Women, heart disease & stroke: The unique risks and signs to know

May 2023

This article is provided by Heart & Stroke.      

There are a unique set of risks and symptoms for women when it comes to heart and brain health. Additionally, statistically women have worse outcomes than men facing heart disease and stroke. Here are some things you should know for yourself or the women in your life.

What's the reality?

The #1 cause of premature death for women in Canada is heart disease and stroke. These conditions impact women more than men. Twenty percent more women in Canada die of heart failure when compared to men. Additionally, 56% more women died of atrial fibrillation than men, 31% more women died of valvular heart disease than men, ​and ​32% more women died of stroke than men. The numbers are startling.

According to Statistics Canada, adult women make up about 50% of the population representing numbers close to 16,000,000. Nearly 9 in 10 women in Canada have at least one risk factor for heart disease and stroke.

Many women aren’t aware of their risk factors and many experience symptoms that are misdiagnosed or ignored. There is ongoing work by Heart & Stroke and other organizations, researchers​,​ and healthcare providers to spread the word and work to improve women’​s​ experience​s​ within the healthcare system when it comes to heart disease and stroke.

Why are women more affected than men? 

There are several factors at play, including women’s unique risks ​​for heart disease and stroke that we’ll discuss in detail below, and a striking ​​research gap. There is a lack of research specifically oriented to women and an under-representation of women in cardiovascular research studies. As a result, heart disease and stroke in women are often poorly understood, which negatively affects the development of clinical guidelines and best practices for women as well as diagnosis, treatment and support for women with cardiovascular disease in Canada. 

• Anatomy – ​​​​There are biological differences between the sexes, and not just the obvious ones. There are many differences in anatomy – for example, women tend to have smaller hearts and smaller arteries than men, and plaque accumulates in these vessels in different ways compared to men. These points have implications when it comes to how doctors diagnose and treat heart disease.


• Life stage ​–​ Oral contraceptives, pregnancy​,​ and menopause are all unique to women and carry unique heart disease and stroke-related risks. As well, heart and stroke disease risk increase​s​ with age, and women tend to live longer than men.
  
  
  • Birth Control: Oral contraceptives, especially high-dose estrogen or estrogen only, can increase the risk of high blood pressure and clots (which are stroke risks). The risk is greater if you smoke, already have high blood pressure, are over 35, have migraines with auras, have a blood clotting problem already or have other risk factors for heart disease and stroke.  Always consult with your healthcare provider.
  
  
  • Pregnancy: During pregnancy, women can develop conditions such as gestational diabetes that put them at higher risk for heart disease and stroke. The risk of stroke is three times higher during pregnancy. A stroke can happen at any stage of the pregnancy, but most often occurs during childbirth and the first few months after delivery.
  
  
  • Menopause: Risk for heart disease and stroke increases at this time of life. If you have early onset menopause your risk is higher. This is due to a variety of factors such as hormone changes, increased risk for other risk factors like high blood pressure, cholesterol​,​ and other physical body changes. Women who are taking estrogen as part of HRT also have an increased risk of heart attack and stroke, so discuss the best options with your healthcare provider.


• Health-related factors ​ –​ Smoking, depression​,​ and diabetes are more strongly linked to risks for heart disease for women compared to men. Similarly, some autoimmune diseases such as rheumatoid arthritis that are experienced more often by women have links to cardiovascular disease.


• Different presentation of heart attack symptoms  – While some signs and symptoms are the same for women and men, women may experience different symptoms or experience them in different ways than men. The most common sign of a heart attack in both women and men is chest pain or discomfort. 

Did you know that heart attack symptoms are not recognized in over 50% of women?

Here’s a quick reference for heart attack symptoms reported by women from the Canadian Women’s Heart Health Alliance.

What can you do?

• Talk about it with your mothers, daughters, wives, sisters, grandmothers, aunts​,​ and friends. Increased awareness is an important step in managing risk and seeking care. Share this article and other important information regarding women’s unique risk factors with friends and family.


• Listen as women share stories, experiences, concerns​,​ and descriptions of health symptoms. Here are some real-life stories from Canadian women who have experienced heart disease and stroke:
  • Straight talk about heart disease from women
  • Young women and stroke
  • The Beat Podcast - We can save more women
  
  
• Learn more about women’s risk factors and what women can do to reduce or manage their risk for heart disease and stroke. While some risk factors can’t be changed, others can. Discover great advice about managing your risk factors with these links from Heart & Stroke:
  
  
  • Healthy eating
  • Active living
  • Quitting smoking and vaping
  • Alcohol and drug use
  • Managing stress
  
  
• Advocate. ​​​T​​​​he​​​​se resources​​ from the​ Canadian Women’s Heart Health Alliance (available in many different languages) can support your own learning and be shared. You can also participate in Wear Red Canada day on February 13^th each year to help raise awareness about women’s heart health.

Please always check with a medical professional to ensure these strategies are right for you.

© 2022, Heart and Stroke Foundation of Canada.