Heart Disease in Women (Subtle signs & risk factors)

Somi Igbene PhD ANutrFebruary 28, 2021

February is Heart Month! Here are the subtle signs and risk factors of heart disease in women. Keep reading to learn how to reduce your heart disease risk with simple diet and lifestyle changes. 

Cardiovascular disease (CVD) or heart disease is a range of conditions that affect the heart.

These conditions include but are not limited to coronary heart disease (CHD), atrial fibrillation, heart attack, congenital heart disease and stroke.

Society led us to believe that CVD primarily affects men, but recent research has discredited this belief.

Apart from the lifetime risk of CVD being similar for women and men, scientists now know that CVD has a higher mortality rate in women than men. They also know that CVD is a more significant cause of death than cancer in women aged over 50.

In the U.K., CHD kills more than twice as many women as breast cancer.

Shocking, right?

And unfortunately, as with most metabolic and lifestyle diseases these days, Black women are more susceptible to heart disease than Caucasian women.

45% of Black women have some type of CVD, compared with 32% of Caucasian women in the United States (U.S.).

In the U.K., Blacks have a higher risk of stroke but a similar or lower risk of heart failure than Caucasians. And in low- and middle-income countries (L.M.I.C.s), CVD rates are spiralling – L.M.I.C.s now contribute 75% of global CVD deaths.

CVD starts earlier in Blacks compared with Caucasians, and Blacks are twice as likely to have CVD in their 30s and 40s compared with Caucasians.

Socioeconomic status and higher risk factors contribute to the differences in CVD prevalence between Blacks and Caucasians. However, even after adjusting for these factors, Blacks still have higher CVD risks than Caucasians.

The risk factors for heart disease in women?

1 | High blood pressure (hypertension) is a critical risk factor for CVD. It is a crucial cause of left ventricular hypertrophy, heart failure and stroke. Substantial evidence shows that Blacks develop hypertension at an earlier age than Caucasians. Moreover, Blacks consistently have higher blood pressure readings at all ages than Caucasians. For instance, among U.S. children aged 8–17, systolic blood pressures were 2.9mmHg and 1.6mmHg higher in Black boys and girls than Caucasian boys and girls.

Your blood pressure is high if your reading is >140mmHg/ 90mmHg.


2 | High blood cholesterol is a risk factor for CVD in both men and women. However, low high-density lipoprotein cholesterol (HDL-C or ‘good cholesterol) is a higher CVD risk in women than men.

Women under 50 years have a lower risk of high blood cholesterol than men. But, as women get older (>65 years), their low-density lipoprotein cholesterol (LDL-C or ‘bad cholesterol’) levels and CVD risk dramatically surpass men.

Your cholesterol level is high if your reading is >200mg/dL or 5.5mmol/L.


3 | Smoking is linked with CVD, and studies show a higher risk of heart disease in women <50 years than in men. A Danish study showed that women who smoke have a 50% greater CVD risk than men.


4 | Bodyweight and obesity are established CVD risk factors in men and women. However, each increment in body mass index (B.M.I.) poses a higher stroke risk in men than women. Although B.M.I. does not distinguish between body fat and muscle, it is still a reliable indicator of obesity in the average (non-elite athletic) population.


5 | Diabetes increases CVD risk three- to sevenfold in women and two- to threefold in men. Women with diabetes have a 50% higher risk of fatal CVD than men with diabetes.


6 | Menopause is associated with an increased risk of CVD. Oestrogen protects women from CVD, but once it depletes, such as during menopause, the risk of CVD increases more than sevenfold.


7 | Pregnancy complications, particularly preeclampsia and gestational diabetes, also increase the risk of CVD. Women with preeclampsia or gestational diabetes have double the risk of CVD later in life.


8 | Physical inactivity is higher among women than men, and adults generally become more inactive as they get older. Epidemiologic studies show lower rates of chronic disease, including CVD, with higher activity levels.


· Diabetes

· Postmenopausal without hormone replacement

· Pregnancy complications

· Lipid abnormalities, especially low high-density lipoprotein and high triglyceride levels

· Hypertension

· Smoking

· Sedentary lifestyle

· Obesity

· Family history

· Age >65 years


Chiamvimonvat and Sternberg, 1998


Subtle signs of heart disease in women

The Subtle signs of heart disease in women

The cardiovascular system is different in men and women due to differences in gene expression from the sex chromosomes and the hormone differences. These differences impact the rates and presentation of CVD in both sexes.

