7 Heart Disease Risks Unique to Women
Published on March 16, 2026
Nearly half of adult women in the United States live with some form of heart disease, and it’s also the leading cause of death. And while men also have high rates of cardiovascular problems, the risk factors for developing them differ widely between the two genders.
Anatomical differences and major life events, including puberty, pregnancy, and menopause, impact a woman’s cardiovascular health in unique ways. Certain conditions, such as atherosclerosis (the buildup of plaque within arteries), behave differently in a woman’s body, making traditional risk assessments less accurate for women. And poor awareness of these differences has led to a persistent treatment gap, which means women generally get less-timely treatment for heart disease than men.
“Recognizing female-specific risk factors can help reduce disparities in care, improving outcomes for women,” says Daniel Ambinder, MD, an interventional cardiologist at UM St. Joseph Medical Center in Towson, Maryland.
1. Timing of Your First Period
An early or late first period might indicate a greater risk of heart troubles later in life. Research on the age at which a woman has her first period has produced mixed results, with studies differing on whether earlier or later menarche is linked to higher cardiovascular risk, says Harmony Reynolds, MD, a cardiologist who specializes in treating women at NYU Langone Health in New York City.
One systematic review of studies spanning 23 years found that both of those scenarios may be true: Women who started their periods at 12 to 13 years old had the lowest risk of cardiovascular events, those younger than 11 had increased risk, but those who were 16 or older before they got their first period had the highest risk.
The researchers hypothesize this could be due to biological and early-life factors, like increased risk of childhood obesity or genetic factors that influence puberty timing and later cardiovascular risk.
Early menarche is also associated with both obesity and diabetes, both strong predictors of heart health issues down the road.
2. PMOS
Polyendocrine metabolic ovarian syndrome (PMOS) — formerly known as PCOS — is a condition that causes your body to make high levels of “male” hormones, known as androgens. This results in a hormonal imbalance that can cause irregular periods, acne, infertility, extra body hair, weight gain, and damage to blood vessels and heart muscle cells.
“Women with PMOS may have metabolic issues like insulin resistance and background low-grade inflammation that can accelerate heart disease,” Dr. Reynolds says.
According to a study of more than 125,000 women over 25 years, 3.4 percent of women with PMOS had a heart attack or ischemic stroke, compared with 2 percent of women without it. Even after accounting for other heart disease risk factors, women with PMOS had a 58 percent higher risk of heart attack and a 56 percent higher risk of ischemic stroke.
“Women with PMOS should mention the condition to their doctor and ask if medication may be needed to manage blood pressure, cholesterol, blood sugar, or weight,” Reynolds adds.
Editor’s Note: Following a May 2026 global consensus, polycystic ovary syndrome (PCOS) is now officially called polyendocrine metabolic ovarian syndrome (PMOS), highlighting the metabolic roots of the condition.3. Preeclampsia
Preeclampsia is a pregnancy complication involving high blood pressure and organ damage. It typically develops after 20 weeks of pregnancy in women who did not previously have high blood pressure.
“Preeclampsia is a marker of higher risk of heart disease, and it's possible, based on recent research, that going through preeclampsia or high blood pressure after delivery puts strain on the heart that can have lasting impact,” Reynolds says.
One large study found that women with preeclampsia during pregnancy had a 72 percent higher rate of cardiovascular disease than women who didn’t. Existing cardiovascular risk factors accounted for only 57 percent of the increased rate of heart disease.
Your doctor may recommend that you take a daily 81 milligram aspirin tablet after 12 weeks of pregnancy if you have one high-risk factor for preeclampsia, which may include chronic high blood pressure, type 1 or type 2 diabetes, kidney disease, autoimmune disorders, or preeclampsia in a previous pregnancy. Black women also have a higher risk of preeclampsia.
4. Gestational Diabetes
Gestational diabetes is a type of diabetes diagnosed during pregnancy. It can develop even if you don’t have diabetes before pregnancy, and though it usually goes away after the birth, it can have lasting health impacts. Although the cause is unclear, experts do know the placenta’s hormones can sometimes block insulin in the mother’s body, which may lead to high levels of blood sugar.
“Gestational diabetes increases cardiovascular risk through blood vessel damage and inflammation that last after the blood sugar normalizes,” Reynolds says.
One study found that 12 percent of women experience gestational diabetes as a pregnancy complication, and those who had gestational diabetes also had a twofold higher risk of coronary artery calcification, a marker of increased heart disease risk.
“Women who had gestational diabetes should be extra attentive to making sure they are eating a healthy diet and getting plenty of exercise,” Reynolds says.
5. Preterm Delivery
When a baby is born before 37 weeks of pregnancy, it’s considered a preterm birth. One study found that women who’d delivered preterm had 2.5-fold higher risk of ischemic heart disease — also referred to as coronary artery disease — than those who deliver at full term. The risk decreases over time, but still remains substantially elevated even 30 to 40 years later.
Make sure your primary care doctor and other healthcare providers are aware if you had a preterm birth, so they can factor it into your ongoing health history. They may recommend a formal heart disease risk assessment.
“For all women with complications of pregnancy, regular screening with a personal physician is important — including blood tests for cholesterol and blood sugar, along with blood pressure checks,” Reynolds says.
