Understanding and Optimizing Women’s Heart Health

Michelle Routhenstein, MS, RD, CDE


February 1, 2024

You may have heard that heart disease is (and has been for years) a top global killer. But let’s zoom in a bit more and focus on women’s heart health specifically. According to the CDC, over 44% of women in the United States are living with some form of heart disease. It is responsible for one out of every five deaths in women. 

What’s more, many women are unaware that they have heart disease, as there may not always be obvious symptoms. That’s why I want to spotlight the importance of recognizing signs of heart disease, female heart attack symptoms, and how to practice prevention. 

Understanding Heart Disease in Women

Women often take on the role of caretaker to everyone, which is beautiful, except when it prevents us from being in tune with our health and wellness. That’s why it’s so important to understand how heart disease can show up in women. 

Heart disease risk factors for women include hormonal changes, such as menopause, pregnancy complications, and health conditions like polycystic ovary syndrome (PCOS). Gender differences in heart disease symptoms also exist, with women often experiencing subtler signs than men. 

Unfortunately, there are also misconceptions surrounding women’s heart health, leading to underdiagnosis and undertreatment. One prevalent misconception is that heart disease primarily affects men. Increased awareness of gender-specific risk factors and heart attack symptoms, and dispelling misconceptions are essential for early detection.

Female Heart Attack Symptoms

The average age of heart attack in females is 72 years, but there’s been an uptick in incidence among women 35-54 years. The classic portrayal of someone having a heart attack in a movie is the clutching of the chest (usually a man) and being rushed to the hospital. But signs of a woman having a heart attack can be very different. We must be acutely aware of what our bodies may tell us. 

Female heart attack symptoms can manifest differently than the stereotypical chest pain. While chest discomfort may still occur, female heart attack symptoms are more likely to be subtler and less recognizable, like: 

  • Shortness of breath
  • Fatigue
  • Cough
  • Nausea
  • Lightheadedness
  • Loss of appetite
  • Indigestion
  • Discomfort or pain in areas such as the jaw, neck, back, or upper abdomen

The challenge lies in the fact that these symptoms are often overlooked or attributed to other causes, leading to delayed medical attention. Recognizing the diversity of symptoms in women is crucial for prompt diagnosis and timely intervention. By being more aware and prepared, we can improve outcomes and reduce the impact of heart attacks on women.

Risk Factors

Women may have several unique heart disease risk factors compared to men, which emphasizes the importance of effective prevention. I’ve listed some of the biggest heart disease risk factors for women below.


Factors like unhealthy and nutrient deficient diet, sedentary behavior, and excessive stress contribute significantly to worsened heart health. Smoking damages blood vessel health and excessive alcohol intake can contribute to high blood pressure, cardiomyopathy, and heart failure. Abdominal obesity is also an independent risk factor for heart disease.


While having a family history is not an automatic sentence when it comes to heart disease, it’s important to be aware of this potential risk factor. Genetics can predispose us or accelerate the timeline in which insulin resistance and atherosclerosis take place. Being proactive can help downregulate these genes. 


Conditions like PCOS, pregnancy complications, and early menopause increase the risk of heart disease in women. Gestational diabetes and preeclampsia (high blood pressure during pregnancy) double the risk of heart disease risk and should be monitored and addressed after pregnancy.

Different seasons of life can impact heart health for women, such as the transition from reproductive years to perimenopause and post-menopause. The depletion in estrogen may lead to stiffer arteries, higher blood pressure, and changes in fat distribution that negatively impact women’s heart health. Additionally, postmenopausal women with osteoporosis are at an increased risk of cardiovascular disease. Potential shared factors between both conditions may be related to the process of calcification in arteries and bone mineralization. 


It’s important to have annual blood work done at a wellness exam, even if you’re not feeling sick. Doing so can help catch heart problems earlier than you might otherwise. For example, your blood work can indicate things like high non-HDL cholesterol and triglycerides, as well as trends in your blood sugar. Your provider will also check your blood pressure (which you can and should also do more than once a year using a home blood pressure cuff). Note that optimal values for heart health markers will differ depending on your genetics, medical history, and coronary artery calcium score

Addressing these risk factors through lifestyle modifications — such as science-based nutrition and other healthy habits — regular wellness check-ups, and early intervention can substantially reduce your risk.


For women, prevention involves a multifaceted approach, including lifestyle choices, regular health monitoring, and personal awareness. Below are some of the biggest areas in which preventive efforts are essential for women’s heart health. 

  • Nutrition: A science-based nutrient-rich diet is critical, not just for heart health but for overall wellness and disease risk. I recommend a nutrient sufficient, balanced diet pattern with adequate amounts of fiber-rich carbohydrates, lean proteins, and heart-healthy fats. 
  • Exercise: Regular physical activity plays a crucial role in preventing heart disease. This should include a combination of aerobic exercises like jogging, biking, swimming, or playing tennis, with strength training. 
  • Healthy habits: Smoking and excessive alcohol consumption increase the risk of heart disease in women.
  • Stress management: Women should be vigilant about managing stress through relaxation techniques, like journaling, talking to a friend, meditation or prayer, yoga, or listening to calming music. 
  • Wellness exams: Routine medical check-ups, particularly for monitoring blood pressure, cholesterol levels, and diabetes, are essential for early detection. Getting proactive screenings for things like Lipoprotein A (a genetic marker that puts you at a higher risk of heart disease) and a coronary artery calcium score (which can show whether you have a buildup of plaque in your arteries) can help paint a better picture of your heart health.
  • Awareness: Being aware of gender-specific risk factors and heart disease symptoms is crucial for women. The bottom line is that we need to talk more about female-specific heart health indicators. 

Client Success Story

A 64-year-old woman came to see me because she had osteoporosis and a high calcium score. She wasn’t sure how to design a healthy diet that encompassed getting enough calcium without increasing her calcium score. She was also struggling to lose a goal of 10 pounds despite trying various diet changes. Also noteworthy is that all of this started when she entered menopause.

In our initial evaluation, it was apparent that her weight loss was likely stubborn due to insulin resistance (she had a hemoglobin A1c of 5.7%). Her cholesterol was not optimal because of her diet and gut health leading to a history of sluggish bowel movements. Her calcium intake (along with her magnesium, zinc, and protein intake) could have also been improved.

We worked closely together in my VIP Intensive Program over 3 months, addressing insulin resistance, bowel health, bone and heart health.  In just 1 month, she lost 2.5 inches off her waist and 4.6 pounds. 

In 3 months, she achieved her goal weight, had more energy, and genuinely felt good. At 6 months, her LDL went from 105mg/dL to 64mg/dL, HgA1c went from 5.7% to 5.2%, and waist circumference remained at optimal levels of less than 34 inches. 

As a cardiology dietitian and member of the National Menopause Foundation medical advisory committee, I love seeing women take charge of their wellness like this and dramatically improve their heart health outcomes. If you’re looking for support, consider enrolling in my Heart Optimization Group Program or getting in touch for 1:1 counseling


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