Women Most Vulnerable to Heart Disease Risk Factors, Study Shows

Certain factors that increase a person’s risk of heart disease, such as unhealthy lifestyle habits, may have a more significant impact on women than they do on men.

New research presented at the American College of Cardiology’s Annual Scientific Session found that while women are nearly twice as likely to live healthier lives overall, having a less-than-ideal diet or high lipids or blood pressure increased their risk of developing cardiovascular disease more than it did in men.

Cardiovascular disease is the number one killer of both men and women in the United States.

Still, factors that raise a person’s chances of heart disease are “frequently under-recognized and under-treated in women, and women may also be receiving less counseling on behavior changes,” said Rachel Bond, MD, system director of women’s heart health at Dignity Health in Arizona, who was not involved with the research.

The new findings emphasize the need for more nuanced guidelines for heart disease risk, said the study’s lead author, Maneesh Sud, MD, PhD, an assistant professor of medicine and interventional cardiologist at Sunnybrook Health Sciences Centre in Toronto. “It’s not one size fits all,” he told Health. 

The new study, which has not yet been published in a peer-reviewed journal, included data from over 175,000 Canadians who enrolled in the Ontario Health Study between 2009 and 2017.

Participants, all of whom didn’t have a history of heart disease at the start of the study, provided information regarding their diet, sleep, exercise habits, whether they used nicotine, their blood glucose and cholesterol levels, and whether they had high blood pressure or obesity—all factors linked with an increased risk of cardiovascular disease.

The researchers took note of this information, as well as whether people developed a stroke, heart attack, heart failure, and other heart diseases, or if death records show they had died of heart disease between the study’s start and March 2023.

The women involved in the study were, on average, 47 years old, and the men were, on average, 50. 

Fifty-four percent of women, compared to 35% of men, ate an ideal diet (at least five servings of fruits and vegetables daily), and 73% of women, compared to 68% of men, had healthy blood pressure. Most people in the study had healthy glucose levels, but slightly more women did than men—92% compared to 89%. 

The men and women in the study had similar nicotine use, sleep habits, cholesterol levels, and obesity rates. However, men beat women in just one metric: physical activity. Only 70% of women were getting enough exercise, whereas 73% of men were.

While scoring poorly on these risk factors was correlated with a higher risk of cardiovascular disease in both men and women, the association was nearly twice as strong in women. 

Sud said for future research, he and his colleagues plan to home in on how hormones and menopause could be affecting women’s risk for heart disease.

Studies have suggested that estrogen, which drops in women usually in their 40s and 50s during perimenopause, has a protective effect on heart health, but it’s unclear from the new study how much of a role the hormone might play in the increased risk that other health factors pose to women.

“One of the factors linked to menopause is age, so it’s hard to untangle that from hormones,” Sud said.

What is clear is that certain risk factors do seem to impact women’s chances of heart disease more than men’s. These individual risks should factor into how doctors counsel their patients about heart health, Bond told Health. “It’s especially critical for women,” she added.

Previous research has shown that if women smoke the same number of cigarettes for the same amount of time as their male counterparts, they are 25% more likely to develop heart disease, Bond noted.

Bond said the new study’s results likely apply to people around the world, particularly those in the U.S.

“Although this study was conducted in Canada, the demographics are quite similar to the U.S.,” she said. “A big theory in the realm of cardiovascular health [is] that oftentimes women do place themselves below their families, their friends, their profession, and it oftentimes does affect their health.”

Furthermore, poor diets are common in the U.S., and the fast pace of life can cause more stress than women experience elsewhere, Annapoorna Kini, MD, director of the Interventional Structural Heart Disease Program for the Mount Sinai Fuster Heart Hospital in New York, added.

“In America, being an overachiever is common. In other countries, parts of Europe and South America, life is slower paced,” she told Health. “If you are stressed, you aren’t taking care of yourself. You have an excuse to not exercise and eat well. You don’t sleep well.”

While having a poorer diet and high cholesterol, blood pressure, and glucose levels appear to have an outsized effect on heart disease risk for women, having healthy lifestyle factors “can have a profound protective effect, especially in women, so we need to emphasize these things in our care of women,” Kini said.