Cardiologists highlight overlooked heart risks across women’s lives

Heart disease remains the leading cause of death for women in the United States, yet awareness of cardiovascular risk—particularly among younger women and women of color—has stalled, even as rates of high blood pressure, diabetes, obesity, and high cholesterol continue to rise. According to experts in the Leon H. Charney Division of Cardiology at NYU Langone Health, this gap underscores the need for earlier screening, stronger prevention efforts, and education to address types of heart disease that disproportionately affect women.

This Heart Health Month, NYU Langone cardiologists Harmony R. Reynolds, MD; Anaïs Hausvater, MD; Shaline D. Rao, MD; Doris Chan, DO; and Nathaniel R. Smilowitz, MD, share what women need to know about protecting their heart health across a wide focus—from pregnancy and menopause to emerging therapies, wearable technology, and the symptoms that shouldn't be ignored.

Women's cardiovascular care is advancing rapidly. New diagnostic tools expanded treatment options and a growing understanding of sex-specific biology are helping physicians detect conditions that were once frequently missed. NYU Langone Heart is building on this progress through specialized women's cardiology services, the Cardio-Obstetrics Program, and multidisciplinary care models focused on tailoring treatment more precisely and improving outcomes across every stage of life.

Pregnancy is a powerful indicator of future heart health

One of the strongest predictors of long-term cardiovascular disease may appear decades earlier—during pregnancy.

Pregnancy is what we call nature's stress test. Blood volume increases, the heart rate rises, and the heart has to work significantly harder."

Anaïs Hausvater, MD, NYU Langone cardiologist

Complications such as preeclampsia, gestational diabetes, pregnancy-related hypertension, preterm birth, low birth weight, or pregnancy loss are now recognized as lifelong cardiovascular risk markers.

"These risks don't disappear after delivery," Dr. Hausvater added. "Even 30 to 40 years later, we see higher rates of heart disease, heart failure, and stroke."

Women have different risk factors across life stages

Although traditional risk factors such as cholesterol and blood pressure remain important, women also face biological and life-stage-specific risks that are often overlooked in routine screenings.

"There's growing evidence linking early menopause, breast cancer treatments, fibroids, endometriosis, polycystic ovary syndrome, autoimmune disease, miscarriages, and pregnancy complications to cardiovascular disease," said Dr. Reynolds, the Joel E. and Joan L. Smilow Professor of Cardiology in the Department of Medicine and director of the Cardiovascular Clinical Research Center at NYU Langone. "We need to bring these factors into everyday clinical conversations, so women receive more personalized risk assessments."

Menopause represents a major cardiovascular transition. "We often see cholesterol and blood pressure rise during menopause," said Dr. Hausvater, co-director of NYU Langone's Cardio-Obstetrics Program. "This is a critical window to reassess heart risk and intervene early."

Women's heart attack symptoms can differ

Heart disease does not always look the same in women as it does in men. Younger women in particular are more likely to experience forms of heart disease that may not show up on standard imaging.

"Younger women don't always present with classic blocked-artery heart attacks," Dr. Reynolds said. "They may develop artery spasms, small-vessel disease, or spontaneous coronary artery dissection—what we often describe as a 'bruise in the artery wall.'"

Because these conditions can be harder to detect, women may face delays in diagnosis.

"Women are often told their symptoms are anxiety, stress, or gastrointestinal issues," Dr. Reynolds added. "But in many cases, it's actually a heart problem."

According to Dr. Chan, an interventional cardiologist at NYU Langone Hospital—Brooklyn, recognizing these patterns is essential.

"These patients don't fit the traditional heart disease profile," Dr. Chan said. "Understanding how heart disease presents differently in women helps us intervene earlier and improve outcomes."

Heart failure looks different in women too

Women are more likely than men to develop heart failure with preserved ejection fraction (HFpEF), a form of heart failure in which the heart pumps normally but cannot relax properly.

"When people hear heart failure, they imagine a heart that barely squeezes," said Dr. Rao, heart failure cardiologist and chief of the Division of Cardiology at NYU Langone Hospital—Long Island. "But many women develop heart failure where the heart looks normal on imaging, yet symptoms such as fatigue and shortness of breath can be just as serious."

Dr. Rao noted that treatment options are expanding. "We're seeing meaningful improvements in symptoms, exercise capacity, and quality of life with newer therapies," she said. "Cardiac rehabilitation and physical activity are also powerful tools for recovery."

Are wearables and advanced testing changing detection?

Smartwatches and other consumer devices are increasingly helping identify abnormal heart rhythms, sleep apnea, dangerous pauses in heart rate, and valve disease.

"These tools can absolutely save lives," said Dr. Smilowitz, interventional cardiologist at NYU Langone. At the same time, experts caution that wearable data should be paired with clinical care.

"Too much data without guidance can increase anxiety," Dr. Hausvater added. "The key is pairing technology with expert care."

Advanced cardiac testing is also improving diagnosis for patients whose symptoms persist despite "normal" scans. "When the diagnosis is unclear, specialized testing can uncover conditions that would otherwise be missed," Dr. Smilowitz noted.

What to know about statins and other heart treatments

Despite decades of evidence supporting their safety and effectiveness, statins remain underused in women.

"Statins are one of the most powerful tools we have to reduce heart attack and stroke risk," said Dr. Chan. "But many women who would benefit from them are either not offered treatment or hesitate because of misinformation."

Dr. Smilowitz noted that risk in women is not always reflected by cholesterol levels alone. "Statins don't just lower LDL cholesterol," he said. "They stabilize plaque and reduce inflammation in the arteries, which helps prevent sudden cardiac events."

GLP-1 medications, including Ozempic and many others, are also reshaping cardiovascular prevention. "These therapies can significantly improve blood pressure, cholesterol, and metabolic health," Dr. Rao said. "But they should complement prevention—not replace it."

What women can do this heart month

NYU Langone cardiologists encourage women to prioritize prevention and early detection:

• Know your blood pressure, cholesterol, and blood sugar numbers.
• Share your pregnancy and reproductive history with healthcare providers.
• Take subtle or persistent symptoms seriously.
• Stay physically active and manage your sleep and stress.
• Ask your doctor about personalized heart risk across the stages of your life.

"Women's heart disease is not one-size-fits-all," Dr. Reynolds said. "Understanding these differences—and acting on them early—can save lives."