Why Every Woman Should Know Her Heart Health Numbers

Periodically, I have a colleague contribute a guest column.  This month, Dr. Lacy Campbell, a naturopathic physician resident at A Woman’s Time in Portland, Oregon has written an excellent article on essential issues in cardiovascular disease in women.  Thank you, Dr. Campbell, and I hope you all take note.

 

Lacy Campbell, ND

Cardiovascular disease is the leading cause of death among women – not just in the United States, but around the world. Yet many women still think of heart disease as a “man’s disease.” The reality is that heart disease affects women differently, and the warning signs and risk factors are often overlooked until it’s too late.

Naturopathic physicians place a high value on prevention, which begins with awareness. Understanding your cardiovascular risk and getting the right screenings at the right time can help you take proactive steps to protect your long-term health and reduce your risk of heart attack, stroke, heart failure, and other cardiovascular conditions.

Heart Disease in Women: More Common Than Many Realize

While breast cancer receives significant attention – and rightfully so – cardiovascular disease claims far more lives each year. The encouraging news is that most cardiovascular disease is linked to risk factors that can be identified early and improved through lifestyle changes, medical treatment, and regular monitoring.

Research shows that the vast majority of heart attacks in women are associated with a handful of modifiable risk factors, including high blood pressure, diabetes, smoking, obesity, abnormal cholesterol levels, physical inactivity, poor nutrition, and chronic stress. While these risks are shared by both men and women, they do not affect women equally.

Risk Factors Affect Women Differently

Certain traditional cardiovascular risk factors carry a disproportionately greater impact in women.

Women with diabetes, for example, have a significantly higher risk of developing heart disease compared to men with diabetes. Elevated blood sugar damages blood vessels over time and can accelerate the development of atherosclerosis – the buildup of plaque within the arteries.

Smoking is another example. Although smoking increases cardiovascular risk for everyone, studies show that women who smoke experience an even greater relative risk of coronary artery disease than men who smoke. Unfortunately, smoking rates have risen among younger women in recent years, making this an important focus of prevention.

High blood pressure is especially common after menopause and is one of the leading contributors to heart failure in women. Because hypertension often causes no symptoms, many women are unaware they have it until complications develop.

Obesity and physical inactivity also play a major role. Women experience higher rates of obesity worldwide, and excess weight contributes to high blood pressure, diabetes, inflammation, and heart failure. At the same time, women tend to be less physically active than men across all age groups. Even modest increases in activity can provide meaningful cardiovascular benefits.

Mental and emotional health cannot be overlooked either. Women experience higher rates of depression, anxiety, trauma-related disorders, caregiving stress, and other psychosocial burdens. These factors can directly influence cardiovascular health through inflammation, increased blood pressure, disrupted sleep, and unhealthy coping behaviors. In fact, depression following a heart attack is associated with a significantly increased risk of future cardiovascular events and mortality.

Female-Specific Risk Factors You Should Not Ignore

One of the most important developments in women’s cardiovascular medicine has been recognizing that a woman’s reproductive history provides valuable insight into her future heart health.

Pregnancy acts almost like a cardiovascular stress test. Complications such as preeclampsia, gestational diabetes, gestational hypertension, preterm delivery, placental abruption, or delivering a small-for-gestational-age infant can all signal an increased risk of cardiovascular disease later in life. Unfortunately, many women are never informed of this connection after pregnancy.

Other female-specific risk enhancers include premature menopause before age 40 and polycystic ovary syndrome (PCOS), now called polyendocrine metabolic ovarian syndrome (PMOS),  which is associated with metabolic changes that increase cardiovascular risk.

Women are also significantly more likely than men to develop autoimmune diseases such as lupus, rheumatoid arthritis, and Hashimoto’s thyroiditis. The chronic inflammation associated with these conditions can accelerate cardiovascular disease.

In addition, some cancer treatments – including certain chemotherapy medications and radiation therapy – may affect cardiovascular health and should be considered when assessing long-term risk.

