Women's Heart Health: While Different, Never Less

04 Sep 2025

Contributed by By Dr Daniel Lim, Senior Resident, Cardiology and Assoc Prof Angela Koh, Senior Consultant, Cardiology

"Women's Health" has long been synonymous with breast or reproductive cancers, yet many remain unaware that heart disease and stroke cause nearly ten times more deaths among women globally than breast cancer¹. This widespread misconception that heart disease is predominantly a men's issue highlights the critical need for women to understand and manage their heart health at every stage of life.

Cardiovascular disease tends to manifest differently in women than in men. While chest pain remains the hallmark symptom of a heart attack, women are more likely than men to experience a different spectrum of symptoms. Women may present with classic symptoms such as central chest pressure or discomfort on exertion, but more frequently develop subtler or atypical signs such as unusual fatigue, shortness of breath, nausea, dizziness or pain radiating to the jaw, neck or back¹. These less apparent symptoms can be overlooked or misattributed to less serious conditions, resulting in misdiagnosis or delayed medical intervention, increasing the risk of complications or even death. Furthermore, heart problems in women often affect the smaller rather than the larger blood vessels of the heart, making detection with standard tests more challenging¹.

Cardiovascular risks for women begin early and accumulate silently from youth to adulthood.

Girls with early menstruation or polycystic ovarian syndrome (a hormonal condition) face a higher risk of developing heart disease later in life². Women are also twice as likely to develop autoimmune conditions like rheumatoid arthritis and lupus, which increase inflammation and damage blood vessels, contributing to future heart problems². These conditions compound traditional risk factors such as high cholesterol, high blood pressure, diabetes, obesity and smoking, creating a lifelong burden on women's hearts.

As women enter midlife, new and different risks emerge. Pregnancy, while a natural process, presents unique challenges. Conditions such as pre-eclampsia (characterised by dangerous blood pressure elevation during pregnancy), and gestational diabetes not only pose immediate health risks but also indicate increased likelihood of developing cardiovascular disease later in life. Some women may develop heart failure or experience heart attack during pregnancy or postpartum³. Menopause marks another critical phase as hormonal balances shift. The decline in oestrogen levels weakens the body's ability to regulate blood pressure, cholesterol and blood sugar, increasing the risk of heart attacks and strokes. This emphasises the importance of regular health screenings during these years.

The challenges continue into older adulthood. Post-menopausal women not only face elevated cardiovascular disease risk, but also experience worse outcomes - they are twice as likely as men to die following a heart attack³. Some medical therapies for chronic illnesses, such as chemotherapy for breast cancer, may also affect heart function, necessitating careful monitoring during treatment. Older women, especially those living independently, often have to manage multiple medications, making regular medical review essential to minimise risks of potentially harmful drug interactions.

Women's hearts age differently from men's. A woman's heart muscle tends to become thicker and stiffer rather than larger and weaker over time. This thickening impairs the heart's ability to relax and fill with blood properly, potentially causing fatigue, breathlessness, or swelling in the legs, even when their heart's pumping strength looks normal on scans. In contrast, men's hearts typically stretch and weaken, reducing the ability to pump blood. These gender-specific differences mean women may present with heart failure symptoms yet be told their heart appears 'normal' when it is actually functioning abnormally.

Traditional heart risk calculators often underestimate women's risk as they do not include female-specific factors such as pregnancy-related conditions⁴, hormonal disorders, and autoimmune diseases. This can potentially delay preventive care and timely treatment.

So what can women do?

Women's Heart Care Tips

• Monitor key health indicators:
Track blood pressure, cholesterol, and blood sugar. Maintain a personal health record to monitor changes over time and enable early intervention when needed.

• Adopt and maintain heart-healthy habits:
Follow a balanced diet, exercise regularly, maintain a healthy weight, and avoid smoking.

• Seek specialised medical care when needed:

Cardio Obstetrics for pregnancy-related heart issues.
Cardio Oncology during cancer treatment to minimise chemotherapy-related heart damage.
Geriatric Cardiology for age-related cardiovascular care.
Cardio-Rheumatology for people with autoimmune diseases like lupus or rheumatoid arthritis.

Note: Heart health evaluations should include an assessment of autoimmune conditions, pregnancy complications, and menopausal status⁵.

Being attuned to one's body is essential. Women should not ignore unusual tiredness, breathlessness, dizziness, or pain in the jaw, neck, or back, as these may potentially indicate heart problems even without chest pain. For older women, staying socially connected and physically active helps preserve independence and reduce frailty. Communities and health systems also play an integral part in providing accessible screening, appropriate treatments and cardiac rehabilitation programmes to support women at every stage of life. Programmes promoting healthy eating, exercise, and mental wellbeing are essential for creating a heart-healthy environment.

Heart disease significantly affects women throughout their lives in unique and often silent ways. Understanding these risks across all life stages and taking early action enables women not only to protect their hearts and health, but thrive well into their golden years with confidence, strength and independence.

REFERENCES

Wenger NK. The Feminine Face of Heart Disease 2024. Circulation 2024;149:489–91. https://doi.org/10.1161/CIRCULATIONAHA.123.064460.
Lewey J, Beckie TM, Brown HL, Brown SD, Garovic VD, Khan SS, et al. Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association. Circulation 2024;149. https://doi.org/10.1161/CIR.0000000000001212.
Farr M. Defining the Actionable Items in Women and Heart Disease: A Conversation With Nanette K. Wenger, MD. Circulation 2024;149:492–7. https://doi.org/10.1161/CIRCULATIONAHA.124.068658.
Limited postpartum follow-up may miss high blood pressure in 1 in 10 new moms. American Heart Association n.d. https://newsroom.heart.org/news/limited-postpartum-follow-up-may-miss-high-blood-pressure-in-1-in-10-new-moms (accessed June 30, 2025).
Non-biological factors and social determinants of health important in women's CVD risk assessment. American Heart Association n.d. https://newsroom.heart.org/news/non-biological-factors-and-social-determinants-of-health-important-in-womens-cvd-risk-assessment (accessed June 30, 2025).