In general, women experience heart disease symptoms differently from men. These differences result in heart disease being detected much later in women with severe consequences. Some of the unusual signs of heart disease in women include:

  • Nausea or vomiting
  • Shortness of breath
  • Pain or discomfort in the lower jaw, teeth, shoulders, back and abdomen
  • Pain in one or both arms
  • Fatigue
  • Chest pain
  • Sweating
  • Palpitations

How to prevent heart disease with diet and lifestyle

Prevent heart disease in women - exercise

1 | EXERCISE: Your risk of developing chronic (non-communicable) diseases, CVD included, reduces with exercise. The National Institute for Health and Care Excellence (NICE) guidelines recommend 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous activity per week with two or more days of strength training exercises.

What to do: Go on a 30-minute brisk walk, jog, run or cycle at least five days per week and include two days of strength training exercises.

Strength training exercises include lunges, bicep curls, push-up or pull-ups. You can perform these exercises with your bodyweight if you’re a beginner and gradually progress to using dumbbells.


2 | IMPROVE YOUR DIET: Many of the dietary recommendations to prevent CVD are based on observational studies. While these studies haven’t identified foods that directly cause CVD, they show strong links between unhealthy dietary patterns and CVD. NICE guidelines recommend reducing saturated fat intake, increasing monounsaturated fats and incorporating at least five portions of fruits and vegetables per day. They also suggest a high fibre diet and two portions of fish per week.

What to do: Choose whole grain instead of refined varieties of starchy food. E.g., instead of white rice, choose brown, red or black rice, and instead of white pasta, choose wholewheat pasta.

  • Reduce your intake of sugar and food products containing refined sugars, including fructose, e.g., soda, beverages, sweets, cakes, agave syrup, maple syrup etc.
  • Eat at least five portions of fruit and vegetables per day. One portion counts as one medium-sized fruit or 80g of fruit or vegetables.
  • Eat at least two portions of fish per week, including a portion of oily fish. One portion of fish is 120g, and oily fish include salmon, mackerel, herring and sardines.
  • Eat at least four to five portions of unsalted nuts, seeds and legumes per week. These foods are good sources of fibre and monounsaturated fats. One portion of nuts and seeds is 30g.


3 | REDUCE YOUR BODY FAT: Maintaining a healthy body weight/body fat is necessary to lower your CVD risk. High-fat levels around your organs and in your liver significantly increase your CVD risk.

What to do: The amount of energy/calories you eat must be less than the amount you burn to reduce body fat. You don’t have to follow a specific diet to achieve this, but whatever you choose, you must ensure that you can sustain it indefinitely.

A great way to lose body fat is to eat a balanced diet containing all food groups (whole grains, starchy vegetables, non-starchy vegetables, fruits, nuts, seeds, legumes, and meats) in the correct portions. This way, you lose body fat but still get all of the essential vitamins and minerals you need to keep you healthy.

Prevent heart disease in women - healthy diet

4 | STOP SMOKING: Smoking is a significant risk factor for CVD and is known to double the risk of dying from CVD. There is no lower safe limit for smoking, and unfortunately, passive smoking is just as harmful as direct smoking.

What to do: If you reside in the U.K., consider using the N.H.S.’ quit smoking service. You may be offered nicotine replacement therapy (skin patches, chewing gum, nasal sprays) or medication such as varenicline and bupropion that reduce nicotine cravings.


5 | ALCOHOL: Alcohol consumption is a controversial topic. Some observational studies link light to moderate red wine intake (up to 1 drink per day for women and 1 or 2 drinks per day for men) with lower risks for cardiometabolic diseases, including CVD.  Higher alcohol intakes are linked with increased CVD risk. However, new guidelines state that there is no safe level of alcohol consumption.

It is worth noting that protective effects of alcohol on CVD risk has only been found in White and Hispanic populations, but not in Black, Indian or Chinese people.

What to do: Abstaining from alcohol is the safest option, but enjoying the occasional drink is unlikely to harm you. The problem arises when you drink frequently and excessively. So, should you avoid or consume it moderately? The choice is yours.


And there you have it…

Now you know the risk factors and subtle signs of heart disease in women. You also know the dietary and lifestyle changes you must make to lower your CVD risk and maintain a healthy lifestyle.

Don’t sleep on this. If you have one or more of these risk factors or signs, start implementing the dietary and lifestyle changes or better yet, consult with your healthcare practitioner or a registered dietician/nutritionist for support and accountability.

You can do this!



