A concise guide to heart disease risk factors for women

Heart disease is often seen as a men’s health issue, but it is the leading cause of death among women worldwide. In 2021 alone, cardiovascular disease (CVD) claimed the lives of nearly 1 in 5 women. Yet, many remain unaware that their risk factors and symptoms often differ from men’s, causing them to be overlooked. 

Hormonal shifts, underlying conditions, and mental health all play a role in women’s heart health. Combine that with standard screenings rooted in male-focused research, and it’s no wonder women need prevention strategies designed specifically for them.

This article explores why women are more at risk when it comes to cardiovascular issues, specific heart disease risk factors for women, and how lifestyle choices, early detection, and genetic insights can help you take charge of your well-being.

Why are women at higher risk of heart disease?

Anatomically, women’s cardiovascular systems differ from men’s in ways that can place extra strain on the heart. For example, women tend to have:

• Smaller blood vessels and heart chambers

• Thinner ventricular walls

• Lower red blood cell count, which reduces the body’s ability to carry oxygen efficiently

Due to differences in cardiovascular adaptation, women are also more prone to sudden blood pressure drops, particularly when standing up quickly.

One condition more commonly seen in women is coronary microvascular disease, which affects the tiny arteries of the heart. Unlike blockages in larger arteries, this type of heart disease is harder to detect with standard tests, often leading to missed or delayed diagnoses.

Source: Marek Studzinski

In addition, women typically develop ischemic heart disease about a decade later than men, most often after menopause. To complicate matters further, many women experience less typical symptoms, like fatigue and sleep disturbances, instead of the classic chest pain.

Even when chest pain is present, studies show it’s less predictive of obstructive coronary artery disease in women, making it easier to overlook. 

While it may not be true that women are at a greater risk of developing heart disease than men, due to all these factors, they are at a greater risk of heart failure and tragic outcomes.

Which of the following cardiovascular disease risk factors is the most significant for women? 

Risk factors for cardiovascular disease in women often overlap with those in men, but some tend to be more pronounced or even unique to women, such as:

1. Hormones 

2. Underlying health conditions

3. Mental health

4. Age

5. Family history and genetics

6. Lifestyle

We'll explore each of these risk factors in the sections below.

1. How hormones impact women’s heart health

Estrogen plays a protective role in cardiovascular function, helping maintain healthy blood vessels and cholesterol levels. After menopause, once estrogen levels decline — either through natural menopause or surgical removal of the ovaries — the risk of heart disease begins to rise sharply.

Women who go through early menopause (before age 40) or have a hysterectomy face an even greater risk. Hormone replacement therapy (HRT) to manage menopausal symptoms can also increase the risk of coronary heart disease.

Source: Pixabay

Pregnancy is another non-controllable risk factor for cardiovascular disease that is unique to women. Several pregnancy-related and reproductive conditions have been linked to cardiovascular risks, as presented in the following table:

2. How underlying health conditions affect cardiovascular risk factors in women

Certain health conditions raise heart disease risk factors for women and amplify the impact of existing ones. Many are more common in women or affect them differently than men.

For instance, women with diabetes are 2–4 times more likely to develop heart disease than men. 

High blood pressure is another concern, especially in women after 65. Postmenopausal women, in particular, tend to be more sensitive to sodium, making blood pressure more challenging to control. Plus, women often have more negative reactions to medications compared to men.

Cholesterol levels also matter, with low HDL (“good” cholesterol) being especially dangerous for women over 65. When combined with high total cholesterol, the risk rises even more.

In addition, autoimmune and inflammatory diseases, including lupus and rheumatoid arthritis, disproportionately affect women. These conditions trigger chronic inflammation that damages blood vessels over time.

Finally, metabolic syndrome, a cluster of risk factors, raises the likelihood of heart disease, stroke, and diabetes. You may have metabolic syndrome if you have three or more of the following:

• A large waistline

• High blood pressure

• High blood sugar levels

• High triglycerides

• Low HDL cholesterol

When these conditions overlap, they can quietly increase heart disease risk, so early detection and personalized management are vital.

Source: Kaboompics.com

3. How mental health contributes to heart disease risk factors for women

The link between mental and physical health is particularly strong in women. For instance, depression, which is more common in women at all ages, is also more closely tied to cardiovascular problems.

Women with depression are more likely to struggle with maintaining a healthy lifestyle or adhering to treatment plans for other conditions, such as diabetes or hypertension. Middle-aged women with clinical depression are twice as likely to experience a heart attack or stroke over the next 20 years.

A striking example of the mind-heart connection is stress cardiomyopathy or broken heart syndrome. Triggered by sudden emotional or physical stress, it mimics a heart attack in its symptoms (e.g., chest pain, ECG changes, and elevated cardiac enzymes) but without artery blockages. Nearly 90% of cases affect postmenopausal women. It’s typically not severe, but can lead to further complications..

4. How aging impacts women’s heart health

Females over the age of 50 have a greater risk of heart disease, and women over 65 are more likely than men of the same age to die from a "silent" heart attack (without noticeable symptoms).

Aging naturally brings changes to the cardiovascular system because:

• Blood vessels become less flexible

• Oxidative stress increases

• The heart becomes more vulnerable to electrical and structural abnormalities

These changes raise the likelihood of developing conditions like atrial fibrillation, heart failure, and atherosclerosis.

Oxidative stress plays a key role because it increases the production of reactive oxygen species (ROS) and inflammatory molecules that damage heart tissue over time.

Age also tends to bring additional risk factors, such as frailty, obesity, and diabetes. 

As you age, it is especially important to be proactive about heart health by getting regular screenings, staying physically active, and eating healthy.

