression, diabetes, hormonal changes around menopause and certain pregnancy complications. Recognising these symptoms matters because women may delay seeking help.
“If a heart attack is suspected, call an ambulance immediately, even without severe chest pain,” says Dr Karim Ghannem, Specialist Interventional Cardiologist, Thumbay University Hospital.
Dr Rachakonda adds, “With a heart attack, every minute matters.”
Risk changes through life
A woman’s cardiovascular risk is not fixed. It can be affected by reproductive health, metabolic conditions, hormonal changes and other factors at different stages of life.
Dr R V L Gowthami, Specialist Cardiologist, Aster Speciality Clinic, International City, says, “A woman’s cardiovascular risk changes throughout life. Pregnancy-related conditions such as hypertension, preeclampsia and gestational diabetes may indicate increased future risk, while cardiovascular risk rises after menopause.”
Pregnancy can provide important clues about future heart health.
“Pregnancy can be an important cardiovascular window,” says Dr Rachakonda. “Problems such as gestational hypertension, pre-eclampsia and gestational diabetes are not complications that end when the pregnancy ends. They can be early indicators of increased cardiovascular risk later in life,”
Dr Sandeep Golchha, Specialist Interventional Cardiologist at NMC Specialty Hospital, Al Nahda, Dubai, says that while the prevalence of cardiac ailments is generally lower among women during their reproductive years, certain factors can increase their risk earlier in life.
“Using oral contraceptives pills can slightly increase blood pressure and clot risks, especially for smokers. Also, high blood pressure and blood glucose levels during pregnancy means possible high risk of cardiac issue in future,” says Dr Golchha.
Dr Ghannem points to family history, blood pressure and healthy habits as important considerations from early adulthood.
According to Dr Georgey, Pregnancy acts as a genuine stress test for the heart because blood volume and cardiac output increase considerably. “Complications such as preeclampsia or gestational diabetes can reveal underlying cardiovascular vulnerability. Women with these conditions should closely monitor their blood pressure, blood sugar, and cholesterol after pregnancy,” he advises.
Risk can also increase around menopause. “After estrogen levels decline around menopause, typically from the mid-40s to mid-50s, cardiovascular risk increases. Menopause before the age of 40 can significantly increase lifetime risk,” says Dr Georgey.
He adds that women should avoid smoking, stay physically active most days, and follow a Mediterranean-style diet.
Dr Ghannem says that changes in cholesterol and body fat around menopause can add to risk. “Diabetes has a stronger effect on heart disease risk in women than in men.”
At a glance
Heart disease can affect women differently, and awareness of the warning signs is essential. The most common symptom of a heart attack remains chest discomfort or heaviness, but women are more likely to experience associated shortness of breath, nausea, excessive sweating, and severe heartburn. These associated symptoms can sometimes distract patients or health care providers,” says Dr Dima Quraini, Staff Physician, Cardiovascular Medicine Department, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi.
“A woman’s cardiovascular risk can also change throughout her life. Alongside high blood pressure, high cholesterol, diabetes, obesity, smoking, and family history, women should be aware of female-specific considerations including adverse pregnancy outcomes such as preeclampsia, gestational hypertension, gestational diabetes, recurrent miscarriages, menopause, and PMOS. Understanding your individual risk factors, having appropriate cardiovascular assessments and making healthy lifestyle changes are important steps towards preventing and managing heart disease.”