I’m a cardiologist’s daughter, so I’ve spent a lot of my life hearing about heart disease. But even for someone like me — who grew up listening to dinnertime conversations peppered with cardiology terms — there’s a very specific picture that pops into mind when I think about heart health, especially in the context of heart attacks.
Societally, we have this idea of who a heart patient is: A middle-aged man. We rarely think about heart health as a women’s health issue, but we need to change that. Because women also have cardiac issues and heart attacks — even young women. And by excluding them from conversations on heart health, we’re failing to give them tools to take full control over their health and lives.
The notion that women rarely have heart attacks is overdue for a reevaluation: An observational study suggests that more young women are having heart attacks, yet our cultural perceptions of cardiac issues rarely include women at all, especially young, otherwise healthy women.
To learn more about women’s heart health and heart attack risks, we spoke to Sabah Siddiqui, M.D. FACC, an interventional cardiologist, who believes women “absolutely 100%” need to be better represented in conversations about heart health.
Why might more young women be having heart attacks?
That’s still somewhat unclear.
“There are some observational studies suggesting that younger women are having more heart attacks,” says Dr. Siddiqui. “I haven’t flushed out all the data yet but the suspicion is that more people are having these risk factors for heart disease at a younger age than seen previously.”
It’s time to talk about it
“Cardiovascular disease is the number one killer of women in the United States and worldwide,” says Dr. Siddiqui.
Awareness of that is necessary, and attempts are underway. “National Wear Red Day is an annual event held each first Friday in February by the American Heart Association to raise awareness about heart disease in women,” says Dr. Siddiqui. “The whole month of February is dedicated to heart health awareness with special initiatives to raise awareness and close gaps of women’s cardiovascular disease.”
Cardiac issues among young women are real.
Dr. Siddiqui can confirm.
“I see a lot of young women from ages 20 on with cardiac issues,” she says. “A lot of younger women have palpitations (feel their heart racing), some with extra heartbeats, some with abnormal heart rhythms, some with familial high cholesterol and blood pressures that reflect at a younger age.”
Pregnancy and menopause can be especially dangerous times.
“I see a lot of pregnant women with changes to their heart function during their pregnancies and some higher risk pregnancies affecting heart health, including high blood pressure amongst other diagnoses (and these may affect cardiovascular risk later in life,” says Dr. Siddiqui. “I see a lot of women in their 40s (which is still young for cardiovascular disease) also dealing with high cholesterol, high blood pressure, heart failure, strokes, and even starting to affect their coronary health.”
Menopause can also be a time when risk factors increase, making women more vulnerable to cardiac issues, according to Dr. Siddiqui.
What are some risks that may increase a person’s odds of having cardiovascular disease or a heart attack?
According to Dr. Siddiqui, common risk factors include having diabetes or elevated blood pressure, smoking, low levels of “good cholesterol”, and being obese or overweight.
So how can we bring down our risk profiles?
It’s advice you’ve certainly heard before, but it’s good advice: Reducing the risk of cardiovascular disease is all about maintaining healthy habits. The good news? It’s truly not that complicated.
“I know this has been said before but it’s worth repeating: Eat well, eat in moderation, stay active as much as you can. Go get annual physicals at your primary care, get a baseline blood pressure, cholesterol levels. This should be done annually as early as age 20,” says Dr. Siddiqui, adding that people with family histories of heart disease need to be especially careful.
Common misconceptions can put women in danger.
We’ve said it over and over again: Lack of information and awareness can be a killer.
“Some common misconceptions are [that] heart attacks usually happen to men and not women, heart disease only affects older people, [and that] being thin means I probably don’t have heart disease,” says Dr. Siddiqui.
“Women with heart attacks present differently than men,” she adds. “Their symptoms can be more vague and not ‘textbook’-like and so unfortunately, they are more likely to be brushed off.”
Because we center our conversations on cardiovascular health around men, it’s easy to make the connection as to why women’s heart health issues are so frequently brushed off — and that’s exactly why we need to do a better job of bringing them into the conversation and making them more aware of heart attack symptoms in women.
What are some heart attack symptoms in women?
According to the CDC, women may experience chest pain or discomfort, upper back or neck pain, indigestion, heartburn, nausea or vomiting, extreme fatigue, dizziness, and shortness of breath, as well as fluttering feelings in the chest (palpitations), shortness of breath, sudden fatigue, or swelling of the feet, ankles, legs, or abdomen when having heart attacks.
“I’m not sure there’s actually science behind this but I believe women often have a higher pain threshold than men,” says Dr. Siddiqui. “And so sometimes women aren’t sure what they are feeling or can’t quite describe it and just say they feel unwell, and that has the possibility of being brushed off. Women often complain of chest discomfort, or tightness, or belly pain, feeling unwell, unable to take a deep breath. They may often complain of nausea, palpitations (heart beating fast), or being unable to breathe.”
Why do heart attacks happen in the first place?
“Heart disease encompasses a whole umbrella of diseases. It’s any condition that affects the structure or function of the heart. It includes issues with coronary vessels (blood supply to the heart), peripheral vessels (blood supply to the extremities), arrhythmias/abnormal rhythms (the electricity of the heart), structure of the heart (valves, walls, muscles of the heart), and heart failure (weakening of the heart),” says Dr. Siddiqui. “Heart attack in the most general sense of the term has to do with issues with the blood vessels supplying the heart itself. So it’s caused by blockages in the coronary blood vessels of the heart.”
So, can we bring down the risk of having a heart attack as a young woman?
“Anyone above the age of 20 should get a yearly basic workup with blood pressure and blood tests (including cholesterol levels). If you have a family history you may need other tests,” says Dr. Siddiqui. “There are so many blood tests and diagnostic tests, such as electrocardiograms, ultrasound of your heart, and various different types of stress tests to name a few. Some tests are specially tailored for the issue at hand.”
The good news? Gaining information about your heart health allows you to take key steps to modify your risks.
“Recognizing risk factors allows [you to] mitigate and reduce these,” says Dr. Siddiqui. “Sometimes diet and exercise alone is not enough and there’s no shame in taking medications to help. Certain populations are at increased risk for heart disease.”
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, MarieClaire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.