By Anandita Agarwala MD, Anne Goldberg MD, Robert Wild MD, MPH, PhD

Heart Disease and Women

Heart disease and strokes are the leading cause of death in women in the United States1. Symptoms of both often go unrecognized and remain undertreated in women2. Men and women often experience symptoms differently. The most important step is to try to prevent it.

Pregnancy can Uncover Risk for Heart Disease and stroke

Pregnancy complications can be risk factors for heart disease and stroke. Identifying these complications can  prevent, delay, or reduce severity if they are appropriately managed3. About 30% of women have a complication or medical condition during pregnancy that can lead to  a higher risk for heart disease and stroke 4. Your obstetrician (Ob/Gyn physician) can screen you and manage some of the following conditions during your pregnancy and help you find continued life-long follow up to reduce your chances for having a stroke or heart attack.  

Pregnancy-induced hypertension (hi-per-ten-shun), often called Gestational Hypertension, is high blood pressure that begins during pregnancy.

Preeclampsia is hypertension, or “High Blood Pressure” that begins after 20 weeks of pregnancy plus a large amount of protein in the urine. It can be seen without protein in the urine if there are signs of low clotting factors in the blood, poor kidney function, or visual and/or liver symptoms.

Preeclampsia can also occur in people who had high blood pressure before becoming pregnant. If it is not treated, preeclampsia can lead to “eclampsia” which can cause severe seizures.

Women who experience high blood pressure during pregnancy are at a higher risk of developing chronic high blood pressure, which can lead to heart disease and stroke.

Gestational diabetes is diabetes (high blood sugar) that starts during pregnancy. Women with gestational diabetes are at a higher risk for developing type II diabetes during their lifetime. Diabetes can lead to heart disease, especially in women. The risk of developing type II diabetes is very high and usually happens within 10 years of delivery if gestational diabetes was found during pregnancy.

Pre-term delivery is the birth of a baby earlier than 37 weeks (gestational age).

Small for Gestational Age Infants are babies below the 10th percentile, that is they are smaller than 90% of all babies at the same time during pregnancy.

Multiple miscarriages are associated with a higher risk for heart disease.

Taking the next steps

Having any of these conditions during pregnancy may mean you are at higher risk for heart disease or stroke. However, there are still ways you can reduce your risk.

The American Heart Association recommends 7 simple steps to for a heart-healthy life5:

  1. Control Cholesterol (LDL-C) – lower is better!
  2. Eat Better
  3. Lose Weight
  4. Get Active
  5. Manage Blood Pressure
  6. Reduce Blood Sugar
  7. Stop Smoking

If you have a genetically (inherited from your family) high bad cholesterol or very high triglyceride+ levels, speak with your healthcare provider before getting pregnant about ways to lower your levels.

Ask your doctor about a plan to reduce your risk for heart disease.

+ Triglycerides (TGs) are a type of fat found in the bloodstream that provide fuel to help with daily activities, just as a car needs gasoline to function properly.  Much of the triglycerides in our bloodstream come from what we eat, although the body also make triglycerides naturally. When we eat, our body takes the TGs it doesn’t immediately need and stores them in fat cells to be used later as fuel.  While TGS are important for your body’s normal function, high levels of TGs can cause health problems including heart disease.


  1. CDC. Women and Heart Disease. In. Centers for Disease Control and Prevention; 2020.
  2. Mehta LS, Warnes CA, Bradley E, et al. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association. Circulation. 2020:CIR0000000000000772.
  3. Agarwala A, Michos ED, Samad Z, Ballantyne CM, Virani SS. The Use of Sex-Specific Factors in the Assessment of Women’s Cardiovascular Risk. Circulation. 2020;141(7):592-599.
  4. Brown HL, Warner JJ, Gianos E, et al. Promoting Risk Identification and Reduction of Cardiovascular Disease in Women Through Collaboration With Obstetricians and Gynecologists: A Presidential Advisory From the American Heart Association and the American College of Obstetricians and Gynecologists. Circulation. 2018;137(24):e843-e852.
  5. Association AH. My Life Check | Life’s Simple 7.–lifes-simple-7. Published 2018. Accessed October 24, 2019.

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