The Hidden Face of Heart Disease in Women

By Dr. Hesham Tayel
Consultant – Cardiology, International modern Hospital, dubai

Heart disease is often thought of as a man’s illness, but this perception couldn’t be further from the truth. In fact, cardiovascular disease is the leading cause of death among women globally. What makes this even more concerning is that heart disease in women doesn’t always look—or behave—the same way it does in men. This difference in presentation, progression, and even diagnosis has led to a silent crisis in women’s heart health.

Unlike men, who typically present with the textbook symptom of crushing chest pain, women often experience subtler signs such as fatigue, shortness of breath, nausea, or discomfort in the jaw, neck, or back. These symptoms are frequently mistaken for anxiety, indigestion, or simply exhaustion, especially in younger women or those juggling multiple roles at home and work. The risk factors also differ. While high blood pressure, diabetes, and smoking affect both sexes, women face additional threats such as pregnancy-related complications, autoimmune diseases, and hormonal shifts—particularly during and after menopause.

Menopause marks a critical turning point in a woman’s cardiovascular health. The decline in estrogen levels leads to increased arterial stiffness, higher cholesterol, and elevated blood pressure—all of which contribute to a heightened risk of heart disease. Women who experience early menopause or undergo surgical menopause are especially vulnerable. Unfortunately, this transition is often overlooked in routine care, despite its profound impact on long-term heart health.

One of the most troubling aspects of heart disease in women is the delay in diagnosis. Studies have shown that women are significantly more likely to be misdiagnosed or discharged from emergency departments without proper cardiac evaluation. This is partly due to the atypical nature of their symptoms, but also because much of our medical understanding of heart disease has been shaped by research conducted predominantly on men. As a result, diagnostic tools and treatment protocols may not fully account for the nuances of female physiology.

Even when diagnosed, women tend to have worse outcomes after heart attacks. They are more likely to experience complications such as depression, pneumonia, and digestive issues, and are less likely to be referred to cardiac rehabilitation. Socioeconomic factors, including limited access to care and lower income levels, further compound these challenges. The recovery process for women is often longer, more complex, and less supported.

Adding to the problem is the underrepresentation of women in cardiovascular clinical trials. Despite being equally affected by heart disease, women are frequently excluded due to strict eligibility criteria, concerns about reproductive health, or logistical barriers like caregiving responsibilities. This lack of representation means that many treatments are not adequately tested for their effectiveness or safety in women, leaving a significant gap in personalized care.

So what can be done? First and foremost, awareness is key. Women must be empowered to recognize the signs of heart disease and advocate for their health. Symptoms such as unexplained fatigue, shortness of breath, chest discomfort, and pain in the jaw or back should never be ignored. If something feels wrong, it probably is—and early intervention can be life-saving.

As a cardiologist, I believe we need to shift the narrative. Heart disease in women is not rare, and it’s not always obvious. It’s time we listen more closely, research more inclusively, and treat more equitably. Every woman deserves to have her heart taken seriously.