Men vs Women: Who's More at Risk of Heart Disease and Why?

When you think about someone at risk of heart disease, who comes to mind?

Perhaps a middle-aged man with high cholesterol, high blood pressure or a stressful job.

But heart disease isn't just a man's health concern. Men and women can both develop heart disease, but their cardiovascular risk can look different depending on age, life stage, health conditions and other factors.

Men, for example, tend to develop coronary heart disease at younger ages. For women, cardiovascular risk can change during midlife and around menopause, while certain pregnancy-related conditions can also provide clues about future heart health.

Understanding how heart disease can affect men and women differently may be more useful than trying to decide who has the higher risk overall.

What Is Heart Disease?

Heart disease isn't just one condition. It is a broad term used for problems that affect the heart and the blood vessels around it.

One of the most common is coronary artery disease, which happens when fatty deposits and plaque build up inside the arteries that supply blood to the heart. As the arteries become narrower, less blood can reach the heart, which can eventually lead to a heart attack.

But blocked arteries aren't the only heart problems to be aware of. Heart disease can also affect different parts of the heart, including:

• Arrhythmias – problems with the heart's rhythm or heartbeat
• Heart valve disease – problems that affect how blood flows through the heart
• Cardiomyopathy – conditions that affect the heart muscle
• Heart failure – when the heart cannot pump blood as effectively as it should

While these conditions can have different causes and symptoms, many share common risk factors. Some may also develop gradually until conditions become more advanced.

That's why understanding your risk is important even when you feel perfectly healthy.

Men May Develop Heart Disease Earlier

Men tend to develop coronary heart disease at younger ages than women.

There isn't one single explanation for this difference. Biological factors, hormones, lifestyle, and the presence of other health conditions can all play a role.

That makes it important for men to pay attention to their heart health earlier, rather than assuming heart disease is something to worry about later in life. High blood pressure, high cholesterol, smoking, diabetes, excess weight, and physical inactivity can all increase the likelihood of cardiovascular problems over time. Some of these conditions can develop without obvious symptoms, making regular health checks particularly important.

This can be especially relevant if you have a family history of heart disease or have several risk factors. Feeling well doesn't necessarily mean your heart is free from risk.

Why Women's Heart Health Can Change in Midlife

For women, age and life stage add another dimension to the picture.

Women generally develop coronary heart disease later than men. However, the years around perimenopause and menopause can bring a number of changes that are relevant to heart health.

As women move through the menopause transition, changes in hormones can occur alongside shifts in cholesterol, blood pressure, body composition and blood sugar. These factors can contribute to an overall change in cardiovascular risk.

That doesn't mean menopause itself causes heart disease. Instead, midlife can be a useful point to take stock of your heart's health and see whether anything has changed.

Some Heart Disease Risks Are Unique to Women

There's another part of the story that doesn't apply to men: pregnancy. Pregnancy can provide important information about a woman's future cardiovascular health.

Certain pregnancy complications, including:

• Pre-eclampsia
• Pregnancy-related hypertension
• Gestational diabetes

Have been associated with a higher risk of cardiovascular disease later in life.

Having one of these conditions doesn't mean that a woman will develop heart disease. Instead, it can be useful information to share with a healthcare professional when assessing long-term health.

For example, someone who experienced high blood pressure during pregnancy may benefit from paying closer attention to their blood pressure and other cardiovascular risk factors in the years that follow.

Your pregnancy history can be part of your heart-health history.

What Are the Risk Factors for Heart Disease?

For all the differences between men and women, many of the biggest risk factors are the same.

These include:

• High blood pressure
• High cholesterol
• Diabetes or high blood sugar
• Smoking
• Physical inactivity
• Excess weight or obesity
• Unhealthy diet
• Family history of cardiovascular disease
• Increasing age
• Poor sleep and chronic stress

The main difference is that women may also have additional risk factors linked to their reproductive and medical history, including pregnancy complications, menopause, autoimmune conditions and previous breast cancer treatments.

Ultimately, there is no single answer to which gender is at higher risk. Your overall cardiovascular risk depends on a combination of factors, including your age, health conditions, family history, and lifestyle.

Do Men and Women Experience Heart Attacks Differently?

There is an important difference between heart disease risk and heart attack symptoms.

The most common heart attack symptom in both men and women is chest discomfort. It may feel like pressure, tightness, squeezing, heaviness, or pain in the centre of the chest. Discomfort can also spread to the arm, shoulder, back, neck, jaw, or upper abdomen.

Other possible symptoms include:

• Shortness of breath
• Cold sweats
• Dizziness or lightheadedness
• Nausea or vomiting
• Palpitations
• Unusual weakness or fatigue

But women may be somewhat more likely to experience symptoms such as nausea, fatigue and breathlessness, either alongside chest discomfort or sometimes without prominent chest pain.

This is important because these symptoms can easily be mistaken for stress, lack of sleep, or simply having an off day.

If you experience new, unexplained or concerning symptoms, particularly when they occur together or with chest discomfort, don't ignore them. Seek medical attention promptly.

How Can You Reduce Your Risk of Heart Disease?

The good news is that many cardiovascular risk factors can be identified and managed.

Start with the basics:

1. Know Your Numbers

Keep track of your blood pressure, cholesterol, and blood sugar where appropriate.

2. Stay Physically Active

Regular physical activity can support cardiovascular health and help manage weight, blood pressure, and blood sugar.

3. Don't Smoke

Smoking is a major cardiovascular risk factor, so quitting is one of the most important steps you can take for your heart.

4. Pay Attention to Your Diet

A balanced eating pattern that prioritises nutritious foods and limits excess saturated fat, salt and added sugars can support heart health.

5. Know Your Family History

If a close family member has had heart disease, particularly at a younger age, let your doctor know. Family history can help put your other risk factors into context.

6. Consider Your Life Stage

For women, pregnancy complications and the menopause transition can be relevant when assessing cardiovascular risk. For men, developing risk factors at a younger age is a reason to take prevention seriously rather than assuming heart disease is something to worry about later.

So, Who Is More at Risk of Heart Disease?

There isn't one simple answer. Men and women experience cardiovascular risk differently across the lifespan. Men can develop coronary heart disease earlier, while women may see their cardiovascular risk change significantly during and after the menopause transition. Both can also be affected by the same major risk factors, from high blood pressure and cholesterol to diabetes, smoking, and physical inactivity.

The most important takeaway is not who wins the risk comparison. It's knowing your own heart health profile.

Because when it comes to heart disease, prevention is not about waiting for symptoms. It is about understanding your risk early, making healthy choices, and getting the right checks at the right time.

Your heart doesn't need to be compared with anyone else's. It needs to be looked after.

Take the Next Step for Your Heart Health

If you're concerned about your heart health or would like to better understand your cardiovascular risk, speak with a cardiologist.

At Nobel Heart Centre, Dr Koh Choong Hou, Dr Leow Khang Leng and Dr Saurabh Rastogi provide specialist cardiac care across prevention, screening, diagnosis and treatment. Whether you’re looking to better understand your heart health, assess your cardiovascular risk or seek treatment for an existing heart condition, our cardiologists can provide personalised care based on your individual needs.

This World Heart Day, make your heart a priority. Understanding your risk is one of the first steps towards protecting your heart and it's never too early to start.

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