Q: What are the symptoms of a heart attack for a woman? Are they different in women than in men?
A: The most common heart attack symptom in women is some type of pain, pressure or discomfort in the chest. However, the pain is not always severe or characterized as a pain. Pain may not be the most prominent symptom, rather shortness of breath, indigestion, palpitations, neck, shoulder, jaw, or back pain. Associated symptoms may be unusual nausea, vomiting, sweating, lightheadedness, or unusual fatigue.

Many women present to medical care well into a heart attack, after much heart damage has occurred, because their symptoms are not typical of a heart attack, or they did not think they were at risk. If you experience any symptoms or think you may be having a heart attack, call for emergency medical help. Do not drive yourself to the emergency room.

Q: What are the risk factors for heart disease in women?
A: Traditional risk factors for coronary artery disease that affect both men and women are:

  • High blood pressure (hypertension)
  • High cholesterol (hypercholesterolemia)
  • Diabetes
  • Family history of heart disease
  • Tobacco use
  • Age

However, other factors such as the metabolic syndrome (a combination of abdominal fat, high blood pressure, high blood sugar, and high triglycerides) can affect women more than men. In addition, mental stress and depression can have a greater impact on women than on men.

The National Heart, Lung and Blood Institute provides an online risk calculator that you can use for the most precise estimate of your own risk. It's called the Risk Assessment Tool for Estimating 10-year Risk of Developing Hard CHD (Myocardial Infarction and Coronary Death).

The Reynolds Risk Score is another online option for calculating risk. It is designed to predict your risk of having a future heart attack, stroke, or other major heart disease in the next 10 years. In addition to your age, blood pressure, cholesterol levels and whether you currently smoke, the Reynolds Risk Score uses information from two other risk factors, a blood test called hsCRP (a measure of inflammation) and whether or not either of your parents had a heart attack before they reached age 60 (a measure of genetic risk).

Q: What is the number-one killer of women?
A: All women face the risk of heart disease. Each year, more women die of heart disease than any other disease including breast cancer. Heart disease is often thought of as a disease that only affects men.

Q: What can women do to reduce their risk of heart disease?
A: There are several lifestyle changes that women can make to reduce their risk of heart disease, including:

  • Exercise 30-60 minutes of aerobic activity such as walking on most days of the week: women who need to lose weight or sustain weight loss should accumulate a minimum of 60-90 minutes of moderate-intensity physical activity on most, and preferably all, days of the week
  • Maintain a healthy weight
  • Quit or don't start smoking
  • Eat a diet that is low in saturated fat, cholesterol and salt
  • Visit your doctor on a regular basis
  • Have your blood pressure checked
  • Have your cholesterol checked - blood pressure goal is less than 120/80 mmHg
  • Medication is indicated if blood pressure is greater than 140/90, or greater than 130/80 in diabetics or patients with kidney disease
  • Treat known risk factors for heart disease, with the advice of your doctor
  • Some women benefit from a daily "baby" aspirin, but check with your doctor prior to starting any new medication

These are the things women can do to take good care of themselves and reduce their risk of heart disease.

Q: Is heart disease something only older women should worry about?
A: No. Women under the age of 65 who have any risk factors for heart disease should pay close attention to their symptoms. Women of all ages should take their heart seriously. Click here to see list of risk factors.

Q: Can taking vitamins reduce a woman's risk of a heart attack?
A: It is uncertain whether taking any vitamins can help reduce your risk of having a heart attack or developing heart disease. Antioxidant vitamin supplements (for example, vitamin E, vitamin C, and beta carotene) should not be used for the prevention of heart disease in women. Folic acid, with or without B6 and B12 supplementation, should not be used for the prevention of heart disease in women.

Q: What is a "heart healthy" diet?
A: The answer is simply this: you must consistently choose healthy eating patterns, and healthy food selections; that is:

  • Fruits and vegetables
  • Whole grains, high fiber
  • Fish, especially oily fish, at least twice per week
  • No more than one drink of alcohol per day
  • Less than 2.3 grams of sodium per day
  • Saturated fats less than 10% of calories, less than 300 mg cholesterol per day
  • Limited trans fatty acid intake (main dietary sources are baked goods and fried foods made with partially hydrogenated vegetable oil)

These particular foods and eating patterns form a heart healthy diet.

Q: Where can I find heart healthy diets for women?
A: You can find a lot of good options for heart healthy eating at the websites of the DASH Diet Eating Plan and the American Heart Association, which offer recipes, healthy cooking tips, secrets to heart-smart shopping, and more.

Q: What is an ideal body weight?
A: Women should maintain or lose weight through an appropriate balance of physical activity, calorie intake, and formal behavioral programs when indicated to maintain the goal of having a body mass index, or BMI, between 18.5 and 24.9 kg/m² (click here for a BMI calculator) and waist circumference less than 35 inches.

Q: Is taking hormone replacement harmful?
A: Hormone therapy and selective estrogen-receptor modulators (SERMs) should not be used to prevent heart disease in women.

Q: Should I avoid secondhand smoke? Can secondhand smoke increase your risk of having a heart attack?
A: Second-hand smoke is a risk factor for having a heart attack. If you are regularly around smokers, encourage them to quit or go outdoors to smoke. This is especially important if you have had a heart attack or have been diagnosed with heart disease.

Q: Concerning care of the pregnant woman with cardiovascular disease, is it safe for a woman with heart disease to have a baby?
A: The answer depends on the problem and the woman's cardiac status. With some types of heart disease, outcomes are excellent without any special management in women with good function. With other types, pregnancy poses a reasonable risk, and still other types should rule out pregnancy altogether. We work together with high-risk obstetrics, midwives, and obstetricians on faculty and in the community. We care for the pregnant woman with cardiovascular disease through a multidisciplinary approach.