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Coronary Artery Disease and Women

Medically Reviewed by James Beckerman, MD, FACC on October 26, 2021

There’s an old myth that heart disease is a “man’s disease.” The truth is this: It’s the leading cause of death for both men and women in the U.S.

The most common type of heart disease is coronary artery disease (CAD). You might also hear the name coronary heart disease. Without treatment and healthy lifestyle changes, it can lead to a heart attack, heart failure, and other serious problems.

If you’re a woman, you’re just as likely as a man to get CAD. But certain aspects of the disease, like the risk factors and symptoms, can be different for you.

When you understand the differences, you can take steps to prevent CAD, spot possible signs of it early, or get treatment for the condition if you have it.

What Can Raise a Woman’s Risk for CAD?

Women are more likely than men to have health conditions or life situations that up their risk for coronary artery disease. Some of these risk factors only affect women, such as:

  • The blood disorder anemia during pregnancy
  • Early menopause (before age 40)
  • Endometriosis, a painful condition that affects your uterus (womb)
  • Past pregnancy-related problems, like gestational diabetes and preeclampsia
  • Using hormonal types of birth control

These risk factors for CAD tend to be more common in women than men:

Some CAD risk factors seem to make a bigger impact on a woman’s risk for heart disease than a man’s, including:

The strongest of these risk factors for women is diabetes. Research suggests it triples women’s odds of getting CAD. It only doubles the chances for men.

About 8 in 10 women between the ages of 40 and 60 years old have at least one risk factor for coronary artery disease. The more you have, the higher your odds of getting CAD. If you have any of these factors -- or think that you might -- ask your doctor what you can do to lower your chances for CAD. Speak up about it even if the doctor doesn’t mention it.

What Makes CAD Different for Women?

Hormonal changes. Before you start menopause, the hormone estrogen helps protect you from getting coronary artery disease. That’s because estrogen boosts your “good” (HDL) cholesterol. It also helps your arteries stay flexible, so they can widen to carry more oxygen-rich blood to your heart. After you go through menopause and your estrogen levels drop, your risk for CAD goes up.

Anatomy differences. In general, a woman’s heart and blood vessels are smaller and narrower than a man’s to begin with. The muscular walls of a woman’s heart are also thinner.

Delays in diagnosis. Women are more likely than men to have types of CAD that are harder for doctors to spot, which means it could take longer to get a diagnosis and treatment.

What Are the Symptoms of CAD in Women?

Many women don’t have symptoms of coronary artery disease, or they’re different from the “classic” ones that men have. Here’s how some CAD symptoms look in women:

Chest pain or discomfort. Your doctor may call this angina. Women with CAD are more likely to have angina while resting. Stress is also more likely to trigger it for them. Men with CAD, on the other hand, tend to get worse chest pain when they’re active.

Crushing pressure. Women who have angina or have a heart attack often describe the feeling in their chest as crushing, squeezing, pressure, or tightness. This sensation may flare up in the chest or the neck and throat. Call 911 right away if you think you might be having a heart attack.

Other possible CAD symptoms. Some common ones for women are:

Talk to your doctor if you’re having symptoms that worry you. If it turns you out that you have CAD, earlier diagnosis and treatment can lower your chances of dangerous complications.

What Should Women Ask Their Doctors About CAD?

If you’re a woman, ask your doctor these questions to help lower the chances of delays in diagnosis or treatment of coronary artery disease:

Should I get tested for CAD? Doctors are less likely to recommend that women get diagnostic tests for coronary artery disease.

When women go to the hospital with heart-related symptoms, doctors tend to look into other causes first and take longer to refer them for an electrocardiogram (EKG) -- the test that checks for CAD. Women are also less likely than men to get care from a heart specialist during their hospital stay or receive certain types of medications and therapy that could help them.

Younger women are more likely than men to get the wrong diagnosis and go home from the emergency room with symptoms of undiagnosed heart disease.

What are my treatment options? If you learn you have CAD, ask your doctor what treatments work well for women and men.

Women may be less likely than men to get:

  • Heart disease treatments like aspirin, statins, and beta blockers
  • Potentially helpful treatments, like a pacemaker or a defibrillator, for complications of CAD
  • Certain procedures that treat CAD, like percutaneous coronary intervention (a nonsurgical way to open narrowed or blocked arteries) or coronary artery bypass grafting (a surgery that uses one of your healthy chest arteries and leg veins to reroute blood around blocked coronary arteries)

What Habits Can Help Women Prevent CAD?

The American Heart Association says that lifestyle changes can prevent almost 75% of coronary artery disease cases in women. Try these:

  • Get regular exercise. Talk to your doctor if you need help getting started.
  • Eat a balanced diet, cutting back on sodium and unhealthy fats.
  • Kick the habit if you smoke. Your doctor can help you do this, too.

Your heart also reaps the benefits when you get enough sleep and take charge of stress.

Show Sources

SOURCES:

CardioSmart: “Women and Heart Disease.”

National Heart, Lung, and Blood Institute: “Coronary Heart Disease.”

American Heart Association: “Cardiovascular Disease: Women’s No. 1 Health Threat,” “About Metabolic Syndrome.”

Baylor Medicine: “Women and Heart Disease.”

CDC: “Heart Disease Facts,” “Coronary Artery Disease (CAD).”

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