When Should Women Be Screened?

The American College of Cardiology and American Heart Association recommend that cardiovascular risk assessment begin in early adulthood.

Between the ages of 20 and 39, women should have regular screening of blood pressure, cholesterol, blood glucose, and lifestyle risk factors approximately every four to six years, or more frequently when additional risk factors are present or abnormal results are observed.

Beginning around age 40, cardiovascular screening becomes increasingly important. This is also when healthcare providers often begin calculating a woman’s estimated risk of developing cardiovascular disease within the next ten years.

Women who experienced gestational diabetes or hypertensive disorders of pregnancy should undergo ongoing cardiovascular monitoring after delivery, as these conditions can signal elevated long-term risk. Similarly, menopause represents an important opportunity to reassess blood pressure, cholesterol, diabetes risk, weight, and overall cardiovascular health.

A New Era in Cardiovascular Risk Assessment: The PREVENT Calculator

For many years, healthcare providers have relied on the ASCVD Risk Calculator, also known as the Pooled Cohort Equations (PCE), to estimate a person’s 10-year risk for heart attack or stroke. While this tool has been useful, it was based on data from approximately 25,000 participants enrolled in studies that began decades ago.

Today, we have a newer and more accurate tool.

The PREVENT™ Risk Equation was developed using health data from more than 3.3 million contemporary U.S. adults and validated in an additional 3.3 million individuals. Because it reflects modern populations, current treatment approaches, and today’s cardiovascular risk patterns, it offers substantially improved accuracy when estimating risk.

The 2026 ACC/AHA Dyslipidemia Guidelines now recommend PREVENT as the preferred tool for estimating 10-year cardiovascular risk.

Why does this matter? Studies have shown that the older ASCVD calculator often overestimates cardiovascular risk in today’s populations, sometimes by nearly two-fold. As a result, some individuals may have previously been classified as higher risk than they actually were. In comparison, PREVENT generally produces risk estimates that are 40–50% lower while maintaining excellent calibration across diverse patient populations.

Another advantage of PREVENT is that it incorporates additional measures of overall health, including kidney function, and can optionally include markers such as hemoglobin A1c and urine albumin-to-creatinine ratio. These factors provide a more complete picture of cardiometabolic risk than cholesterol and blood pressure alone.

Why Risk Calculators Don’t Tell the Whole Story for Women

Although PREVENT is a major step forward, no cardiovascular risk calculator fully captures the unique factors that influence women’s heart health. Neither the traditional ASCVD calculator nor the PREVENT equation directly accounts for a history of preeclampsia, gestational diabetes, premature menopause, PMOS, or many other female‑specific risk factors. These conditions are considered “risk enhancers” and may warrant a more aggressive prevention strategy even when a calculated risk score appears relatively low. For example, a woman with a low PREVENT score but a history of severe preeclampsia and premature menopause may have a higher lifetime cardiovascular risk than the calculator alone suggests.

ApoB should be checked periodically as part of comprehensive cardiovascular risk assessment, and Lipoprotein(a) should be checked once in a lifetime unless new clinical concerns arise.  A family history of parents, siblings or children with early cardiovascular disease should trigger the addition of these two tests.

This is why cardiovascular prevention should never be reduced to a single number.

If You Need a Statin, Don’t Be Afraid of It

One of the most common concerns we hear from women is, “I don’t want to take a statin.” While it’s reasonable to have questions about any medication, statins are among the most extensively studied medications in medicine and have been shown to significantly reduce the risk of heart attack, stroke, and cardiovascular death in appropriately selected patients.

Unfortunately, misinformation and alarming stories on social media can make statins seem more frightening than they actually are. The reality is that most people tolerate statins very well. When side effects do occur, they are typically mild and reversible.

