Heart Health After 40: What Every Woman Needs to Know

How to Lower Your Risk of a Heart Attack: What Women Over 40 Need to Know 

Did you know that cardiovascular disease is the leading cause of death for women in the U.S.? Despite this, many women are still unaware of their risk. By the time a woman turns 45, 1 in 9 will already have heart disease—and by age 65, that number jumps to 1 in 3. 

Understanding your personal risk factors, how heart disease presents differently in women, and what steps to take for prevention can make a real difference in outcomes. So, share this article with your friends, your family, and your group chats—this is the kind of information that can save lives. 

 Why Heart Disease Risk Increases for Women 

Heart disease doesn’t look the same in women as it does in men—and too many women are unaware of that fact. Research shows that only about 44% of women recognize their risk of cardiovascular disease, even though more than 60 million American women are currently living with it. 

What makes it particularly important to talk about when you enter your 40’s? Menopause. Estrogen plays a protective role in heart health, and as estrogen declines, the risk of inflammation, high cholesterol, and arterial plaque increases. That’s why menopause marks a sharp rise in cardiovascular risk for women. 

Key Risk Factors for Heart Disease in Women 

Cardiovascular risk factors fall into two categories: those you can change (modifiable) and those you can’t (non-modifiable). 

Well-known risk factors include: 

• High blood pressure 
• Elevated cholesterol 
• Type 2 diabetes 
• Smoking 
• Excess weight 

These can all contribute to damage in the blood vessels, making it easier for plaque to build up and harder for your heart to function properly. 

Other, less commonly discussed risks for women: 

• Autoimmune diseases (e.g., rheumatoid arthritis, lupus) 
• History of preeclampsia or gestational diabetes 
• Early menopause (before age 40–45) 
• Severe hot flashes or night sweats 
• Sudden emotional trauma or stress 
• Coronary microvascular disease (which often goes undetected in standard tests) 

What a Heart Attack Looks Like in Women 

Heart attack symptoms in women can be subtle—and very different from the dramatic chest-clutching scenes we see on TV. 

Symptoms may include: 

• Shortness of breath 
• Pain or discomfort in the jaw, neck, back, or abdomen 
• Nausea or lightheadedness 
• Cold sweats 
• Extreme fatigue 
• Heart palpitations 

Many women report feeling like they just have indigestion or need to rest. This can delay care when time is critical. Always trust your instincts—if something feels “off,” seek medical attention. 

Tests and Markers That Help Evaluate Heart Health 

To get a full picture of cardiovascular health, your doctor may recommend: 

• Blood pressure checks (ideally under 120/80) 
• Lipid panel for cholesterol levels (LDL under 100 is optimal) 
• High-sensitivity C-reactive protein test to detect inflammation 
• Cardiac calcium score to assess arterial plaque 
• Carotid IMT ultrasound to evaluate arterial thickness 
• Genetic screenings for inherited markers like APOE e4 or elevated lipoprotein(a) 

If you have a strong family history or are already experiencing symptoms, it’s worth asking your provider about additional testing. 

What to Ask Your Doctor 

Here are some proactive questions for your next appointment: 

• What tests should I get to assess my heart health? 
• Do I have any specific risk factors based on my history or symptoms? 
• Are my cholesterol and blood pressure levels within a healthy range? 
• Should I consider medications for prevention? 
• Is hormone therapy right for me based on my cardiovascular risk? 

Everyday Lifestyle Tips to Support Heart Health 

You can’t change your age or genetics—but there’s a lot you can do to reduce cardiovascular risk through daily habits: 

1. Eat the Mediterranean Way 

Dr. Speck recommends a mostly plant-based diet with healthy fats, lean proteins, and lots of fiber-rich fruits and vegetables. Think: olive oil, legumes, leafy greens, and fish over red meat. 

2. Move Consistently 

Aim for 150 minutes a week of moderate to vigorous physical activity. Focus on workouts that engage your core and legs (like brisk walking, cycling, or swimming) to improve circulation and reduce inflammation. 

3. Manage Stress and Sleep 

Chronic stress can increase blood pressure and inflammation. Prioritize relaxation, mindfulness, and sleep to help regulate your heart health from the inside out. 

Be Your Own Best Advocate 

Heart disease is preventable—but only if you know the risks and take action. If you are struggling with menopause symptoms, it can help to speak to a provider about what you’re experiencing. Remember, everyone’s experience is unique, so there’s no one-size-fits-all solution. If you’re feeling stuck or uncertain, reaching out to your provider is a great first step to getting answers and feeling more like yourself again. Not sure where to start? Find a provider who fits your needs.