  1. Karnati, S.A., Wee, A., Shirke, M.M., Harky, A. (2020) Racial disparities and cardiovascular disease: One size fits all approach? Journal of Cardiac Surgery, 35, 3530–3538.
  2. British Heart Foundation; Women and heart disease https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women/coronary-heart-disease-kills.
  3. Peters, S.A.E., Muntner, P., Woodward, M. (2019) Sex Differences in the prevalence of, and trends in, cardiovascular risk factors, treatment, and control in the United States, 2001 to 2016. Circulation, 139(8); 1025–1035.
  4. Gao, Z., Chen, Z., Sun, A., Deng, X. (2019) Gender differences in cardiovascular disease. Medicine in Novel Technology and Devices; 4: https://doi.org/10.1016/j.medntd.2019.100025.
  5. Williams, RA (2009) Cardiovascular disease in African American women: A health care disparities issue. Journal of the National Medical Association; 101:536–540.
  6. Jolly, S., Vittinghoff, E., Chattopadhyay, A., Bibbins-Domingo, K. (2010) Higher cardiovascular disease prevalence and mortality among younger blacks compared to whites. The American Journal of Medicine, 123, 811–818.
  7. George, J., Mathur, R., Shag, A.D., et al. (2017) Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients. PLoS One; 12(6); e0178945.
  8. Ruan, Y., Guo, Y., Zheng, Y., et al. (2018) Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: results from SAGE Wave 1. M.C. Public Health; 18: 778.
  9. Muntner, P., He, J., Cutler, J.A., Wildman, R.P., Whelton, P.K. (2004) Trends in blood pressure among children and adolescents. A.M.A.; 291(17), 2107–13.
  10. Lackland, D.T. (2015) Racial differences in hypertension: Implications for high blood pressure management. American Journal of Medical Sciences, 348(2), 135–138.
  11. Gao, Z., Chen, Z., Sun, A., Deng, X. (2019) Gender differences in cardiovascular disease. Medicine in novel technology and devices, https://doi.org/10.1016/j.medntd.2019.100025.
  12. Cercato, C., Fonseca, F.A. (2019) Cardiovascular risk and obesity. Diabetology & Metabolic Syndrome, 11, 74, https://doi.org/10.1186/s13098-019-0468-0
  13. Garcia, M., Mulvagh, S.L., Merz, C.N.B., Buring, J.E., Manson, J.E. (2016) Cardiovascular disease in women: clinical perspectives. Circulation Research, 118(8), 1273–1293.
  14. Heida, K.Y., Franx, A., van Rijn, B.B., Eijkemans, M.J.C., Boer, J.M.A., Verschuren, M., Oukijk, M.A., Bots, M.L., van der Schouw, Y.T. (2015) Earlier age of onset of chronic hypertension and type 2 diabetes mellitus after a hypertensive disorder of pregnancy or gestational diabetes mellitus. Hypertension, 66(6), 1116–22.
  15. Chiamvimonvat, V., Sternberg, L. (1998) Coronary artery disease in women. Canadian Family Physician, 44, 2709–2717.
  16. Maas, A.H.E.M., Appelman, Y.E.A. (2010) Gender differences in coronary heart disease. Netherlands Heart Journal, 18(12), 598–602.
  17. Sheikholeslami, S., Ghanbarian, A., Azizi, F. (2018) The impact of physical activity on non-communicable diseases: Findings from 20 years of the Tehran lipid and glucose study. International Journal of Endocrinology and Metabolism, 16(4 Suppl): e84740.
  18. Cardiovascular disease: risk assessment and reduction, including lipid modification. NICE Guideline CG181, 2016.
  19. O’Keefe, J.H., Bhatti, S.K., Bajwa, A., DiNicolantonio, J.J., Lavie, C.J. (2014) Alcohol and cardiovascular health: the dose makes the poison…or the remedy. Mayo Clin Proc, 89(3), 382-93.
  20. Stewart, J., Manmathan, G., and Wilkinson, P. (2016) Primary prevention of cardiovascular diseases: A review of contemporary guidance and literature. Journal of the Royal Society of Medicine Cardiovascular Disease, 6, 1–9.
  21. Chiva-Blanch, G., Badimon, L. (2020) Benefits and risk of moderate alcohol consumption on cardiovascular disease: Current findings and controversies. Nutrients, 12(1): 108.






Was this post helpful?

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Prev Post

Sweet Potato and Balsamic Chicken Buddha Bowl

Next Post

Control PCOS with diet (lose weight and get pregnant)

%d bloggers like this: