Heart Health Is Not One-Size-Fits-All: How Women Experience Heart Disease Differently
Heart disease is the leading cause of death for both men and women in the United States—but the way it presents, progresses, and is treated is anything but equal. For decades, cardiovascular research, education, and clinical guidelines were based almost entirely on male biology. As a result, women’s symptoms have too often been overlooked, misdiagnosed, or dismissed—sometimes with devastating consequences.
At Ms.Medicine, we’re working to close the gender gap in care by helping women understand how their hearts function differently, why prevention needs to be personalized, and how to take action long before symptoms appear.
A Different Kind of Warning Sign
When most people picture a heart attack, they think of sudden chest pain, clutching the arm, and collapsing to the floor. That’s because the “classic” heart attack symptoms—those most recognized by the public and most often studied—tend to reflect how heart disease presents in men.
But women’s symptoms are often less obvious and more likely to be chalked up to fatigue, stress, or anxiety.
Common heart attack symptoms in men:
Crushing chest pain or pressure
Pain radiating down the left arm
Sudden, intense onset
Common heart attack symptoms in women:
Shortness of breath
Nausea or vomiting
Dizziness or lightheadedness
Fatigue that feels extreme or “out of the blue”
Pain in the jaw, back, neck, or shoulders
A sense of anxiety, dread, or something feeling “off”
Women may not feel chest pain at all. In fact, many women who experience heart attacks never report chest discomfort—one of many reasons their symptoms are missed or misattributed.
Biology, Hormones, and the Cardiovascular System
The structural differences between male and female hearts go beyond surface-level symptoms. Research from institutions like Harvard and Johns Hopkins has highlighted the biological distinctions that influence everything from heart function to treatment response.
Size matters: Women’s hearts are typically smaller and beat slightly faster than men’s.
Blood vessels respond differently: Women are more likely to develop microvascular disease, which affects the smaller arteries that don’t always show up on traditional angiograms.
Hormones play a major role: Estrogen provides protective effects on blood vessels, helping maintain flexibility and supporting healthy cholesterol levels. But after menopause, that protection declines, leading to a spike in cardiovascular risk.
This helps explain why women tend to develop heart disease later in life than men, but when they do, the outcomes are often worse—especially if their symptoms go undiagnosed or untreated for too long.
Underdiagnosed and Undervalued
One of the biggest challenges in women’s heart health is that their symptoms are not always taken seriously—even by medical professionals.
Studies have shown that women are more likely than men to:
Be misdiagnosed with anxiety or indigestion during a cardiac event
Wait longer for emergency treatment or diagnostic testing
Be discharged from the ER without appropriate follow-up
Be underprescribed life-saving medications like statins or aspirin after a cardiac event
Women of color are even more likely to experience these disparities—due to both systemic bias and unequal access to preventive care.
The result? Women are more likely to die within a year of a heart attack than men, and less likely to receive timely, guideline-based treatment.
Risk Factors That Hit Women Differently
Some heart disease risk factors are universal, like smoking, high blood pressure, high cholesterol, and a sedentary lifestyle. But there are also risk factors unique to women, or more impactful because of female biology and life stages.
Pregnancy complications such as preeclampsia, gestational diabetes, and preterm birth increase long-term risk.
Polycystic Ovary Syndrome (PCOS) can lead to insulin resistance and inflammation, both of which raise cardiovascular risk.
Autoimmune diseases (which disproportionately affect women) like lupus and rheumatoid arthritis also raise risk.
Menopause has been associated with increases in LDL (bad) cholesterol and can affect changes in blood pressure.
Mental health conditions such as depression and chronic stress are more common in women and directly linked to heart disease.
Women who have these risk factors may not be flagged by traditional screening tools—another reason gender-specific risk assessments are essential.
Why Prevention Must Be Personalized
At Ms.Medicine, we go beyond routine physicals to offer comprehensive Cardiovascular Risk Assessments that are tailored to women’s needs. These include:
In-depth history including pregnancy, hormonal transitions, and autoimmune conditions
Lipid panels, inflammatory markers, and advanced cholesterol testing
Blood pressure tracking and monitoring
Counseling around nutrition, movement, stress management, and hormone health
Recommendations for screening like coronary calcium scoring when appropriate
This kind of preventive care helps identify risk before symptoms appear, giving women the opportunity to change their trajectory—not just manage disease after it develops.
Your Heart Deserves More
Heart disease doesn’t just affect older men. It affects mothers, daughters, caregivers, and professionals. It affects women who appear healthy, who are managing a dozen roles, who are told their fatigue is “just stress.”
You know your body best. If something feels off, don’t ignore it—and don’t let it be ignored.
Ms.Medicine is building a new model of care where women’s symptoms are taken seriously, their risk is evaluated comprehensively, and their questions are answered without rush or dismissal. Whether you’re 35 and planning for the future or 65 and navigating menopause, your heart health deserves a plan that fits your life.
Next Steps That Matter
If it’s been a while since you talked with your provider about heart health—or if you’ve never had a risk assessment tailored to women—now is the time.
Schedule your Cardiovascular Risk Assessment with a Ms.Medicine provider today. Together, we’ll look at the full picture of your health and create a plan that supports your heart for the long haul.
Because women’s heart health isn’t a side note. It’s the heartbeat of whole-person care.
