The 7 Things Every Woman Needs to Know About Her Heart

Heart disease is the leading cause of death in women. One in three of us will be affected by it, yet more than half of women do not know it is their biggest health threat.

I lost my mom to breast cancer and that was the threat that lived in my head. I had never once been to a cardiologist. Nobody had ever suggested I should.

I sat down with Dr. Tara Narula, cardiologist and author of The Healing Power of Resilience, for an episode of The Tamsen Show. I walked out and immediately made my first cardiology appointment with her. At that appointment I found out I have a heart murmur I had no idea about.

Here is everything I learned that every woman needs to know…

1. The medical system has failed women on this and it is costing lives.

Women have been understudied, underdiagnosed, and undertreated when it comes to cardiovascular health. A woman who comes to the emergency room with chest pain is statistically less likely to receive appropriate care than a man with the same symptoms. 50% of women who have a cardiac event are misdiagnosed. Dr. Narula has had patients sent home and told their symptoms were anxiety, only for blood tests to come back showing they had actually had a heart attack.

This is a pattern and it is one of the reasons this conversation needs to get louder.

2. Your heart disease risk starts much earlier than you think.

Most women assume cardiovascular risk is something to think about after 60, but the research says otherwise.

Getting your first period before age 11 is a risk factor. PCOS, lupus, rheumatoid arthritis, and inflammatory bowel disease in your 20s and 30s are risk factors. Preeclampsia, gestational diabetes, miscarriage, and early delivery are all markers of increased cardiovascular risk. Hot flashes during perimenopause appear to be connected to how blood vessels respond and may predict future cardiovascular risk. After menopause, cholesterol and blood pressure both tend to rise.

Your entire reproductive history is a window into your heart health and most women are never told that.

3. The symptoms in women do not always look like a heart attack.

Chest pressure or tightness is still the most common symptom. But women also present with jaw pain, left shoulder pain, nausea, shortness of breath, unusual fatigue, and lightheadedness. Dr. Narula asks her patients whether they are unusually exhausted, whether they get out of breath walking up stairs, whether they have had to cut back on activity. All of those can be signs of cardiovascular disease that get chalked up to stress or aging.

If you are experiencing any of these, they deserve a real conversation. 

4. There are screening tools most women have never heard of.

Ask your doctor about these specifically:

• Calcium score: A five-minute CT scan of the heart, no contrast, low radiation, costs about $100. It looks for calcified plaque in your heart arteries and gives you a number that tells you your actual risk. Zero is low risk. Above 100 is high risk. It is one of the most powerful cardiovascular screening tools available and most women have never heard of it.
• LP(a): A genetically inherited bad cholesterol not controlled by diet or exercise. One in five people worldwide have elevated LP(a) and most have never been tested. It is associated with increased risk of heart attack, stroke, and aortic valve disease. Ask for it to be added to your next blood panel.
• PREVENT risk calculator: A free online tool from the American Heart Association. Put in your age, blood pressure, and cholesterol numbers and it gives you your ten-year and thirty-year cardiovascular risk in about five minutes. You can do it today.

5. 80% of cardiovascular disease is preventable.

The only risk factors you cannot control are your age and your family history. Everything else is modifiable. That means what you do right now matters more than almost anything else.

Sleep seven to nine hours. Your body performs critical cardiovascular maintenance during sleep that cannot happen when you are awake. Chronic poor sleep is a direct risk factor.

Move 150 minutes per week of moderate cardio or 75 minutes of vigorous. Walking counts. 

Eat in a way that supports your heart. The Mediterranean diet, plant-based diets, and the DASH diet are all well-supported by research. More whole foods, more plants, less processed everything.

Manage your stress and your mental health. Anxiety, depression, and PTSD are all associated with increased cardiovascular risk. These are not separate conversations.

Know your numbers. Blood pressure below 120 over 80. Cholesterol, LP(a), ApoB, CRP, and blood sugar should all be part of your annual picture. If your doctor is not running them, ask.

6. Your family history is more important than most people realize.

If a female first-degree relative had a heart attack or stroke before age 65, or a male first-degree relative before age 55, that is a genetic flag for early cardiovascular disease. Most of us do not know our family history in enough detail to have this conversation with a doctor. Start asking your family now before you need to.

7. You should see a cardiologist before something goes wrong.

The answer to when should I see a cardiologist is not only when you have a problem. Dr. Narula recommends that cardiovascular screening start in your 20s. Your primary care doctor and OB-GYN are not doing the level of assessment a cardiologist does. Getting a baseline is worth doing and it is never too early.

I did not go until after recording this episode and I found out I have a heart murmur. I am so glad I know.

We see the pink ribbons everywhere in October, we run races for breast cancer, we know to get our mammograms. Heart disease gets none of that cultural attention and it is killing more women than breast cancer, lung cancer, and stroke combined.

That has to change and it starts with women like you having this conversation, making these appointments, and asking these questions out loud.

Please share this with someone you love and go make the appointment.

Listen to The Heart Doctor: 5 Warning Signs Your Heart Is in Trouble here or you can watch it here.