What is the number one cause of death in women? Is it breast cancer? Complications from diabetes? Heart disease? You may have guessed by the topic of this blog, it’s heart disease. In fact, women have a greater risk of dying from heart disease, which encompasses heart attacks and strokes, than from all cancers combined!

Risk Factors

Some risk factors for heart disease are more risky for females than they are for males. These include high blood pressure (hypertension) and diabetes. Menopause is a time of accelerating cardiovascular disease (CVD) risk. With the dramatic decline in estrogen that occurs with menopause, there is an increase in the atherogenic types of cholesterol particles and a worsening of blood glucose control. Decreased estrogen level is also associated with an increased amount of visceral fat, the type of fat that is deep in the belly region. This type of adipose tissue (aka fat) is more dangerous than superficial fat depots located near the thighs and buttocks.

Risk Modifiers Specific to Women

While certain risk factors for CVD, such as overweight/obesity, sedentariness, depression, and tobacco use apply to both males and females, there are other conditions which exclusively affect females. These are called risk modifiers. These female-specific conditions include:

  •  polycystic ovarian syndrome (PCOS)
  • pre-term delivery
  • pre-eclampsia or gestational hypertension
  • gestational diabetes
  • premature menopause (defined as younger than age 40)

In addition, autoimmune conditions including rheumatoid arthritis, lupus, and psoriasis increase the likelihood of developing cardiovascular disease. While men can have these conditions too, autoimmune diseases more often affect women by a factor of 2 to 1.


Primary care providers and even cardiologists often underestimate a woman’s risk of heart disease if they are unaware of her obstetric history. Commonly used calculators of CVD risk use factors such as age, blood pressure, cholesterol levels, and family history of early cardiac disease but these calculators do not take into account the above risk modifiers. Therefore, the true risk of CVD is under appreciated and an opportunity for early intervention and risk reduction can be missed. It’s important for women to advocate for optimal health. You can do this by making sure your providers know if you have any of the above cardiovascular disease risk enhancers.

Menopause and Heart Disease

As mentioned above, menopause is a time of increasing cardiovascular risk. This begs the question, does treatment of menopausal symptoms therefore reduce the risk of CVD? Initial studies had conflicting results, with some showing benefits, while other studies demonstrated harm. Upon further investigation, the timing hypothesis became understood. This posits that early initiation of menopausal hormone therapy results in a reduction of risk of cardiovascular disease, while late initiation can be harmful. Early initiation means starting hormonal therapy within 10 years of menopause and/or by the age of 60. The risks of estrogen therapy also vary by route of administration, with the oral route being associated with an increased risk of clot formation. Topical (creams, gels, patches) and injectable routes, however, have a lower likelihood of clot formation.

Be sure you know your full risk for heart disease and take action early to reduce that risk. At Afiya Health, we proactively consider your heart health. We combine the latest research on aging with traditional knowledge to develop programs that help our clients live their best lives.

If you’re ready to start your journey to longevity, Afiya Health is here to help. Our personalized, data-driven plans use trusted biomarkers to help you live longer and healthier. We’ll empower you to feel your best, while providing the support you need to make lasting changes.


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