Heart disease is the leading cause of death for women in the United States — but most of them don’t know it. Despite years of awareness efforts, research from the American Heart Association (AHA), shows that fewer than 45 percent of women recognize heart disease as their biggest health threat.
Stacey E. Rosen, MD, FAHA, volunteer President-elect of the AHA, says this lack of awareness is rooted in a long-standing misconception that heart disease is primarily a "man's illness"—a perception that has delayed research, treatment, and recognition of symptoms in women. But that’s changing, and on National Wear Red Day, Feb. 7, 2025, Rosen is urging women to take charge of their heart health.
In an exclusive interview with Cure, Rosen spoke about women’s heart health risks, as well as new innovations in the space of heart health that may one day increase women’s lifespan.
Heart Health’s Gender Gap
Heart health is the leading cause of death in both men and women, but it can affect women differently. Many people know the classic male symptoms of heart attack: chest pain, discomfort in other areas of the body such as one or both arms, and shortness of breath. While these symptoms are also present in women, they don’t tell the whole story, leading to what some have termed “the heart disease gender gap.”
Women are more likely to experience additional symptoms including anxiety, upset stomach, and unusual tiredness or weakness. A lack of recognition of these symptoms can lead to a delay in treatment, but it can also lead to less research and fewer clinical trials for women.
For a long time, “women were excluded from trials,” Rosen said, “whether it’s drugs or devices or procedures or operations.” In fact, a 2020 study found that out of more than 800,000 adults who participated in cardiovascular-related clinical trials over a period of seven years, only 38 percent were women.
The reasons for women’s lack of participation in clinical trials are multifaceted, but the gender of her physician may have something to do with it, Rosen, the executive director for Northwell’s Katz Institute for Women’s Health and a professor of cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, noted.
“Women are less likely to be asked by male doctors to be in a clinical trial,” she said, which is a problem when only about 15 percent of cardiologists are women.
Lack of research into women’s cardiovascular disease can have dire consequences.
“If we don't study women, then we may not be able to glean side effects or advantages for women taking a certain medication,” Rosen said. And if women’s heart disease symptoms aren’t recognized in time, women may be sent home from emergency rooms instead of given proper care.
Younger women, aged 45 to 55, are especially at risk, Rosen said, and they may not know it. Young women have seen the greatest percent increase when it comes to populations hospitalized with heart attacks, recent data shows. “It’s never too early for prevention,” Rosen said.
Starting Small to Decrease Heart Risk for Women
Luckily, there are easy steps that women of any age can take to decrease their risk of heart disease and increase their lifespan. The AHA calls these “Life’s Essential 8,” and they include: not smoking, physical activity, healthy diet, healthy body weight, sleep health, and control of cholesterol, blood pressure and blood sugar.
You don’t have to make huge changes at once, however, Rosen said. Don’t think about running a marathon, but do think about how you might incorporate a few more steps of movement or stretching into your current daily routine. Don’t try to become a vegetarian overnight, but do try to think about whether you could swap a bread basket for a salad for one meal a week.
“It’s the small things that can become habitual that you find easy and, shall I say, enjoyable,” she said. Rosen even coauthored a book with fellow Northwell cardiologist, Jennifer Mieres, MD, FACC, MASNC, on the topic: Heart Smarter for Women: Six Weeks to a Healthier Heart, which was published by Advantage Media Group in 2022.
Another thing that is important is to become engaged with your own health and advocate for yourself, she said. That means finding a doctor that you trust, understanding your family history and risk factors for heart disease, and preparing for checkups by writing down questions and understanding what tests might be needed depending on your symptoms.
“You would never leave a gynecologist’s office being told you don’t need a pap smear,” she said, “so if you’re having symptoms in your chest, of course you may need a stress test. But you need to know that.”
New Advances in Heart Disease: Pregnancy and Metabolic Disease
In addition to taking your own preventive measures, Rosen said there is also new research and advances happening in the field of cardiovascular medicine that will hopefully reduce the risk of heart disease, or treat it effectively when it occurs.
One significant focus of the AHA is the link between pregnancy and heart health, a new field that scientists are just starting to understand. Cardiovascular disease is a leading cause of pregnancy complications, and approximately one in three pregnancy-related deaths in the US are due to cardiovascular problems.
Recent research shows that pregnant women who experience racism, lower incomes, limited insurance, live in rural areas, or have poor social support are significantly more likely to have cardiovascular disease during pregnancy. Better understanding of why some women get heart disease during pregnancy is essential, Rosen said, “because that is such an opportunity to really improve a woman’s lifelong health.”
Another area of focus is metabolic health, Rosen said. Metabolic syndrome is a common cluster of conditions including a large waistline, high blood pressure, high blood sugar levels, high blood triglyceride levels and low HDL cholesterol that raises your risk of coronary heart disease, diabetes and stroke. Recent transformative innovations in this sector include GLP-1 medications and medications that target the gut microbiome.
Metabolic syndrome is also a top area of interest for healthcare investors, according to Cure’s 2024 Women’s Health Benchmark Report. More than 100 healthcare industry leaders ranked metabolic diseases and cardiovascular diseases in the top five most interesting disease areas for future investments and research in women’s health.
“I think the science around nutrition and food as medicine has been extraordinary,” Rosen said.