Warning Signs of a Heart Attack in Women

Heart disease is the leading cause of death in American women — killing more women than all forms of cancer combined. Yet for decades, heart disease was viewed as a "man's disease," and the gender gap in recognition, research, and treatment has had deadly consequences. Women are more likely than men to die from a first heart attack; they are more likely to be misdiagnosed; and they are more likely to delay seeking care. A primary reason: women's heart attack symptoms are more frequently atypical — less likely to include the dramatic chest-clutching pain of popular imagination, and more likely to include symptoms easily attributed to anxiety, fatigue, or stomach problems.

The Biological Context

Women typically develop coronary artery disease 7–10 years later than men, in large part because estrogen exerts a protective vascular effect during the reproductive years. After menopause, when estrogen levels fall, women's cardiovascular risk accelerates and begins to approach men's. By age 70–75, men and women have roughly equal rates of heart disease.

Women also have a higher prevalence of non-obstructive coronary artery disease — heart attacks occurring in women with less severe arterial narrowing — and more microvascular dysfunction (small vessel disease) than men. These differences partly explain why women's presentations are more often atypical.