5. How genes and family history affect heart disease risk in women

A family history of heart attacks or early-onset cardiovascular disease significantly increases heart disease risk in women. The heritability of coronary heart disease is estimated to be around 40%, with studies showing that women whose close relatives develop heart disease before the age of 60 are at especially high risk.

Source: RDNE Stock project 

Still, genetic risk for heart disease isn’t only a matter of inheritance. Sex-based differences in cardiovascular structure and function are also influenced at the genetic and molecular levels. Emerging research reveals that some genes may operate differently in women, affecting how heart disease develops, presents, and is diagnosed.

One such gene under investigation is RAP1GAP2, which may affect platelet activity and blood clot formation. Overactive signaling in this gene could potentially increase the risk of heart attacks by promoting excessive clotting — an effect that appears to impact women more than men.

This kind of sex-specific gene expression may help explain why women often experience heart disease differently and why their symptoms are more likely to go unrecognized or misdiagnosed.

💡 Pro tip

Heart disease in women is often underdiagnosed, and genetics may be the missing link.

Many women don’t realize they’re at risk until it’s too late, because traditional screenings often miss hidden hereditary factors and genetic markers that play a critical role in heart health. 

If you're ready to take a more proactive approach to your heart health, consider Nucleus — a DNA testing platform that uses whole-genome sequencing to screen for over 130 cardiovascular-related conditions. 

Combined with personalized consultations from expert genetic counselors via SteadyMD, Nucleus gives you actionable insights to protect your heart.

Order your Nucleus Health kit and take control of your heart health.

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6. How do lifestyle factors influence heart health in women?

While genetics and hormones are critical heart disease risk factors for women, it’s often everyday habits that shape how soon those risks become real. Thankfully, lifestyle choices are among the most modifiable risk factors. 

Habits that can significantly increase your risk of heart disease include:

• Smoking: Raises blood pressure and damages blood vessels

• A diet high in saturated fats, salt, and sugar: Contributes to weight gain and high cholesterol

• Physical inactivity: Increases the risk of high blood pressure, high cholesterol, and poor circulation

• Excessive alcohol consumption: Raises blood pressure and causes heart rhythm problems

• Chronic stress and poor sleep: Contribute to inflammation and heart strain

Knowing how your lifestyle impacts your health can help you make changes before problems arise. 

Bonus read — Check out these helpful guides for deeper insights and actionable lifestyle tips:

• NAD benefits

• Sleep tracking

• Nutrigenomics

• Biohacking diet

• Biohacking for women

What are the early signs of heart disease in women?

Heart disease in women can have various symptoms that may differ from those typically experienced by men. While some symptoms, such as chest discomfort, are common across both genders, women are more likely to experience atypical signs like unusual fatigue. 

Many women experience early warning signs, known as prodromal symptoms, which can occur on and off for days, weeks, or even months before a heart attack.

The table below shows common, atypical, and early signs of heart disease in women:

What are some things that women can do to reduce their risk of heart disease?

Strategies for heart disease prevention in women should be proactive, not reactive. 

Regular screening should start at age 40, or earlier if you have risk factors, such as family history or pregnancy complications. Check lipid profiles as early as 20, and consider more advanced tests like stress tests or coronary calcium scoring after age 50.

Equally important is monitoring key health metrics like blood pressure, cholesterol, blood sugar, weight, and BMI. It can help detect changes before serious problems develop.

Adopting a healthy lifestyle can also significantly reduce your risks and improve your overall well-being. Some foundational habits include: 

• Eating a heart-supportive diet (Mediterranean, DASH, or plant-forward)

• Doing at least 150 minutes of moderate aerobic activity a week

• Managing stress (doing yoga or spending time with loved ones)

• Limiting alcohol 

• Avoiding tobacco 

Even with a healthy lifestyle and regular checkups, some women may still be at risk, especially when genetics come into play. 

Many heart-related conditions, like APOB mutations or long QT syndrome, have a hereditary component, and traditional screening methods can miss these. Since hormonal factors and pregnancy history can also affect heart disease development, it’s crucial to go deeper than surface-level screenings.

Heart health requires a tailored approach for many women, which is where genetic testing for heart disease becomes invaluable.

A whole-genome sequencing platform like Nucleus provides advanced genetic testing that offers a deeper understanding of heart disease risks. With over 130 cardiovascular-related screenings and 40+ genetic markers related to food and nutrition, Nucleus can help you take action before symptoms appear. 

Understand heart disease risk factors in women better with Nucleus

Nucleus is a cutting-edge whole genome sequencing platform that can help you understand and address your personal heart disease risk. It analyzes nearly 100% of your genome, considers your lifestyle, general health, and environmental factors, and provides reports with 99.9% accuracy.

Nucleus offers comprehensive insights through over 130 screenings for genetic variants linked to heart disease and 2,000+ diseases in total. These reports help identify hereditary risks that traditional screening methods may overlook. 

It also tests over 40 genetic markers related to food and diet, enabling you to make more informed dietary choices to reduce your risk of heart disease.

See the table below for a snapshot of the heart health-related genetic screenings Nucleus performs:

Through partnership with SteadyMD, Nucleus offers consultations with expert genetic counselors who can give actionable and personalized advice to improve your heart health.

How to get the Nucleus DNA test

Starting with Nucleus is simple:

1. Sign up for Nucleus Health

2. Provide the required information

3. Place your order

Your DNA kit will arrive with easy-to-follow instructions. Once you’ve collected your cheek swab sample, send it back using the pre-paid, pre-labeled envelope. Your personalized results will be ready in six to eight weeks and accessible in your secure Nucleus account. 

Featured image source: Giulia Bertelli