Heart Disease: The Leading Killer of Women – And Why Awareness Lags

You know what a pink ribbon signifies. Breast cancer, right? Now what about a red dress? Did you arrive up with heart disease? No? Don’t worry: You’re not alone. Heart disease is the leading killer of American women—and that trend shows no signs of slowing. New projections estimate the share of U.S. Women with heart disease will keep rising through 2050, affecting more than 22 million women, with the sharpest increases among younger women ages 20 to 44. Heart attacks are already becoming more deadly for adults under 55—again, particularly for younger women who don’t have the traditional risk factors. The prevalence and deadliness of heart disease for women specifically has been a public health problem for a long time, and it’s getting worse.

Yet awareness of that crisis seems to be shrinking, not growing. An American Heart Association survey published in 2020 found that U.S. Women’s awareness that heart disease is the No. 1 cause of death and that women can experience unique heart symptoms fell sharply, from 65 percent in 2009 to 44 percent in 2019. Knowledge about the symptoms of a serious cardiac event also declined. More recent data isn’t much more encouraging: In a 2025 survey of cardiologists by the Women’s Health Alliance, 84 percent said that they had treated a female patient whose heart condition was misdiagnosed by another doctor.

The Awareness Gap

In the 2020 American Heart Association survey, a growing number of women thought it was breast cancer, not heart disease, that killed the most women. Cardiologists observe their oncologist colleagues with a hint of envy. “I’m just jealous of them. They’ve done a good job at getting out the message. We have not,” said Dr. Martha Gulati, a cardiologist at Houston Methodist Hospital.

Despite efforts from groups like the American Heart Association, including campaigns like The Heart Truth and Move Red for Women, progress in raising awareness has stagnated, suggesting a need for a new approach. Dr. Gulati notes she wears a red dress pin at function, but her own patients rarely know what it signifies. “These are people that are living with heart disease, and they don’t even know what it means,” Gulati said. “The problem is that we are not reaching women. It is not resonating with women… I actually really believe that a rebrand is required.”

Why Women’s Heart Health Has Been Overlooked

The lack of awareness is perplexing given that scientists have known about women’s unique risk for years. Research in the 1980s and 1990s revealed that while men were seeing improvements in heart disease outcomes, women were not. Subsequent research identified physiological changes that put women at unique risk, leading to different symptoms and pathologies that were initially missed by clinicians.

However, this research has faced disadvantages. A June 2024 report from the American Heart Association and McKinsey found that 72 percent of animal studies from 2006 to 2016 used only male mice. In human trials from 2010 to 2017, only 38 percent of participants were women, with post-menopausal women—who are at the highest risk—represented in only 26 percent of studies. A 2025 study in the American Heart Journal revealed that there have still not been randomized controlled trials for some heart conditions that disproportionately affect women.

The health system itself has also failed to prioritize women’s heart health. According to the AHA/McKinsey report, less than one in four primary care doctors feel well-equipped to assess cardiovascular disease risk in women. This issue starts in medical school, where more than 70 percent of schools do not include gender-specific content in their curriculum.

How Heart Disease Presents Differently in Women

When women develop heart disease, it can manifest differently than in men. This can be confusing for doctors lacking proper training. For example, women are more likely to experience blockages in their small arteries, rather than the large arteries typically focused on in diagnostic tests. EKGs can also be less reliable in women due to incorrect placement near breast tissue.

“We have to do better. I think it has to come from training up. I can only teach so many medical students, but the ones I teach, I try to integrate it from the start,” said Dr. Harmony Reynolds, a cardiologist at NYU-Langone. “I think that has to be true for paramedics, for nurses, for doctors, for every level of the medical establishment and patients.”

This systemic bias disadvantages patients in understanding their own bodies and advocating for themselves. Women are almost twice as likely as men to attribute chest pain to stress rather than a heart condition. Women of color are at higher risk and less aware of heart disease than white women.

Raising Awareness and Improving Outcomes

Convincing people to prioritize long-term health is always a challenge, especially among young people who believe they are invulnerable. However, framing the conversation around brain health—and the link between vascular problems and dementia—may be more effective than focusing solely on heart health. “Heart attack is the thing that happens to old guys. But when you say dementia, they’re like, ‘Oh my God, I don’t want that,’” said Dr. Mary Cushman, a cardiologist at the University of Vermont.

Unique Risk Factors for Women

Women share common heart disease risk factors with men—obesity, smoking, and diabetes—but also face unique risks rooted in their physiology:

• Having your first period before the age of 12
• Irregular periods (affecting around 20 percent of women)
• Complications from pregnancy, such as hypertension and gestational diabetes
• Frequent hot flashes or night sweats during menopause
• Developing diabetes outside of pregnancy

Recognizing Heart Attack Symptoms in Women

While chest pain, pressure, and discomfort are common heart attack symptoms, women may experience less severe chest pain or other symptoms, including:

• Pain in the arms and neck
• Shortness of breath
• Sweating
• Stomach pain, including nausea and vomiting
• Extreme fatigue

Improvements are being made, with doctors working towards gender-specific training, increased awareness among OB-GYNs, and a greater willingness to take female patients’ concerns seriously. New treatments, like GLP-1 drugs, also offer hope.

patients must be their own advocates. The American Heart Association offers an online risk assessment tool. If you are experiencing symptoms, seek medical attention immediately. “It’s asking questions. ‘What is my risk? Should I be treated? How would you decide if I need to be treated? If you don’t think this symptom is heart disease, what do you think it is?’” Reynolds said. “Everybody recognizes that they don’t become a doctor just by searching Google. But it can empower you to inquire the right questions.”