Not Just a Man’s World- Prioritizing Women’s Heart Health

By: Linda Anegawa, M.D., F.A.C.P.

During February’s Heart Health observance, we might approach men and women’s heart health like we view gender quality:  using an “equal but different” framework.

When we imagine someone having a heart attack, we are used to seeing dramatic Hollywood-style depictions of men clutching their chest, suddenly keeling over. That is usually not how cardiac events manifest in women. In fact, heart attacks can occur in women without any chest pain at all.  The symptoms of heart attacks in women, including shortness of breath, pressure or pain in the abdomen, dizziness, lightheadedness, nausea, upper back pressure or fatigue can be much more subtle and can be easily misdiagnosed or overlooked.  This is especially true in women who also have diabetes.  What could be mistaken for anxiety might actually be a sign of something way more serious.

Many women are surprised to hear that more die each year from heart disease than breast cancer.  In fact, heart disease is the leading killer of U.S. women, responsible for one-third of their deaths – more than all forms of cancers combined.

We are losing women at an alarming rate, because fewer women than men survive their first heart attack.   Now more than ever, it is critical that we step up our game.

According to the American Heart Association:

  • An estimated 44 million women in the U.S. are affected by cardiovascular diseases.
  • Ninety percent of women have one or more risk factors for heart disease or stroke.
  • Eighty percent of heart disease and stroke events may be prevented by lifestyle changes and education, including smoking cessation and obesity intervention

Over two-thirds of women in the United States are overweight or obese. We know that overweight and obesity are associated with coronary heart disease, stroke and hypertension. Women who smoke and use oral contraceptives are at an even higher risk.

After reaching menopause, women’s risk for heart disease rises exponentially. Partly due to a decrease in estrogen, post-menopausal women are at increased risk for coronary heart disease. In fact, new research shows that this naturally occurring loss of estrogen promotes a type of heart fat that is linked to many cardiovascular diseases. Also, women tend to gain weight after menopause; especially around the middle- which is the most dangerous form of fat.

In optimizing female heart health, avoiding obesity is critical – especially as women get older. Because of societal pressures, women are often motivated by a slim appearance, but maintaining a healthy weight  should not revolve around vanity or achieving an arbitrary measure of beauty. This is not about looking great in a bikini. This is about living a longer and healthier life by decreasing risk for cardio-metabolic disease.

Over the past fifty years or so, the landscape for women in the world has changed. Whether we work in or out of the home, many of us have been societally programmed to be care-takers. A great deal of us are taught early on to be selfless, and put others before ourselves – whether it be children, spouses, elderly parents, employers, clients, colleagues or the community at large. Because so many of us are busy caring for others, we often put our own health on the back burner, minimizing or dismissing troubling heart-related symptoms and avoiding preventative care, including seeking help for weight management. This is a very dangerous trap to fall into.

Instead, we may wish to prompt women to think of caring for their own heart health first, in the same manner as being on a plane and putting on their oxygen masks first. We must take care of ourselves before we are able to care for all the others who depend on us.  Womenʻs guilt surrounding healthy and appropriate self-care has to be smashed. Our lives depend on it.

To join the ranks of doctors fighting obesity, visit Doctors Fighting Obesity on Facebook or follow @DrsFightObesity on Twitter.


Linda Anegawa, M.D., F.A.C.P. is the founder of OSR Weight Management-Hawaii Metabolic Medicine. She serves on the University of Hawaii’s medical school faculty and developed the school’s first Obesity Medicine interdisciplinary clerkship experience. Dr. Anegawa also sits on the Ideal Protein Medical Advisory Board.