Women's Heart Health: It's Time We Took This Seriously
By Dr Hannah Burrage, Lead GP at Livi UK
My patient Sarah was 52 when she came to see me complaining of nausea, upper back pain, and what she described as "overwhelming tiredness". She'd been to A&E twice in the previous month. Both times, she was told it was anxiety. The third time, she had a heart attack.
Sarah's story isn't unusual. It's a pattern I've witnessed too many times in my career, and it reflects a troubling reality: cardiovascular disease remains the leading cause of death among women, yet it continues to be widely viewed as a "man's disease". This February, as we mark Heart Health Month, it's time to challenge this dangerous misconception and confront an uncomfortable truth about women's heart health in the UK.
The Hidden Crisis
The statistics are sobering. Over 3.6 million women in the UK are living with ischaemic heart disease, which claims one in 14 female lives. Yet cardiovascular disease kills more women than breast cancer every year. Despite this, women remain systematically underdiagnosed and undertreated across all areas of heart disease.
The British Cardiovascular Society's recent consensus statement laid bare the scale of this inequality. Women presenting with heart disease symptoms are less likely to receive appropriate diagnostic tests, less likely to be prescribed life-saving medications, and less likely to have their concerns taken seriously by healthcare professionals. The consequences are devastating – and often fatal.
Why Women's Hearts Are Different
Part of the problem lies in how we understand and diagnose heart disease. For decades, the "classic" heart attack has been defined by what men experience: crushing chest pain, radiating down the left arm. But women's hearts don't always follow this script.
When women have heart attacks, they're more likely to experience what medical textbooks have long labelled "atypical" symptoms – though perhaps it's time we stopped calling them atypical when they affect half the population. These can include nausea, vomiting, dizziness, indigestion, back pain, or excessive sweating. These symptoms are often dismissed, misdiagnosed, or attributed to anxiety or stress.
Compounding the problem, women are less likely to seek help for these very symptoms precisely because they don't match the "typical" heart attack they've been taught to recognise. When symptoms feel vague or could be attributed to other causes, many women delay seeking care or downplay their concerns – sometimes with tragic consequences.
The tools we use to diagnose heart disease weren't designed with women in mind either. The cardiac troponin test, which measures proteins released during a heart attack, can miss heart attacks in women because they may have naturally lower levels of these proteins. Even cardiac catheterisation, the gold standard diagnostic procedure, is less effective in women because their blood vessels are typically smaller and their plaques distribute differently.
The Menopause Connection
There's another critical factor that's often overlooked: menopause. The hormonal changes during menopause significantly increase a woman's cardiovascular risk, yet this connection remains poorly understood by many women and healthcare professionals alike.
Before menopause, oestrogen provides some protective effect on the heart and blood vessels. When oestrogen levels fall during menopause, women lose this protection. Blood pressure may rise, cholesterol levels can change unfavourably, and the risk of developing cardiovascular disease increases substantially. In fact, within 10 years of menopause, a woman's risk of heart disease catches up to that of men.
Some menopausal symptoms can also mimic or mask heart problems. Palpitations, breathlessness, and fatigue are common during menopause, but they can also be signs of cardiovascular disease. This overlap can make it even harder for women – and their doctors – to recognise when something more serious is happening.
Understanding this connection is crucial. Women going through or past menopause should be particularly vigilant about cardiovascular risk factors and ensure their heart health is being monitored appropriately.
It's Not Just Older Women
Whilst heart disease is more common as we age, younger women mustn't assume they're immune. A major UK study found that improvements in coronary heart disease rates have almost exclusively benefitted those over 60, with little to no improvement in younger age groups. Research suggests that almost a third of 25 to 30-year-olds now have a "heart age" older than their actual age – a worrying indicator of future cardiovascular risk.
Risk factors that might cause concern in a 60-year-old man are often overlooked in a 35-year-old woman. Yet factors like high blood pressure, diabetes, smoking, and family history don't discriminate by age or gender. In fact, diabetes increases the risk of dying from coronary heart disease 2.6 times more in women than in men.
What Needs to Change
As GPs and healthcare professionals, we must do better. This means:
Listening differently. When a woman presents with fatigue, nausea, or back pain, we need to consider cardiovascular causes alongside other possibilities. Women's voices have been unheard for too long in healthcare settings.
Testing appropriately. We need to consider that diagnostic thresholds developed primarily in men may not be suitable for women. This includes everything from blood pressure targets to cardiac imaging interpretation.
Educating ourselves and our patients. Healthcare professionals need better training on how heart disease manifests in women. Equally, women need to know they're at risk. The perception that heart disease is a "man's problem" persists not just among the public but within medicine itself.
What You Can Do
If you're a woman reading this, here's what I want you to know:
Know your risk factors. Check your blood pressure, cholesterol, and blood sugar levels regularly. If you have diabetes, hypertension, or a family history of heart disease, you're at increased risk. If you're approaching, going through, or past menopause, pay particular attention to your cardiovascular health.
Understand your symptoms. Heart attack symptoms in women can be subtle. Persistent unusual fatigue, shortness of breath, nausea, or discomfort in your jaw, neck, or back should never be dismissed – especially if you have risk factors. Don't wait for "classic" chest pain before seeking help.
Advocate for yourself. If you're concerned about your heart health and feel your symptoms aren't being taken seriously, ask for specific tests. Request a referral to a cardiologist if needed. Keep a symptom diary. Bring someone with you to appointments if it helps you feel more confident. Your instincts matter.
Look after your heart. Many forms of heart disease are preventable. Regular exercise, a balanced diet, not smoking, managing stress, and maintaining a healthy weight all make a real difference. Even small changes can significantly reduce your risk.
A Call to Action
Sarah, my patient, survived her heart attack. But she shouldn't have needed three emergency visits before being diagnosed. Her story should be a rare exception, not a common pattern.
This February, let's commit to changing the narrative around women's heart health. Whether you're a healthcare professional, a woman concerned about your own heart health, or someone who cares about the women in your life, we all have a role to play in ensuring women get the cardiac care they need and deserve.
Your heart matters. Every woman's heart matters. It's time our healthcare system reflected that truth.
If you're concerned about your heart health or experiencing symptoms that worry you, speak to a GP. Livi's digital GP service offers same-day appointments where you can discuss your concerns and get advice on next steps. Book an appointment today.
References:
· British Cardiovascular Society consensus statement, Heart journal (2024)
· British Heart Foundation, Women and Heart Disease statistics
· British Heart Foundation, Menopause and Heart Disease: https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease
· University of Oxford study on cardiovascular disease trends (2024)
· British Medical Journal study on declining coronary heart disease rates (2024)