6. Menopause
The risk of cardiovascular disease typically increases for women after menopause because of a sharp decrease in estrogen. This hormone has a protective effect against heart disease by contributing to healthy blood flow, fighting inflammation, and keeping blood vessels flexible. A drop in estrogen leads to an increase in LDL “bad” cholesterol and triglycerides, plus a decrease in HDL “good” cholesterol.
“As women age, they also tend to gain weight in the chest and abdominal areas, which can affect the health of your heart, blood vessels, and metabolism, and increase your cardiometabolic risk,” says Dr. Ambinder.
Hormone therapy is prescribed for menopausal symptom relief, and its impact on heart health depends on how and when it’s used. Starting hormone therapy closer to the menopausal transition may be safer than starting it long after menopause has occurred. But it hasn’t been a proven strategy to prevent heart disease, and it may raise risks of coronary heart disease and stroke in some circumstances.
The perimenopausal and menopausal life stages are considered critical opportunities to assess heart disease risk. This is the time to speak to your doctor about blood pressure, cholesterol, weight, and blood sugar issues so you can address potential issues early.
“When we, as physicians, say that a risk factor is borderline — such as blood pressure or cholesterol — we mean that we want those numbers lower,” says Reynolds. “If the numbers don't go down to the normal range, medication is often warranted.”
7. The Treatment Gap
One major risk for women’s heart health isn’t about hormones or the female anatomy: It’s a lack of medical representation. For decades, women were underrepresented in heart-related clinical trials because of the belief that cardiovascular disease was largely a man’s condition. The U.S. Food and Drug Administration (FDA) also discouraged women of childbearing age from participating in clinical trials due to fear of harm to fetuses, leading to treatments and guidelines that were developed without a full understanding of how women are affected.
Steps have been taken to address this gap, but more work needs to be done to raise awareness of women’s heart health risks and treatment. Many people are unaware that women have different heart attack signs than men, and women are also less likely to receive CPR than men in public settings. Bystanders may be afraid of being accused of inappropriately touching or hurting a woman physically with CPR — plus, many people believe, incorrectly, that women are less likely to have heart problems.
It’s important for women to advocate for themselves to get appropriate heart health care based on their specific risk factors. Make sure you’re seeing a doctor who listens to you, ask questions about treatment, and seek support from your network as well as women’s heart-health groups.
Resources We Trust
- Cleveland Clinic: Cardiovascular Disease in Women
- Mayo Clinic: Strategies to Prevent Heart Disease
- Menopause Society: Is Hormone Therapy Good for Heart Health?
- UCLA Health: The Connection Between PCOS and Heart Health
- American Heart Association: Understand Your Risks to Prevent a Heart Attack
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- Behboudi-Gandevan S et al. The J Shaped Association of Age at Menarche and Cardiovascular Events: Systematic Review and Meta-Analysis. Scientific Reports. February 1, 2024.
- Kheradmand M et al. The Association Between Early Menarche and Higher-Risk Cardiometabolic Profile: A Dose–Response Analysis of the Tabari Cohort at Enrollment Phase. Frontiers in Cardiovascular Medicine. August 31, 2023.
- The Connection Between PCOS and Heart Health. UCLA Health. June 27, 2025.
- Havers-Borgersen E et al. Polycystic Ovarian Syndrome and Long-Term Risk of Acute Myocardial Infarction and Ischaemic Stroke. European Journal of Preventive Cardiology. August 30, 2025.
- Preeclampsia. Mayo Clinic. April 15, 2022.
- Stuart JJ et al. Cardiovascular Risk Factors Mediate the Long-Term Maternal Risk Associated With Hypertensive Disorders of Pregnancy. Journal of the American College of Cardiology. May 9, 2022.
- Gestational Diabetes. American Diabetes Association.
- Gunderson EP et al. Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study. Circulation. February 1, 2021.
- Preterm Birth. Cleveland Clinic. February 23, 2024.
- Crump C et al. Pre-Term Delivery and Risk of Ischemic Heart Disease in Women. Journal of the American College of Cardiology. June 29, 2020.
- Preterm Birth. American College of Cardiology. March 11, 2021.
- Ryczkowska K et al. Menopause and Women’s Cardiovascular Health: Is It Really an Obvious Relationship? Archives of Medical Science. December 10, 2022.
- The Reality of Menopause Weight Gain. Mayo Clinic. July 8, 2023.
- D’Costa et al. Cardiovascular Risk Associated with Menopause and Menopause Hormone Therapy: A Review and Contemporary Approach to Risk Assessment. Current Atherosclerosis Reports. February 10, 2020.
- Iyer TK et al. Clinical Impact of 2020 American Heart Association Statement on Menopause and Cardiovascular Disease Risk. Cleveland Clinic Journal of Medicine. January 2022.
- Klein HE et al. Why Are We Still Seeing Gaps in Women’s Heart Care? The American Journal of Managed Card. October 15, 2024.
- Women Need CPR Too Infographic. American Heart Association.
- Doner K et al. Positive Self-Advocacy for Female-Centered Care. Mayo Clinic. June 12, 2024.
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Chung Yoon, MD
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Chung Yoon, MD, is a noninvasive cardiologist with a passion for diagnosis, prevention, intervention, and treatment of a wide range of heart and cardiovascular disorders. He enjoys...
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