Women’s Heart Health Part 1: What to Know about Women and Heart Disease across the Lifespan

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Allison J. Carroll, PhD; Research Associate, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine

Lisette T. Jacobson, PhD, MPA, MA; Assistant Professor, Department of Population Health, University of Kansas School of Medicine - Wichita

Allison E. Gaffey, PhD; Research Associate, Department of Internal Medicine, Yale University School of Medicine

Heart disease is the leading cause of death among American women. Most research that has guided heart disease treatment comes from studies of men. However, growing research over the past several decades has shown us that women have unique experiences related to heart disease. In this article, we explain how women’s health issues can uniquely contribute to a woman’s risk for heart disease across the lifespan, including puberty, pregnancy, and menopause.

How Childhood, Adolescence, and Puberty Affect Heart Health:

Puberty, which usually takes place between ages 8 and 13 for girls, is a time of biological and psychological transition from childhood to adulthood. Girls with early or late puberty timing have greater risk of developing heart disease later in life, making it all the more important for girls to learn healthy behaviors and practices in their youth. See a few tips for teaching healthy behaviors:

  • Girls (and their parents) should attend regular medical check-ups, know her family history of heart disease, and undergo appropriate genetic testing when indicated.
  • Common mental health concerns, including depression, anxiety, stress, and a history of trauma, can increase risk for heart disease across the lifespan. It is important to monitor girls’ mental health and help them to engage in mental health treatment when needed, to decrease the risk that poor mental health will cause heart disease.
  • Parents can model and support healthy lifestyle behaviors. For example, children who grow up in smoke-free homes (including parents who quit smoking) are less likely to start smoking. Children who are physically active are more likely to continue this habit into adulthood. Regular family meals are associated with healthier diet choices.

Heart Health related to Pregnancy:

Pregnancy is associated with numerous physical and psychological changes and can be a window to a woman’s future health. The long-term impact of those changes on heart health is emerging, and recommendations for healthy levels of weight gain and lifestyle changes during pregnancy continue to evolve.

  • Weight gain is a major risk factor for pregnancy complications. Being overweight or obese during pregnancy is associated with numerous problems for mother and child, such as gestational diabetes and preterm labor. Research shows that women with these and other conditions during pregnancy are more likely to develop heart disease later in life.
  • Some research has shown that breastfeeding protects against developing Type 2 diabetes, lowers post-pregnancy weight, and helps reset women’s metabolism to pre-pregnancy levels. Breastfeeding for 6 months or more can decrease risk of heart disease and stroke.
  • Other actions women can take during their reproductive years to decrease their risk of heart disease include birth-spacing of at least 18 months and engaging in healthy behaviors such as eating healthier foods, being physically active, and not smoking, vaping, or using tobacco products.   

Menopause, Post-menopause, and Heart Health:

Menopause, which usually takes place around age 54, involves decreasing levels of estrogen in the body. Estrogen is a natural hormone, and one of its effects in the body is that it helps blood flow more easily through the arteries of the heart. The hormonal changes that occur during menopause, as well as natural age-related changes, significantly increase women’s risk for heart disease.

  • Estrogen helps to keep blood pressure low. After menopause, a woman is at greater risk of developing high blood pressure, even if she had normal blood pressure throughout her life.
  • Many women take post-menopausal hormone replacement therapy (or HRT) to increase their estrogen levels but, due to recent research studies, the American Heart Association recommends against using HRT as it may be harmful.
  • Following menopause, women often have higher levels of cholesterol than men. Natural age-related changes in cholesterol, including higher levels of triglycerides and low-density lipoprotein (LDL), or “bad cholesterol,” and lower levels of high-density lipoprotein (HDL), or “good cholesterol,” can also increase risk for heart disease.
  • Among women, the risk of having a heart attack greatly increases during the 10 years after menopause. Because heart disease is more common in older age, it is especially important to have routine appointments with your doctor and monitor risk factors.

A woman’s risk for developing heart disease and her experience of a heart attack is significantly different from a man’s. With changes across the lifespan, women often have different issues and concerns. Throughout a woman’s life, good health behaviors (physical activity, healthy diet, not smoking, etc.) are important for the prevention and management of heart disease. Learn more about this in Women’s Heart Health: Part 2.


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