Heart disease in women

Heart disease is often seen as a problem for men, but it's the most common cause of death for women and men in Aotearoa New Zealand.

Key points about heart disease in women

  1. Women and men share largely the same risk factors for heart disease, but certain risk factors can have a bigger effect on women than men.
  2. Heart disease symptoms in women tend to be milder, less ‘typical’ and may not be noticeable until the heart disease has progressed further, so you need to learn what to look for.
  3. Heart disease also tends to occur at a later age for women than men, due to an increased risk after menopause.
  4. The age when you need to start having regular heart health checks depends on your sex, ethnicity and other risk factors.
  5. While some risk factors cannot be changed, many heart disease risk factors can be reduced with a change in lifestyle.

Image credit: Canva

What puts women at risk of heart disease?

Women and men share largely the same risk factors for heart disease. These include smoking, being overweight, being inactive, having high blood pressure or high cholesterol and having diabetes, as well as a family history of heart disease. 

However, some of these risk factors can affect women differently:

  • Women metabolise nicotine faster than men, so smoking creates a bigger risk for women.
  • Women with diabetes are at a greater risk of heart disease than men with diabetes.
  • A family history of heart disease can be a stronger predictor of heart disease in women.

In addition, the following risk factors affect only women:

  • gestational diabetes or pre-eclampsia during pregnancy
  • hormonal dysfunctions such as polycystic ovary syndrome 
  • menopause – after menopause, a woman’s risk of heart disease increases substantially. This is believed to be because the low levels of the hormone oestrogen may provide less protection from heart disease.

How does women’s experience of heart disease differ from men’s?

Women’s symptoms are often milder and less ‘typical’. There may be no obvious symptoms until the heart disease is well developed. For example, while both men and women often experience central chest pain when having a heart attack, women often interpret this pain as indigestion because they do not expect a heart attack. Read more about heart attack symptoms in women.

Some tests used to diagnose heart disease are also less accurate in women than they are in men. Because heart disease in women often goes undetected, the damage caused can be more advanced and outcomes can be poorer than for men.

How can I work out my risk of heart disease?  

See your GP for a heart risk assessment or heart check to help you find out your risk of heart disease. Your GP will build a picture of your risk based on factors such as your age, sex, ethnicity, cholesterol levels, smoking history, blood pressure, family history and other health conditions. 

The age when you are advised to start having heart checks depends on your sex, ethnicity and other risk factors.

If you are a woman, you should start seeing your GP for a heart check at the following ages:

  • All women without known risk factors from 55 years of age.
  • All women with significant known heart disease risk factors from 45 years of age.
  • All Māori, Pacific or South Asian women from 40 years of age.
  • All women with type 2 diabetes as part of the annual diabetic review.
  • All women with severe mental illness from 25 years of age.

Read more about heart risk assessment.

My Heart Check

As well as seeing your GP for a heart check, you can check your heart health with My Heart Check. It's a free online heart health check designed for Kiwis by the Heart Foundation. 

How can I reduce my risk of heart disease?

While some risk factors cannot be changed, most heart disease risk factors can be reduced with a change in lifestyle.

You can help reduce your risk of heart disease by taking steps to change the factors that put you at greater risk: 

Learn more about risk factors for heart disease. 

Learn more

Women and heart disease Heart Foundation, NZ
Women and heart disease Heart Research Institute, NZ
Lower your risk of heart disease Heart Foundation, NZ
What is a heart check? Heart Foundation, NZ

Information for healthcare providers

Cardiovascular disease risk assessment and management for primary care Ministry of Health, NZ, 2018
Māori, Pacific, Aboriginal and Torres Strait Islander women’s cardiovascular health – where are the opportunities to make a real difference? Heart, Lung and Circulation, 2020
Cardiology Research Review Issue 80 Research Review, NZ, 2019

Reviewed by

Dr Sharon Leitch is a general practitioner and Senior Lecturer in the Department of General Practice and Rural Health at the University of Otago. Her area of research is patient safety in primary care and safe medicine use.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Sharon Leitch, GP and Senior Lecturer, University of Otago Last reviewed: 07 Jul 2021