Women’s Heart Health: Key Risks & Lifespan Changes – 2026 Update

Key takeaways:

• Wear Red Day is recognized on the first Friday in February.
• Heart disease remains the leading cause of death for women.
• Cardiovascular deaths declined for the first time since 2018, with 915,973 total cardiovascular-related deaths in 2023.

Heart disease remains the leading cause of death for women. Despite advancements in awareness and research, gaps remain in the diagnosis and treatment of cardiovascular disease in women. February is American Heart Month, a highlight of which is Wear Red Day, observed on the first Friday of the month, to raise awareness about heart disease in women.

Recent data indicates a positive trend: cardiovascular deaths declined for the first time since 2018. In 2023, there were 915,973 total cardiovascular-related deaths, including those from heart disease, stroke, heart failure, and hypertension, a decrease from the 941,652 recorded in 2022. The age-adjusted death rate also fell, from 224.3 to 218.3 per 100,000 people.

Healio spoke with Janet Wei, MD, FACC, associate professor of cardiology and biomedical sciences at Cedars-Sinai Medical Center, the Erika J. Glazer Chair in Women’s Cardiovascular Research, Education and Innovation and a Healio | Cardiology Today Editorial Board Member, about how women’s physiology affects CVD risk, how factors such as autoimmune disease and stress contribute to risk and steps women can take to protect their hearts.

Healio: Despite rising awareness, why is heart disease still the leading cause of death in women?

Wei: “We were gaining traction for increasing awareness for women but, unfortunately, we have not done so well in the last 5 to 10 years, particularly for women aged younger than 55 years. Most women still do not recognize that heart disease is the leading cause of death, so we need to do better.”

Dr. Wei explained that differences between women and men play a significant role in disparities in cardiovascular outcomes. Risk factors contributing to heart disease, such as high blood pressure and high cholesterol, are often undertreated in women. Studies suggest that the normal blood pressure range may be lower for women than for men, and women experience a higher risk of stroke and heart attack at the same blood pressure threshold. This highlights the importance of sex-specific research and treatment thresholds.

Generally, women present with heart disease approximately 10 years later than men, thought to be due to the protective effects of estrogen. Risk scores used to estimate a woman’s cardiovascular risk over the next 10 years often indicate low risk for women younger than 60. However, certain sex-specific conditions, such as a history of preeclampsia, autoimmune diseases, and premature menopause, are associated with a higher risk of CVD. Even traditional cardiovascular risk factors like diabetes or obesity confer a higher risk for heart disease in women than in men.

Healio: What are some of the most important issues in women’s heart health today?

Wei: “I’d like to highlight three important issues. One, there is increasing recognition that cardiovascular-kidney-metabolic (CKM) syndrome disproportionately affects women. We are trying to understand how adipose tissue affects women differently than men. Postmenopausal women have excess inflammatory adipose tissue. There is a critical need for us to understand sex differences in the pathophysiology of CKM syndrome to promote tailored approaches for treating women.”

Dr. Wei also noted that women are often dismissed when presenting with angina or heart attack symptoms, particularly when experiencing nonobstructive coronary artery disease. Research is ongoing to understand the role of coronary microvascular dysfunction and coronary vasospasm in ischemic heart disease, heart attacks, and heart failure with preserved ejection fraction, which is more prevalent in women than men.

Finally, Dr. Wei emphasized the maternal mortality crisis in the U.S., stating that cardiovascular disease is the leading cause of mortality in pregnant and postpartum women, with at least 75% of these deaths being preventable. Improved recognition of cardiac signs and symptoms in pregnant and postpartum women is crucial, as symptoms often overlap with normal pregnancy experiences. Cardiovascular risk stratification before, during, and after pregnancy is recommended to identify and address potential risks.

Healio: When is it important for women to begin to pay attention to their heart health?

Wei: “Every adult woman should get a BP screen, particularly if they plan to or could become pregnant in the next year.”

Dr. Wei recommends cardiovascular screening beginning at age 20, including screening for cholesterol, blood pressure, and diabetes or prediabetes. Utilizing the American College of Cardiology/American Heart Association ASCVD risk calculator can help estimate 30-year risk, and even with a low short-term risk, this information can be used to discuss next steps with a healthcare professional. Starting at age 30, the American Heart Association PREVENT Calculator can be used to determine risk for both ASCVD and heart failure.

Healio: How does a woman’s heart disease risk change across the lifespan?

Wei: “You can begin thinking about a woman’s heart health as early as the in-utero stage. Research demonstrates that a child’s cardiometabolic risk is increased if the mother experienced gestational diabetes, hypertension, premature birth and, particularly, preeclampsia. These risk factors can predict childhood obesity, diabetes and high BP. The buildup of plaque also starts earlier with these conditions. Early or late menarche may be signs of underlying cardiometabolic risk and are associated with increased risk of CVD.”

Pregnancy is considered a woman’s first physiologic stress test, and how the heart adapts can provide clues about future cardiovascular health. Preeclampsia doubles the risk for heart disease within 10 years postpartum. Menopause is another significant transition, with declining estrogen levels potentially leading to increased blood pressure, cholesterol, and plaque deposition. This is an important time for women to consult with their doctors to assess and manage their risk factors.

Healio: Can you discuss the impact of autoimmune disease and chronic inflammation on women’s heart health?

Wei: “Autoimmune diseases, like rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis, predominantly affect women and are unfortunately associated with a threefold higher risk for heart disease. Chronic inflammation leads to endothelial dysfunction. Inflammatory cytokines and macrophage activity disrupt the CV system, leading to premature atherosclerosis.”

Dr. Wei noted that medications used to treat autoimmune conditions, such as steroids, can also have side effects that increase cardiovascular risk.

Healio: What is the link between chronic stress, anxiety and depression and women’s heart health?

Wei: “There is a brain-heart connection. The cardiac autonomic nervous system is affected by chronic stress, releasing cortisol, epinephrine and norepinephrine. These stress hormones and neurotransmitters impact the cardiometabolic system by increasing BP, vasoconstriction, insulin resistance and inflammation. Research has shown that chronic stress, anxiety and depression increase risk for stroke and heart attack by about 30% to 40%. Stress can also trigger poor health habits such as poor sleep, less physical activity and unhealthy diet.”

Conversely, Dr. Wei pointed out that positive mental health attributes, like optimism, a sense of purpose, or mindfulness, are associated with lower cardiovascular risk and mortality.

Healio: What is one action women can take today to better protect their heart health?

Wei: “No. 1 is to know your numbers and risk factors. Get your BP, cholesterol, blood sugar, family history and reproductive history evaluated.”

Dr. Wei also emphasized the importance of lifestyle changes, including increased physical activity, a healthy diet, and adequate sleep.

For more information:

Janet Wei, MD, FACC, can be reached at cardiology@healio.com.