While regular mammograms remain an essential part of preventive care, evidence shows that women, particularly those aged 55 and younger, face a significant and often underestimated risk from heart disease. Studies indicate that women in this age group are nearly twice as likely as men of the same age to die following a heart attack, challenging the long-held belief that premenopausal or early postmenopausal women are largely protected.
One major contributor is the way heart attacks present in women. Research from Yale University’s VIRGO study, which examines heart attack outcomes among people aged 18 to 55, found that women are more likely than men to experience symptoms beyond classic chest pain. These include discomfort in the jaw, neck, arms or upper back, shortness of breath, palpitations, indigestion, nausea and stomach pain. Such symptoms are frequently overlooked or misattributed—by patients and clinicians alike—leading to missed or delayed care.
Delays are further compounded by differences in how women respond to symptoms. Research has shown that women are more likely to call emergency services when a male family member experiences signs of a heart attack, but are far less likely to do so for themselves. Even when women seek help, they tend to wait longer before calling an ambulance, particularly those under 55, many of whom believe they are too young to be having a heart attack. These delays reduce the likelihood of receiving treatment within the critical window needed to limit heart damage.
Beyond symptom recognition and response, women also face unique risk factors that are not always incorporated into cardiovascular assessments. Adverse pregnancy outcomes—including gestational diabetes, preeclampsia, pregnancy-related hypertension, pregnancy loss, placental abruption and delivering a small-for-gestational-age baby—are now well established as predictors of higher cardiovascular risk later in life. However, postnatal healthcare often shifts focus almost entirely to the infant, with limited long-term follow-up of maternal heart health.
Certain gynecological conditions also increase risk. Women with polycystic ovary syndrome are estimated to be about 50% more likely to develop cardiovascular disease, partly due to hormonal imbalances such as elevated androgens. Endometriosis has been linked to roughly a 20% increase in cardiovascular risk, potentially driven by chronic inflammation and psychological stress.
Despite growing evidence, most widely used cardiovascular risk calculators fail to account for these sex-specific factors. Instead, they rely primarily on traditional indicators such as smoking status, diabetes, cholesterol levels and blood pressure. As a result, clinicians may underestimate risk in women unless patients proactively raise these issues during consultations.
In the absence of more tailored risk assessment tools, public health guidance continues to emphasize established prevention strategies. These include avoiding smoking and secondhand smoke, engaging in regular physical activity, following a heart-healthy diet rich in fruits, vegetables, whole grains, fish, legumes, nuts and seeds, managing stress, and undergoing routine screenings for blood pressure, blood sugar and cholesterol.
While such recommendations may lack glamour, health experts stress that they remain the most effective foundation for reducing cardiovascular risk—and are particularly critical for women whose heart disease risk has long been under-recognized.