Here's something that surprises most women when I tell them: heart disease is the number one killer of women in the United States — responsible for one in five female deaths.
More than breast cancer. More than all cancers combined.
And yet cardiovascular disease in women is dramatically underdiagnosed and undertreated, partly because women's symptoms are different from the "classic" heart attack presentation we see in movies, and partly because heart disease has long been thought of as a "man's disease."
As a nurse, I want to change that. Here's what every woman over 50 needs to know.
Why Risk Increases After Menopause
Estrogen has a protective effect on the cardiovascular system. It helps keep blood vessels flexible, raises HDL ("good") cholesterol, and reduces inflammation. When estrogen drops at menopause, that protection disappears.
In the decade after menopause, women's cardiovascular risk rises sharply — often surpassing men's risk by the mid-60s. This is why heart disease is primarily a post-menopausal condition in women.
Women's Heart Attack Symptoms Are Different
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The classic heart attack presentation — crushing chest pain radiating to the left arm — is more common in men. Women are more likely to experience:
Women are more likely to dismiss these symptoms as anxiety, indigestion, or "just stress." Please don't. If something feels wrong, get it checked.
Know Your Numbers
These five numbers tell you most of what you need to know about your cardiovascular risk:
Blood pressure: Optimal is below 120/80. Hypertension (140/90 or above) significantly increases heart disease and stroke risk. Many people have no symptoms.
LDL cholesterol: Lower is better. Above 130 mg/dL is borderline high; above 160 is high. Your doctor may recommend medication if lifestyle changes aren't enough.
HDL cholesterol: Higher is better. Below 50 mg/dL in women is a risk factor.
Triglycerides: Below 150 mg/dL is normal. High triglycerides are often related to diet, particularly refined carbohydrates and sugar.
Blood sugar (fasting glucose or HbA1c): Diabetes and prediabetes dramatically increase cardiovascular risk. Many people don't know they have prediabetes.
Get these checked at your annual physical. Know your numbers.
The Lifestyle Factors That Matter Most
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Don't smoke. Smoking is the single most modifiable cardiovascular risk factor. If you smoke, quitting is the most important thing you can do for your heart.
Move your body regularly. Walking and other moderate activities can be part of a healthy routine. Questions to ask your healthcare provider: what activity level is appropriate for you.
Eat a heart-healthy diet. The Mediterranean diet — rich in vegetables, fruits, whole grains, fish, olive oil, and nuts — has the strongest evidence for cardiovascular protection.
Manage stress. Stress-management practices can be a meaningful part of overall well-being. Questions to ask your healthcare provider: which approaches are appropriate for you.
Maintain a healthy weight. Particularly important is reducing visceral (belly) fat, which is directly associated with cardiovascular risk.
Consider alcohol intake. Questions to ask your healthcare provider: what guidance is appropriate for your health history and medications.
Have the Conversation With Your Doctor
Ask your doctor to calculate your 10-year cardiovascular risk using the Pooled Cohort Equations — a validated tool that estimates your risk based on age, cholesterol, blood pressure, smoking status, and diabetes.
If your risk is elevated, discuss whether medication (statins, blood pressure medication) is appropriate. These medications save lives and are often underused in women.
You are your own best health advocate. Know your risk. Ask the questions. Take action.
Your heart has been working for you every second of your life. Take care of it.
— Amy Barry Jankowski, RN
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