Heart Disease in Women: The Risk Factors We Don't Always Talk About

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This week, we’re talking about heart disease—and some of the less traditional risk factors for heart disease in women.

A hand-drawn illustration of a light bulb with a heart inside, symbolizing the power of love and creativity, set against a red textured background.

Now, a disclaimer before we get started: some of these risk factors are based largely on observational data, which means we still need more research to fully understand the connections. But I think they’re important to know about, particularly when you’re advocating for your own health.

Because sometimes the most important question isn’t, “Is this definitely causing my heart disease?” It’s, “Is this something my doctor and I should at least be talking about?”

Pregnancy Complications

Pregnancy isn’t always a bed of roses. Sometimes (ok fine a lot of times) it’s a nine to ten-month-long adventure in nausea, heartburn and never-ending opinions from strangers. And sometimes it is even harder and scarier. There are multiple pregnancy complications which increase a woman’s risk of heart disease.

Preeclampsia is high blood pressure that develops after 20 weeks of pregnancy along with signs of organ damage, particularly involving the kidneys or liver. It is associated with an increased risk of coronary artery disease, heart failure and stroke later in life.

Gestational diabetes is associated with approximately a two-fold increased risk of cardiovascular disease.

Gestational hypertension is high blood pressure that develops after 20 weeks of pregnancy without protein in the urine or other signs of organ damage. The cardiovascular risk appears to be lower than with preeclampsia, but it is still there.

And then there are miscarriages, stillbirth and preterm birth, which have also been associated with an increased risk of cardiovascular disease.

So, pregnancy history isn't just something your doctor asks about because they need to fill out another form. It can actually provide important information about your long-term health.

Silhouette of a pregnant woman standing near a softly lit window.

Irregular Menstrual Cycles

Your period isn't just there to ruin your white pants on vacation (but really that is what happens- am I right?).

Irregular menstrual cycles can sometimes be a sign of insulin resistance, low-grade inflammation or cardiometabolic problems. Both short cycles (less than 21 days) and long cycles (more than 35 days) have been associated with an increased risk of coronary heart disease and atrial fibrillation (an irregular heart rhythm).

This doesn't mean that every woman with an irregular cycle is destined to have heart disease. It does mean that your menstrual history is another piece of information that can help tell the larger story about your health.

Polyendocrine Metabolic Ovarian Syndrome (PMOS)

PMOS can cause irregular menstrual periods, excess hair growth, acne, infertility and ovarian cysts.

There is an association between PMOS and cardiovascular disease, although the evidence is not convincing that PMOS itself increases the risk of dying from cardiovascular disease. (Learn more about PMOS here: https://www.rx4trauma.com/post/polyendocrine-metabolic-ovarian-syndrome-pmos-the-new-pcos)

Again, this is about looking at the whole picture—especially because PMOS can overlap with insulin resistance and other metabolic risk factors.

Autoimmune Disease

Autoimmune disease is associated with chronic inflammation, immune system activation and damage to the lining of blood vessels. All of that can contribute to plaque buildup, hardening of the arteries and problems with the tiny blood vessels that supply the heart.

And importantly, heart disease can present at younger ages in women with autoimmune conditions.

This is one of those situations where knowing your history really matters. Your medical history isn't just a collection of random diagnoses sitting in your chart. It can change how we think about your present and future cardiovascular risk.

Microscopic view of immune cells, intricately detailed with vibrant colors and complex textures, highlighting their crucial role in the body's defense system.

Breast Cancer

Breast cancer itself isn't necessarily the main culprit here. Some of the increased cardiovascular risk is related to the treatments used to treat breast cancer, including certain chemotherapy medications, HER2-targeted therapies and radiation to the chest.

And let's just pause here for a minute.

The decisions women have to make when facing breast cancer are not easy. Treatment can be lifesaving, but some treatments can also have long-term effects on the heart. That doesn't make those treatment decisions wrong—it means that survivors deserve continued attention to their cardiovascular health, too.

Breast cancer survivors can have an increased risk of heart disease, particularly during the first 10–15 years after treatment.

Breast Arterial Calcification

Sometimes, calcification of the arteries in the breast can be seen on a mammogram. Several studies have found an association between breast arterial calcification and cardiovascular disease, although the results have been mixed.

So, this is one we're still investigating.

But if your mammogram report mentions breast arterial calcification, it may be worth asking your healthcare provider whether it changes how they think about your cardiovascular risk.

How to reduce the risk of heart disease in women?

Thankfully, we don't have to sit around worrying about our hearts while waiting for science to figure out every last detail.

There are plenty of things we do know can help reduce cardiovascular risk:

Eat a Mediterranean-style diet.

Yes, I know. Vegetables again (even broccoli!)  Apparently, they are not going away.

Exercise.

Aim for about 150 minutes of moderate aerobic activity each week, along with two strength-training sessions.

Know your cholesterol.

And it might be worth discussing whether additional testing, such as lipoprotein(a), makes sense. A lipoprotein(a) level is not in the usual standard panel and looks at a different inherited type of cholesterol particle.

Don't smoke.

Your heart would really prefer that you don't.

Decrease alcohol.

I know. I'm such a bummer. Worse than the vegetables.

Know the symptoms of heart disease and stroke.

And remember that symptoms in women aren't always the dramatic chest-clutching episode we see in the movies.

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And Please Don't Wait Until Perimenopause

I talk a lot about perimenopause, but I don't want us to make the mistake of thinking that heart health suddenly becomes important when our periods start doing weird things.

Your cardiovascular history starts much earlier.

Pregnancy complications, menstrual patterns, autoimmune disease, metabolic conditions and other health events can all provide clues about your future cardiovascular health.

So even if you're not thinking about your heart right now, your body is keeping score.

And finally: advocate for yourself.

You know your body.

So, what if the doctor looks at you like you're crazy?

(Okay. That's not entirely true. I personally hate it when my doctor looks at me like I'm crazy.)

But seriously—if something doesn't feel right, ask about it. Explain what you're worried about. Tell your doctor what you're experiencing and why it concerns you.

Advocating for yourself doesn't mean walking into the office demanding a specific test or diagnosis. Sometimes it simply means saying, “This is concerning me. Can we talk about it?” And if they look at you like you're crazy, maybe it's time for a new doctor.

Your body will thank you for it.