Heart Disease Is a Woman's Disease

Updated July 2026

If you had to guess, which kills more women: breast cancer or heart disease? The answer is heart disease, by a landslide. And yet most women don't know this, which is a problem, because heart disease is a largely preventable disease that too often goes unrecognized until it's advanced.

Is heart disease really a woman's disease?

Yes. Heart disease is the leading cause of death for women in the United States. In 2023 it was responsible for the deaths of 304,970 women, about 1 in every 5 female deaths, more than all cancers combined. Breast cancer, by comparison, kills roughly 45,000 American women a year. Every death is a tragedy, but that's a 7 to 1 ratio. Yet only about 56% of women recognize that heart disease is their number one killer.

That gap between reality and awareness is dangerous. The stereotype that heart attacks strike only older, overweight men is simply wrong. Plenty of women, including young women, have heart attacks too. And the misconception has consequences: a woman may chalk chest pain up to indigestion or stress, while a man might head straight to the ER. A doctor may assume a woman's fatigue isn't cardiac, since fatigue isn't a classic male symptom. Recognizing that heart attacks can look different in women is one of the most important things we can do.

Why does heart disease show up differently in women?

Part of the answer is biology, and part is a research gap. Women aren't just smaller men; we're genetically different. In every cell. And that can affect how heart disease develops and how it announces itself.

We may represent slightly more than 50% of the population, but women have historically made up only about 20 to 25 percent of participants in heart disease clinical trials. This means that much of what medicine “knows” about diagnosis and treatment of heart disease was learned primarily from men.

The end-result of all of this is that we are just not as well versed in how to interpret - or treat - a woman's heart symptoms or disease. Which is why knowing your own risk and advocating for yourself matters so much. As a side note, blood vessels are everywhere and not only the ones in your heart can narrow. Indeed, reduced blood flow can also affect women's sexual health, another under-discussed dimension of cardiovascular disease.

What raises a woman's risk of heart disease?

The big, familiar risk factors apply to women just as they do to men: high blood pressure, high LDL (“bad”) cholesterol, smoking, diabetes, excess weight, physical inactivity, and family history. There are also some female-specific considerations worth knowing. Cholesterol profiles almost universally worsen after menopause as estrogen falls, which is why it's worth rechecking your numbers around menopause even if they've always been good. Pregnancy complications like gestational diabetes and pre-eclampsia are red flags for future cardiovascular risk. And some breast cancer treatments can affect the heart, making cardiovascular care part of survivorship. Building and keeping muscle helps too: strength training lowers heart disease risk in women.

Can women prevent heart disease?

In the vast majority of cases, yes. This is the part I never want to get lost: heart disease is preventable roughly 80% of the time. The same steps work whether you're in your 20s and 30s, your 40s and 50s, or beyond. If you smoke, quit. Know your blood pressure and get it checked regularly. If your cholesterol is elevated, talk to your doctor about lowering it with diet before you need statins. And if you don't have any of the major risk factors, do everything you can to keep it that way by eating a colorful, whole-food, plant-based diet and building more movement into your day.

To underscore what I tell every one of my patients every single day: you don't have to be perfect. You just have to be better. If there's one thing we've proven at Step One Foods, it's that small changes can add up to big health results. Heart disease may be the number one killer of women, but that doesn't mean you have to become a statistic.

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