Heart disease, including heart attack, coronary artery disease, and related conditions, is the number one killer of women in the US, especially in the South. More than one in three women have some form of cardiovascular issue.

Women can have a heart attack at any point in our lives, and the risk of cardiovascular disease and heart attack goes up in midlife and beyond.

Menopause itself does not cause heart disease, but decreases in estrogen can make blood vessels less flexible and able to adjust to blood flow. (Despite the role estrogen plays in heart health, the American Heart Association does not recommend hormone replacement therapy.)

Stress literally kills

You can’t control your age, race, sex at birth, family history, estrogen levels or other predisposed heart attack risk factors, but there are certain controllable risk factors.

Stress is a biggie when it comes to your ticker.

In theory, the human body’s reaction to stress is a good thing: it’s our fight or flight mechanism. Homo sapiens evolved an elevated heart rate, raised blood pressure, and faster breathing in times of danger to outrun whatever tiger was chasing us at the moment. However, for all our evolutionary advantages, the subconscious human brain isn’t great at distinguishing between immediate danger (tiger!) and the subtleties of daily existence (money, bills, deadlines, and so on).

Compared to our male peers, stress and mental health disorders in midlife have more of an impact on women’s hearts. Women under 50 are twice as likely as men of the same age to have reduced blood flow to the heart after a stressful emotional event.

A little motivating pressure before a deadline isn’t always a bad thing, but watch out for chronic stress or stress triggered by an emotional event. 

In addition, the menopause blues or depression and anxiety that women are more prone to can make it harder to exercise and eat healthy meals, which in turn increases heart disease risk.

Working ourselves to death

Whether your boss is making you miserable or your work is truly life or death, anyone who has worked in a stressful professional setting can attest to the impact a job can have on your mental and physical health. 

A landmark 2010 study showed that women with stressful jobs have a 40% increased risk of cardiovascular disease (including heart attack and surgery) than peers in lower stress positions. For the purposes of the study, “job strain” was determined by both pace, workload, and difficulty of the job and amount of control over professional decisions or creative direction.

Women who worry about being fired or laid off also see increased cardiovascular risk.

Another study, among nurses in Denmark, showed that the greater the professional stress, the greater the risk of heart disease in women 51 and younger. 

A third study, of white-collar workers in China, showed that job strain in women (but not men) is associated with thickening of the carotid artery wall, an indicator of heart disease. 

It’s important to note that job-related stress doesn’t just apply to professional settings; many women in midlife juggle parenting, taking care of their own parents, work, and household duties, all of which can accumulate dangerous levels of stress.

PTSD

Posttraumatic stress disorder (PTSD) is an unfortunate reality for many women. 

Women are more than twice as likely as men to develop PTSD after trauma (10% compared to 4%); one theory is that sexual assault is more likely to cause PTSD than other events and women experience sexual assault at a higher rate than men. Another is that women with PTSD are more likely to blame themselves for the experience.

Regardless, there’s a correlation between PTSD and heart disease. A study of more than 1,000 civilian women showed that women with PTSD were three times as likely as women without PTSD to develop coronary heart disease.

Broken-heart syndrome

Do you remember the Wallflowers’ (Bob Dylan’s son Jakob) ‘90s hit “One Headlight”? It turns out, you can actually die of “a broken-heart disease”: Takotsubo cardiomyopathy (also called stress-induced cardiomyopathy or broken-heart syndrome). 

The symptoms of Takotsubo cardiomyopathy are identical to a heart attack and are brought on by a sudden stressor, like the death of a loved one, a natural disaster, an accident, or receiving bad news. In fact, up to 5% of heart attacks in women may actually be Takotsubo cardiomyopathy.

Death from Takotsubo cardiomyopathy is rare, but around 20% of patients experience heart failure.

Talk to a menopause practitioner. Book your Telemedicine appointment today.

Relax (just do it)

You can’t always just quit, find a new job, or reduce your panic-inducing responsibilities, but there is hope for your heart if your stress levels are off the charts. Harvard Medical School recommends the following methods to reduce stress:

1. Develop and lean on a support network of friends, family, and trusted colleagues.
2. Exercise! Not only is physical activity already good for your heart, you’ll feel better and sleep better too.
3. Maintain a solid work-life balance; reduce professional activities (yes, even email) outside of work. 
4. Meditate, practice deep breathing, or explore other relaxation techniques.
5. Get help from a mental health professional.

Other ways to reduce your risk:

The American Heart Association (AHA) recommends following a healthy lifestyle to further reduce your risk of heart disease:

• Don’t smoke for your estrogen's sake
• Limit alcohol use
• Get plenty of exercise.
• Know your blood pressure and cholesterol numbers (Read: <>Cholesterol, Heart Disease, and menopause)
• Eat a balanced diet full of fruits, vegetables, whole grains, low-fat dairy, poultry, fish, and nuts and low in sugar, red meat, and processed foods.

Recognizing the symptoms of a heart attack

Call emergency services (9-1-1) and get to the hospital immediately if you or another woman are experiencing any of the following symptoms:

1. Discomfort, pressure, pain, fullness, or squeezing in the middle of your chest that lasts more than a couple of minutes or disappears and then returns.
2. Pain or discomfort in either or both arms, back, jaw, neck, or abdomen.
3. Feeling short of breath, with or without pain in your chest.
4. Breaking out in a cold sweat, nausea/vomiting or lightheadedness.

The most common heart attack symptom in women is chest pain, but women are more likely than men to experience pain in the back or jaw, nausea and vomiting, and shortness of breath.

Seconds count. Women are all-too-often conditioned to put others before ourselves or don’t want to be a bother. You may wonder if your symptoms are serious enough to warrant concern.  But you only get one heart: don’t take any chances. 

If you are worried about stress and heart disease in your transition, a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

Have you dealt with heart disease or are you concerned about your heart health? Join the conversation in the Gennev community forums and share your story!