Some individuals may experience muscle aches, fatigue, or digestive symptoms after starting a statin. In most cases, these symptoms improve with supplementation, when the medication is stopped, switched to a different statin, or adjusted to a lower dose. Serious side effects are uncommon, and your healthcare provider can monitor for them through routine follow-up and lab testing when appropriate.

It’s also important to remember that taking a statin does not mean you’ve failed at living a healthy lifestyle. Heart disease is influenced by many factors beyond diet and exercise, including genetics, age, pregnancy history, menopause, inflammation, and other health conditions. For many women, statins are simply another tool that works alongside healthy eating, exercise, stress management, and other preventive measures.

With newer risk assessment tools like the PREVENT calculator and a better understanding of female-specific cardiovascular risk factors, we can make more personalized decisions about who is most likely to benefit from medication. If your risk is high enough that a statin is recommended, the goal is not to add another prescription unnecessarily – it’s to reduce your chances of experiencing a preventable heart attack or stroke years down the road.

If a statin is being considered,  discuss  with your clinician and ask questions regarding your individual risk, potential benefits, possible side effects, and alternatives so that you can make an informed decision that feels right for you.

There are also naturopathic approaches that can help lower cholesterol, support healthy blood pressure, and reduce overall cardiovascular risk. Regardless of whether statins are part of your plan, we always address foundational pillars first: nutrition, exercise, and stress management. When your numbers indicate borderline – but not high – risk, we can consider targeted natural options such as berberine, bergamot, and/or red yeast rice as alternatives to statins, alongside lifestyle strategies to improve long‑term cardiovascular health.

The bottom line: Statins are not scary, and any side effects that do occur are typically reversible when the medication is stopped. For the right patient, they can be one of the most effective tools we have for protecting long-term heart health.

Know Your Numbers

Understanding your health metrics is one of the most empowering steps you can take for your long-term health.

Important cardiovascular measures include:

• Blood pressure, ideally below 120/80 mmHg
• LDL (“bad”) cholesterol, ideally below 100 mg/dL
• HDL (“good”) cholesterol, ideally above 50 mg/dL
• Triglycerides below 150 mg/dL
• Blood glucose within a healthy range based on your age and medical history

These numbers provide valuable information, but they should always be interpreted within the context of your personal health history.

The Power of Prevention

The most effective strategies for reducing cardiovascular risk are often the simplest.

A heart-healthy diet rich in vegetables, fruits, legumes, nuts, whole grains, and fish has been shown to reduce cardiovascular risk. Women who consume higher-quality diets experience significantly lower rates of cardiovascular mortality. Regular exercise is equally important. Current guidelines recommend at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity each week, with even greater benefits seen at higher activity levels.

For women who smoke, quitting remains one of the most powerful interventions available. Likewise, prioritizing sleep, stress management, social connection, and mental health support can have meaningful effects on both emotional well-being and cardiovascular health.

It’s also important to note that hormone therapy should not be used solely for the purpose of preventing cardiovascular disease after menopause. Women considering hormone therapy should discuss the benefits and risks with their healthcare provider based on their individual health goals and medical history.

Find a Clinician with a Comprehensive Approach. 

At our clinic, A Woman’s Time, we take a comprehensive and personalized approach to cardiovascular prevention. During your wellness visits, we look beyond cholesterol and blood pressure alone. We consider the factors unique to women – including pregnancy history, hormonal transitions, metabolic health, autoimmune conditions, stress, sleep, and family history – to gain a more complete understanding of your cardiovascular health.  There are clinics and clinicians in most areas of the country that can offer this comprehensive and personalized approach as well.  You can look for a licensed naturopathic physician, or an integrative/functional medicine M.D. or D.O. or nurse practitioner as well.

Whether you’re in your 20s, navigating pregnancy, transitioning through menopause, or planning for healthy aging, understanding your cardiovascular risk is one of the most important investments you can make in your future.

Because when it comes to heart disease, knowing your numbers is important – but understanding your story is essential. ❤️