Last spring, we had a close call. A patient of ours, a 48-year-old female sales executive, had been experiencing nausea and weakness. But the end of a first-quarter sales push took precedence. She dismissed her symptoms as resulting from stress and too little sleep, and she didn’t reach out to us. Her commitment to her work almost cost her life: She suffered a heart attack. Yet the event was almost completely preventable.

Our patient’s experience is not unusual. Heart disease in women is tricky. Though it is the leading cause of death for American women—responsible for roughly a third of those deaths—it does not receive the research funding or media exposure it deserves. The American Heart Association’s Go Red for Women information campaign is a step in the right direction, but much more needs to be done.

Related: 25 Ways to Live Longer

Part of the problem is that men experience heart disease differently than women, and the focus to this point has been on men’s health. Men tend to manifest heart attacks, for example, with more intense symptoms like chest and arm pressure while women often present with a generalized weakness, nausea, anxiety or mild shortness of breath: all symptoms that can be brushed off as something else. Women also tend to downplay their discomfort and put other people and projects first, thus creating a major delay in the diagnosis that is so essential to the survival of a heart attack.

Women tend to downplay their discomfort and put other people and projects first, thus creating a major delay in diagnosis.

How does a woman know if she is at risk for heart disease? There are several things to keep in mind. First, she should learn her family medical history, especially those family members who had heart disease before age 60. Second, she should be aware of other risk factors that are impacted by lifestyle choices. Principal among them is obesity in the form of excess belly fat (leading to insulin resistance and accelerated atherosclerosis), smoking, lack of exercise, a diet rich in simple carbohydrates and saturated fats, and depression.

Third, she should know her numbers. There is still some controversy among cardiologists about exactly what they should be but, at a minimum, the targets are a total cholesterol level of less than 180 and an LDL of less than 120. She should also know her fasting blood sugar, as well as her baseline kidney and liver function tests. This is not a one-size-fits-all situation, however.

Illustration by Jennifer Tapias Derch

There are other tests available for identifying cardiac risk including high-sensitivity CRP (hs-CRP), LDL particle size, lipoprotein A and apolipoprotein B. Each of these tests reveals a molecular component of ongoing vascular injury and together they help create a more accurate assessment of heart attack risk over time. A quick way to assess your numbers is the Cardio IQ Advanced Lipid Panel Plus & Inflammation, which costs about $275 and includes all of the above tests. Your primary care physician can order the test and review the results to help create a plan to diminish your risk.

Related: Can We Turn Back Time on Women’s Biological Clocks?

If your numbers come in high and are coupled with some of the treatable risks described above, a visit to a preventive cardiologist is warranted. The specialist can help you accurately assess the situation and create a holistic plan that may include specific supplements, prescription medication and personalized strategies for weight loss, exercise and nutrition to minimize your chances of a heart attack.

I wish our sales executive patient had had a chance to take these steps. Today, she is back at work—but with a coronary stent in place. More important, she is now on the medication (a low-dose statin), exercise program (20 minutes of morning treadmill walking) and diet (low-carb Mediterranean) to help prevent this from ever happening again. So far, so good. 


  • More than 42 million American women are living with some form of cardiovascular disease.
  • 35.3 percent of deaths in American women over the age of 20 are caused by cardiovascular disease each year.
  • More than 200,000 women die each year from heart attacks—five times as many women as die of breast cancer.
  • More women than men die of heart disease each year.
  • 23 percent of women and 18 percent of men will die within one year of a first recognized heart attack; 22 to 32 percent of female and 15 to 27 percent of male heart attack survivors will die within five years.
  • 12 to 25 percent of female and 7 to 22 percent of male heart attack survivors will be diagnosed with heart failure within five years.
  • Women comprise only 27 percent of participants in all heart-related research studies.

Source: CardioSmart/WomenHeart and Centers for Disease Control and Prevention

Dan Carlin, a physician, is CEO of WorldClinic, a New London, N.H.-based telemedicine practice. Read more of his columns here.

Originally Published on

Follow us here and subscribe here for all the latest news on how you can keep Thriving.

Stay up to date or catch-up on all our podcasts with Arianna Huffington here.