Heart disease in women: Understand symptoms and risk factors

Heart disease is the most common cause of death for both women and men in the United States. But some heart disease symptoms in women can differ from those in men. Knowing the symptoms of a heart attack and heart disease may help save a life.

Chest pain is the most common symptom of heart attack in men and women. But women are more likely than men to have symptoms that may seem unrelated to a heart attack, such as nausea and brief pain in the neck or back.

Women often describe heart attack chest pain as pressure or tightness. But it's possible to have a heart attack without chest pain.

Women are more likely than men to have these symptoms of a heart attack:

• Neck, jaw, shoulder, upper back or upper stomach pain.
• Shortness of breath.
• Pain in one or both arms.
• Nausea or vomiting.
• Sweating.
• Lightheadedness or dizziness.
• Unusual fatigue.
• Heartburn, also called indigestion.

These symptoms may be vague but more noticeable than the chest pain.

Compared with men, women tend to have symptoms more often when resting, or even when asleep. Emotional stress can play a role in triggering heart attack symptoms too.

Women are more likely than men to have a heart attack with no severe blockage in an artery. When this happens, it's called nonobstructive coronary artery disease.

Also, women tend to have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart. A blockage in the smaller arteries is called small vessel heart disease or coronary microvascular disease.

If you have symptoms of a heart attack or think you're having one, get emergency medical help right away. Don't drive yourself to the hospital unless you have no other way to get there.

Heart disease risk factors include high cholesterol, high blood pressure and obesity. They affect both women and men. But other things may play a bigger role in the development of heart disease in women.

Women are more likely than men to have health conditions that increase the risk of heart disease such as:

• Smoking. Smoking is a greater risk factor for heart disease in women than it is in men.
• Not being active. A lack of physical activity is a major risk factor for heart disease.
• Emotional stress and depression. Stress and depression may affect women's hearts more than men's. Depression may make it difficult to maintain a healthy lifestyle and follow recommended treatment for other health conditions.
• Diabetes. Women with diabetes are more likely to develop heart disease than are men with diabetes. Also, because diabetes can change the way people feel pain, there's an increased risk of having a silent heart attack. A silent heart attack is one that happens without symptoms.
• Menopause. Low levels of estrogen after menopause increase the risk of developing small vessel heart disease.
• Pregnancy complications. High blood pressure or diabetes during pregnancy can increase women's long-term risk of high blood pressure and diabetes. These conditions also make women more likely to get heart disease.
• Family history of early heart disease. This appears to be a greater risk factor in women than in men.
• Other health conditions. Some autoimmune diseases, such as lupus and scleroderma, and inflammatory conditions also raise the risk of heart disease.

Everyone should take heart disease seriously. Women under age 65 — especially those with a family history of heart disease — should pay close attention to heart disease risk factors.

Living a healthy lifestyle can help reduce the risk of heart disease. Try these heart-healthy steps:

• Do not smoke or use tobacco. Smoking damages blood vessels. It is a major risk factor for heart disease. If you smoke and can't quit, talk with your healthcare team about programs or treatments that can help.
• Eat a healthy diet. Choose whole grains, fruits and vegetables, low-fat or fat-free dairy products, and lean meats. Eat less salt and sugar. Don't eat saturated or trans fats.
• Exercise and keep a healthy weight. If you're overweight, losing even a few pounds can lower your risk of heart disease. Ask your healthcare team what weight is best for you.
• Manage stress. Stress can cause the arteries to get tight. This can increase the risk of heart disease, particularly coronary microvascular disease. Some ways to beat stress are to get more exercise, practice mindfulness and connect with others in support groups.
• Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
• Control blood pressure, blood sugar and cholesterol. Make lifestyle changes and take medicines as directed. Get regular health checkups.
• Get good sleep. Poor sleep may increase the risk of heart disease and other health conditions. Adults should aim for 7 to 9 hours daily.

Regular activity helps keep the heart healthy. In general, try to get at least 30 minutes of moderate exercise, such as walking at a brisk pace, on most days of the week. If that's more than you can do, start slowly and build up. Even five minutes a day of exercise has health benefits.

For a bigger health boost, get about 60 minutes of moderate to vigorous exercise a day, five days a week. Also do strength training exercises two or more days a week.

It's OK to break up your workouts into several 10-minute sessions during a day. You'll still get the same heart-health benefits.

Interval training switches between short bursts of intense activity and lighter activity. It can help people keep a healthy weight and improve blood pressure. To do this, try adding short bursts of jogging or fast walking into your regular walks.

You can also add exercise to your daily activities with these tips:

• Take the stairs instead of an elevator.
• Walk or ride your bike to work or to do errands.
• March in place while watching television.

In general, heart disease treatment in women and in men is similar. It can include medicines, angioplasty and stenting, or coronary artery bypass surgery.

Some differences in heart disease treatment among men and women are:

• Women are less likely to be treated with aspirin and statins to prevent future heart attacks than are men. However, studies show the benefits are similar in both groups.
• Women are less likely than men to have coronary artery bypass surgery. This may be because women have less obstructive disease or smaller arteries with more small vessel disease.
• Cardiac rehabilitation can improve health and aid recovery from heart disease. However, women are less likely to be sent to cardiac rehabilitation than men are.

If you've had a heart attack, your healthcare professional might tell you to take low-dose aspirin every day to help prevent another. Aspirin guidelines for the primary prevention of heart attacks vary. Don't start taking daily aspirin before talking with your healthcare team about the risks and benefits.