Women and Heart Disease: The Awareness Gap

What comes to mind when thinking of symptoms of heart disease? For most people, the answer is obvious: chest pain.

But here’s the reality: in women, heart disease often shows up as unshakable fatigue, nausea, or pain in the jaw, neck, or back. These signals are easy to dismiss as stress, indigestion, or “nothing serious,” but they are the body’s warning signs of something life-threatening (Keteepe-Arachi & Sharma, 2017). That misunderstanding has consequences.

Heart disease is the leading cause of death for women in the United States, taking nearly 305,000 women’s lives in 2023 alone, about 1 in every 5 female deaths (CDC, 2023).

And yet, only half of women in the U.S. realize that heart disease is their number one killer (CDC, 2023). Awareness is a matter of life or death.

The Gender Divide

Art by Shea Davis

Women don’t just share the same risks as men; they carry their own set of unique ones. Hormonal changes after menopause remove the protective effects of estrogen, increasing risk (Keteepe-Arachi & Sharma, 2017). Complications during pregnancy, such as preeclampsia or gestational diabetes, can more than double the chances of cardiovascular disease later in life (Wenger et al., 2022). Autoimmune conditions such as lupus and rheumatoid arthritis, which also disproportionately affect women, play a significant role as well (Wenger et al., 2022).

Even traditional risk factors pose a larger burden for women. Smoking, for instance, has been shown to be more damaging for women than men under age 50, in part, because it disrupts the estrogen-dependent processes that normally help blood vessels relax and function properly (Keteepe-Arachi & Sharma, 2017). Add to this the effects of early menopause or a hysterectomy, and the risk becomes even more layered and complex.

The issue is not just biology: for decades, women were underrepresented in clinical trials, which means the “classic” symptoms of heart disease, the ones doctors are trained to look for, were largely derived from men’s experiences (Wenger et al., 2022). As a result, women’s symptoms often get brushed aside as “atypical,” leaving many undiagnosed or diagnosed too late.

A Declining Awareness

Awareness campaigns once helped close the gap. From 1997 to 2009, recognition among women that heart disease was their number one killer nearly doubled. But by 2019, that progress had started to unravel, with awareness dropping most sharply among younger women and women of color (Wenger et al., 2022).

Black women are nearly 60% more likely to have high blood pressure than white women, yet they face greater challenges in accessing consistent treatment (CDC, 2023). Rural women are more likely to delay or forgo care altogether, often due to cost or lack of providers (Wenger et al., 2022). These disparities are preventable, but only if awareness and access move forward, not backward.

Art by Shea Davis

Why This Matters

The challenge goes beyond public knowledge. The real problem is that the healthcare system is still not designed with women in mind. Women cannot be expected to recognize their own risk if physicians are not trained to take their symptoms seriously. Almost 70% of medical trainees report little to no instruction on sex-based differences in cardiovascular disease (Wenger et al., 2022). The result is a cycle where women’s symptoms are overlooked, diagnoses are delayed, and outcomes are worse.

If we only frame the issue as a “lack of awareness,” we risk blaming women themselves, when the responsibility lies equally with institutions that have failed to study, teach, and treat women’s cardiovascular health with the same urgency as men’s.

Moving Forward

Research shows that up to 80 to 90% of cardiovascular disease could be prevented with earlier intervention and lifestyle changes (Wenger et al., 2022). But prevention must be personalized. Doctors should be connecting the dots between pregnancy complications, hormonal changes, and later-life cardiovascular risks.

Ultimately, improving women’s cardiovascular health will take more than red dresses or awareness slogans. It requires rewriting the very framework of cardiovascular medicine so that women are not treated as deviations from a male “norm,” but as patients with unique biology, risks, and experiences that deserve recognition.

Visit these sites for more information:

1. Centers for Disease Control and Prevention. (2023). Heart disease and women: Overview. Retrieved September 2025, from https://www.cdc.gov/heart-disease/women

2. Keteepe-Arachi, T., & Sharma, S. (2017, February). Cardiovascular disease in women: Understanding symptoms and risk factors. European Cardiology Review, 12(1), 10–13. https://doi.org/10.15420/ecr.2016:32:1

3. Wenger, N. K., Lloyd-Jones, D. M., Elkind, M. S. V., Fonarow, G. C., Warner, J. J., Alger, H. M., Cheng, S., Kinzy, C., Hall, J. L., & Roger, V. L. (2022, June 7). Call to action for cardiovascular disease in women: Epidemiology, awareness, access, and delivery of equitable health care. Circulation, 145(e1059–e1071). https://doi.org/10.1161/CIR.0000000000001071