Women’s Heart Health: The Heart of the Matter

By Dr. Janine A. Clayton

Dr. Clayton headshotCardiovascular disease (CVD) is the most common cause of death among women,1 killing more women than all forms of cancer combined.2 However, in a 2005 study, a surprisingly high number of physicians were not aware of the extent of CVD risks for women.3 A more recent study found that doctors who care for women may be less attentive to their CVD risk factors, as compared with male patients, and women sensed that their concerns were not taken seriously.4 Although clinicians play a critical role here, women clearly need to be their own health care advocates and encourage others in their lives to do the same. As American Heart Month, February is the ideal time for women to address their own heart health and for clinicians to review the latest CVD research. Investigators also should use this as an opportunity to ensure that they’re taking sex and gender into account. 

The unfortunate misconception that women are at lower risk for CVD has been caused, in part, by diagnostic and treatment approaches based on studies that didn’t include large numbers of women—or that weren’t designed to look at outcomes for women and men separately. So what do we know about sex effects and differences in CVD?

  • Women may be more susceptible to developing certain types of CVD at different points in life.5 For example, heart disease deaths in middle-aged women are on the rise.6 The risk of preeclampsia in pregnancy is associated with a subsequent increased risk for CVD.7 The Chronic Hypertension and Pregnancy (CHAP) Project found that the risk for developing hypertension can occur as soon as 3 years after a diagnosis of hypertension in pregnancy.8 After menopause, women are more likely to get heart disease, in part because their production of estrogen drops.9 Women who go through early menopause are twice as likely to develop heart disease as women of the same age who do not. 
  • There are widespread sex differences in cardiovascular structure and function. To identify what women need for better heart health, it’s critical to design studies with women in mind, including both recruiting sufficient numbers of women (including healthy women) for clinical trials and analyzing and reporting study results by sex.10 Studies should address how women experience disease in real-life conditions (i.e., pragmatic trials) and take patients’ other medical conditions into account. (For example, there are surprising links between CVD and mental health disorders, although the nature of these links is still being studied.11

With more studies reporting important sex-related effects and differences in CVD, doctors need to stay current and look at heart disease from a life course perspective. Asking women of all ages about their pregnancy or menopause history is more important than we once thought. Clinicians need to listen better to women when they say something is wrong. To assist clinicians and the public, the NIH Office of Research on Women’s Health, in collaboration with the Food and Drug Administration’s Office of Women’s Health, is developing a module focused on CVD for its new online course, Bench to Bedside: Integrating Sex and Gender to Improve Human Health. The module will soon be available on our website at no cost.

The work of incorporating sex and gender into this research—and, more broadly, into clinical practice—is in its initial stages. More needs to be done. This work is critical for understanding how sex differences affect heart health and for the development of safe and effective treatments for everyone.

However, there are many steps you can take to protect your heart right now. Here’s what you can do:

  • Be more physically active.
  • Eat a healthy diet.
  • Identify ways to better manage stress.
  • Don’t smoke, and avoid secondhand smoke.
  • Get the right amount of sleep; 7 to 9 hours of sleep is needed by most people.
  • During your annual checkup, ask your doctor for your “numbers”—blood pressure, lipids, glucose, and body mass index—and ask him or her to explain your results and whether you need to make changes in your lifestyle.
  • You know your own body, so be persistent. Get a second opinion if you feel something is wrong and your doctor isn’t addressing your concerns.
  • Consider participating in clinical research to help others and contribute to moving science forward. To learn how, talk to your doctor or visit Opportunities for Volunteers.
  • For more heart health advice, see the National Heart, Lung, and Blood Institute’s American Heart Month page.

This month, please take action to reduce your risks. “The best time to plant a tree is 20 years ago,” an old proverb says. “The second-best time is today.” There’s no time like the present to begin a healthy lifestyle. Health professionals—as well as family, friends, and coworkers—can help you along the road to better health. It’s easier to change when you have social support. It’s never too late to protect your heart’s health, for yourself and your loved ones.


1 Institute of Medicine. 2010. (U.S.) Committee on Women’s Health Research. Women’s Health Research: Progress, Pitfalls, and Promise. Washington, DC: National Academies Press.
2 https://www.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_480086.pdf.
3 8% of primary care providers, 13% of OB/GYNs, and 17% of cardiologists were aware of women’s death rate. Mosca et al. 2005. National Study of Physician Awareness and Adherence to Cardiovascular Disease Prevention Guidelines. Circulation 111(4):499–510. https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.0000154568.43333.82.
4 Okunrintemi et al. 2018. Gender Differences in Patient‐Reported Outcomes Among Adults With Atherosclerotic Cardiovascular Disease. JAHA 118:010498. doi.org/10.1161/JAHA.118.010498.
5 https://www.nbcnews.com/health/heart-health/blood-pressure-rises-faster-earlier-women-men-possibly-explaining-heart-n1116186.
6 https://www.nbcnews.com/health/heart-health/heart-disease-deaths-middle-aged-women-rise-n1008396.
7 https://www.preeclampsia.org/health-information/heart-disease-stroke.
8 Haas, D. M. et al. 2019. Association of Adverse Pregnancy Outcomes With Hypertension 2 to 7 Years Postpartum. Journal of the American Heart Association. 8:e013092. doi.org/10.1161/JAHA.119.013092.
9 https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-truth/listen-to-your-heart.
10 Taking cardiology clinical trials to the next level: A call to action: https://onlinelibrary.wiley.com/doi/full/10.1002/clc.22907.
11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016051.