American Heart Month: Gender-Specific Information for Women


Heart disease is the number one killer of both women and men but many people are unaware that more women than men die each year from cardiovascular disease.

February is American Heart Month and heart health professionals, like Dr. Paula Miller, Clinical associate professor at the UNC School of Medicine and current director of UNC’s Women’s Heart Program, are devoted to increasing awareness and changing misperceptions.

Risk Factors

Family History

It is common knowledge that older women are more at risk than younger women but as Miller stresses, “Young women are not off the hook.”

“Family history, smoking and diabetes definitely increase your risk as a younger woman,” Miller explains.  “Every woman should know her risk and if she has a parent or sibling with heart disease—younger than age 50 for a male relative or younger than 60 for a female relative—then they should be screened early and all risk factors modified or suggestions made.”



Smoking, however increases the risk for heart disease and young women are the most likely demographic to start smoking.

“This is the single most important thing we need to educate women about,” Miller claims, “A woman who smokes has her first heart attack 19 years earlier on average than a woman who does not smoke.”



Men are more likely to develop plaque buildup in the major arteries near the heart while women are more likely to develop plaque in smaller arteries, making women more susceptible to coronary miscrovascular disease than macrovascular disease.

More women suffer from chronic and/or acute stress, as well as stress-related mental disorders, like depression, which makes stress more of a risk factor for women than men.  Miller even hypothesizes that stress may be one of the worst risk factors a woman can have.



Autoimmune diseases can increase risk for developing heart disease and such diseases, like rheumatoid arthritis, are more common among women than men.



There is sufficient evidence to support higher risks in certain ethnic groups, particularly among African-American women and Hispanic-American women.

“African-American women are more likely to be hypersensitive and obese with an increased risk of Coronary Heart Disease (CHD).” Miller says, “If you look at Center for Disease Control and Prevention (CDC) tables on risk and ethnicity, there are differences in incidence of CHD, Hypertension (HTN), activity, smoking, etc. between ethnic groups. All of these change your risk for Coronary Artery Disease (CAD).”



While men and women both suffer from the classic heart attack symptoms like chest pain, pressure, tingling or pain in the left arm and shortness of breath, women are more likely to incur atypical symptoms, such as nausea, overwhelming fatigue, dizziness and back, neck or jaw pain.

“It is now well known what causes women to have such atypical symptoms.  Women do present differently and often later than men with their first heart attack,” Miller says, “Generally, women present an hour later on average.  The symptoms are most likely reproducible with activity or have been present previously and may be getting worse with less and less provocation.  Women have a tendency to ignore or minimize their symptoms.”



Cardiac stress tests are a common form of detection that is used to determine if there is enough blood flow during physical activity.  They are not as reliable for women and can produce misleading results. However, if stress tests are coupled with other forms of detection, like echocardiograms or nuclear scans, then they improve their accuracy.  Furthermore, stress tests induced by drugs can be more effective for females.

Women have smaller coronary arteries than men do, which makes angiography, angioplasty, and coronary bypass surgery more difficult to do, consequently reducing their chance of receiving a proper diagnosis.


Gender-Specific Treatment

Statins, or cholesterol lowering drugs, are more effective for men than women (Women are more likely to have low levels of high-density lipoprotein (HDL) cholesterol or, the good cholesterol).

Not only are surgeries like angioplasty and heart bypass more difficult to perform on women but there are also more recorded deaths of females who underwent such surgeries.


Diet and exercise can lower women’s risk for heart disease. According to a recent study conducted by the US National Institute of Health, berries may cut heart attack risk by one-third. The study found less risk in women who consumed three or more servings of blueberries and/or strawberries a week rather than one or less a month. The direct cause and effect is unknown but berries contain high levels of compounds that widen arteries, preventing plaque buildup and blockage.

Other heart-healthy foods include salmon, spinach, almonds, flaxseed, tofu, sweet potatoes, papaya, tomatoes, asparagus, soy milk, red pepper, carrots and even dark chocolate.

Exercise is another preventative measure. Doctors recommend exercising for 20-30 minutes at least three to four times a week. The best types of exercise for preventing heart disease are aerobics and strengthening exercises.

Education and Awareness:

To make women more aware that heart disease is the biggest threat to their health, Miller suggests educating women through outreach and making sure providers are routinely informing their patients.

“I think it is a little like a pyramid scheme or model she expounds —if I tell two women and those two women each tell two women, then the message will eventually reach a large number.”

It is important for all women to familiarize themselves with their own numbers, such as blood pressure levels, cholesterol, weight, body mass index (BMI) and blood sugar so that women can ask their providers what they can do to lower their risk according to their numbers. Miller and her team at the UNC Women’s Heart Program provide assistance with worksite wellness and outreach health fairs that screen women and provide education health education.

Miller is hopeful that women are becoming more aware and feels current statistics are encouraging.

“In 2000, only one in three women were aware that their risk for heart disease was higher than men,” she says, “In 2010, that [number] had improved to about 54% of women who were aware.” However, she explains, “That is still just about 50% so we have work to do.  The more we talk about it, the more likely women are to become aware.  Dr. Nanette Wenger,” Miller continues, “who is one of the pioneers in women and heart disease says that if a woman does not perceive that she is at a higher risk, then she won’t look for signs and symptoms.  We need to make women aware.”

Miller believes that with educational outreach efforts and providers placing more emphasis on relaying information, awareness among women will continue to increase.  She advises generating a pyramid model by spreading the facts, figures and other data amongst others in your social circle.

“Know your numbers and ask your doctor/provider what you can do to make your risk less,” Miller emphasized, “If you don’t ask, you may not know!”

To learn more about UNC and heart health visit


Clara Owen is a senior Women’s Studies major at the University of North Carolina, Chapel Hill currently interning with the Center for Women’s Health Research.

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