by Noel Peterson, MD, FACC, FASE
Eastern Cardiology, Greenville, NC
Director of Women’s Cardiovascular Disease and Preventative Cardiology for the East Carolina Heart Institute

February is Go Red month, dedicated to raising awareness of heart disease in women.  Traditionally heart disease has always been thought of as a man’s problem. However, the incidence of cardiovascular disease is similar in both sexes.  Please take a few minutes to educate yourself regarding the signs and symptoms of heart disease in women. It may save your live or the live of someone you love.

One in four women die from heart disease, making it the #1 killer of women, regardless of race or ethnicity. It kills more women than breast, lung and colon cancer combined – yet we often fail to recognize that we are at risk for developing heart disease.  In addition our symptoms of heart disease are much more subtle – sometimes we do not even experience chest pain! And our outcomes are worse than men – two-thirds of women who suffer a heart attack never fully recover.

Statistical Differences between Men & Women

• Women have a higher mortality rate from heart disease than men.
• 64% of women (compared with 50% of men) who die suddenly from heart disease do not have classic warning symptoms of an imminent heart attack.
• 42% of women who have heart attacks die within 1 year, compared to 24% of men.
• Women who have a heart attack are twice as likely to die within first 2 weeks compared with men. 

Why do these statistical differences exist?

Multiple studies have proven that there is a gender bias when diagnosing and treating heart attacks.


• Women tend to present with atypical symptoms, therefore their symptoms are not being recognized as heart attack.

• Even when a heart attack is recognized, men are much more likely to be referred for invasive testing and treatment compared to women – even when both showed the same abnormal diagnostic test results.

• Women are four times as likely as men to be given a psychiatric diagnosis (like panic attacks or anxiety) to explain their heart attack symptoms.

Treatment Differences

Women were not included in many of the original clinical research trials; which determine treatments for cardiovascular disease.  Even today far fewer women participate in clinical research trials than men. Even when a heart attack is properly recognized, women are not being treated as aggressively as men. Therapy given to women is often inferior to that offered to men.  Various recommended treatments are delayed and underused in women.  Women are less likely to receive early aspirin, beta-blockers, reperfusion therapy to restore blood flow, or urgent angioplasty to open an obstructed blood vessel in the heart.

Men are five times more likely than women to recognize their symptoms as being related to their heart.

So, what are the warning signs of a heart attack?

Classic Symptoms

• A crushing, squeezing, or burning pain, pressure, or fullness in the center of the chest.  The pain may radiate to the neck, one or both arms, the shoulders, or the jaw. The chest discomfort lasts more than a few minutes or can go away and return.   May be confused with indigestion.

• Shortness of breath, dizziness, nausea, chills, sweating, or weak pulse. 

• Cold and clammy skin, gray pallor, or a severe appearance of illness.

Women often have more subtle symptoms than their male counterparts.

Heart attack symptoms in women may manifest as:

• A feeling of shortness of breath may not be accompanied by any chest pain. 

• Symptoms that are flu-like such as  feelings of nausea, cold sweats, and clamminess 

• Weakness, unexplained fatigue, dizziness 

• Pain in the neck, the jaw, the chest, shoulders and upper back 

• General discomfort, feelings of anxiety, loss of appetite

If you think that you are having a heart attack – please do not go and lie down to see if you will feel better!!!  Chew (don’t swallow) 325 mg of aspirin (4 baby aspirin) – this can help restore some blood flow during the time period that it takes you to get to the hospital.  Do not drive yourself (or have someone drive you) to the emergency room.  Call 911 – you will be seen immediately upon arrival to the emergency room (versus arriving in a personal vehicle) and life-saving treatments can be started while enroute to the hospital.

Common Risk Factors for Heart Disease in Women 

• Overweight 
• Physically inactive or having a sedentary lifestyle
• Smokers
• High blood pressure or cholesterol levels
• Diabetes or pre-diabetes
• Age > than 65 years
• History of pre-eclampsia, pregnancy induced hypertension, diabetes during pregnancy 
• Have other inflammatory diseases (psoriasis, inflammatory bowel disease)
• Certain autoimmune disorders 

Given the gender specific differences in the presentation, manifestation, and diagnosis of heart disease, it’s important that women learn about these differences so that they can recognize when a heart attack is occurring and get proper, life-saving care as quickly as possible.  Being proactive and taking steps to ensure your optimum health are key to preventing heart disease.  Make this your year to take care of yourself by increasing physical activity (10,000 steps/day), commit to exercising on a regular basis (150 min/week), receive adequate sleep (7-8 hours a night), and making healthier food choices by eliminating fast food, limiting processed food and choosing a clean diet composed of whole foods (that either come from the ground or have a mama), and by reducing stress.