Heart disease remains the leading cause of death for women in the United States, yet many women still don’t see it as their biggest health risk. Even when they do, the symptoms don’t always look the way people expect.
That’s why Rebecca Bierle and Kelly Brandsted, both certified nurse practitioners with Monument Health, spend so much time helping women understand how heart disease really shows up.
“Many women don’t realize heart disease is their number one risk,” Bierle said. “And even when they know that, they don’t always recognize the warning signs in themselves.”
Why Heart Disease Looks Different in Women
For decades, heart attack education focused on one classic symptom: crushing chest pain. While chest pain still matters, it isn’t the full picture for women.
“Women don’t always have that textbook chest pressure,” Bierle said. “Some do, but many experience fatigue, dizziness, shortness of breath, nausea, or a general feeling that something isn’t right.”
Those symptoms are easier to dismiss.
“Women are more likely to think it’s stress, anxiety, or just being tired,” Brandsted said. “That’s part of why heart disease in women is more likely to be missed or diagnosed later.”
Hormones also play a role, especially during pregnancy, perimenopause, and menopause. Emotional stress and daily responsibilities add another layer.
“It’s rarely one single cause,” Bierle said. “It’s usually a combination of biology and life circumstances.”
Awareness Efforts Like Go Red for Women Matter
National education campaigns have helped bring attention to these differences, including Go Red for Women, which focuses on educating women about heart disease risk, symptoms, and prevention.
The campaign emphasizes that women’s symptoms can look different and encourages regular checkups and honest conversations with healthcare providers.
“A lot of women wait too long because they don’t think their symptoms count,” Bierle said. “Awareness helps change that.”
The Overlooked Link Between Mental Health and Heart Health
Mental health is one of the most overlooked contributors to heart disease in women.
“Depression, anxiety, and chronic stress all have a direct impact on cardiovascular health,” Brandsted said.
Long-term stress keeps the body in a constant fight-or-flight state, leading to inflammation, elevated blood pressure, and increased heart disease risk over time.
“There’s also a bidirectional relationship,” Brandsted said. “People with heart disease are more likely to experience anxiety and depression, and people with mental health conditions have a higher risk of developing heart disease.”
Mental health struggles can also affect daily habits.
“When someone is overwhelmed, they may exercise less, eat differently, or skip routine care,” Bierle said. “Those changes can quietly increase risk.”
Symptoms Women Shouldn’t Ignore
Because many heart-related symptoms are vague, the most important factor providers look for is change.
“Everyone gets tired sometimes,” Bierle said. “What matters is when fatigue or shortness of breath starts interfering with your normal routine.”
Symptoms worth checking out include persistent fatigue, shortness of breath with activities that used to feel easy, lightheadedness, nausea, jaw or upper back pain, and chest discomfort that doesn’t feel sharp or dramatic.
“There’s no rule about how long symptoms have to last,” Brandsted said. “If it feels out of the ordinary for you, it’s worth getting evaluated.”
Pregnancy as an Early Warning Sign
Pregnancy can reveal future heart risk.
“Conditions like preeclampsia, gestational hypertension, and gestational diabetes significantly increase long-term heart disease risk,” Bierle said.
Those risks don’t disappear after delivery.
“Continued follow-up, blood pressure monitoring, and routine care really matter,” Brandsted said.
What Women Can Do Now
Both providers stressed that this information isn’t meant to be alarming.
“This is about awareness, not fear,” Bierle said.
Regular visits with a primary care provider are a strong first step. Women should talk openly about symptoms, stress, mental health, and family history.
“Heart health isn’t just about cholesterol numbers,” Brandsted said. “It’s about the whole person.”
A Simple Takeaway
Heart disease in women doesn’t always announce itself clearly. It doesn’t always look dramatic. But the body often sends signals when something isn’t right.
“You know your body better than anyone,” Brandsted said. “If something feels off, trust that instinct.”
Early conversations lead to earlier answers, and early care saves lives.
