Heart Disease Is Women’s No. 1 Killer. What Should You Check?

What does this mean for you?

Heart disease is the number one cause of death for women in the United States. What does that mean for you if you feel well and you've been told your blood work is normal?

What should you actually check?

I'm Lisa, a physician assistant, a mother of four, and the founder of Heart Reserve. I began my career in heart care. Years later, during my complicated twin pregnancy, I experienced heart failure myself.

I know how different a medical conversation feels when you're the person who needs answers.

Today, let's connect four things: your symptoms, your pregnancy history, your blood pressure, and your blood tests. There's new research from September, and a change in this year's cholesterol guidance that you may not have heard about.

The symptoms that should not wait

First, symptoms. Chest pain or discomfort is still the most common heart attack symptom in women. It can feel like pressure, squeezing, or heaviness. It doesn't have to look like someone clutching her chest and falling down.

Women can also have shortness of breath, nausea, a cold sweat, or pain in the jaw, back, or an arm. Sometimes there is no chest pain.

If you think you could be having a heart attack, call 911. Don't drive yourself or wait for a routine appointment.

If something keeps happening, describe it clearly. For example: I used to climb these stairs without stopping. Now I'm short of breath halfway up. When did it start? What brings it on? What makes it better?

That kind of detail helps your care team understand what changed.

A normal test answers a particular question

Heart disease includes more than blocked arteries.

Some women have trouble with the tiny blood vessels supplying the heart. Those vessels may not open properly when more blood is needed. Tests looking for a large blockage may not find that problem.

That doesn't mean every unexplained symptom comes from your heart. It means continuing symptoms deserve a clear follow-up plan. Ask: What did this test rule out, and what are we considering next?

Heart failure is another condition. The heart isn't filling or pumping well enough to meet the body's needs. It doesn't mean the heart has stopped. Different heart problems need different tests and treatments.

Your pregnancy history still belongs in your medical history

Did your blood pressure rise during pregnancy? Did you develop diabetes while pregnant? Was your baby born early?

Those details still belong in your medical history, even if your children are grown.

A study published in twenty twenty three followed more than two million women in Sweden who had single-baby deliveries. Several pregnancy complications were linked with a higher chance of disease affecting the heart's blood supply decades later.

That was an observational study. It found a connection; it didn't prove that a pregnancy complication caused the later heart disease.

And a complication doesn't mean you will develop heart disease. It gives your care team useful information about what to watch.

You can say: My blood pressure went up during pregnancy and came down afterward. Does that change how often we check my blood pressure, cholesterol, or blood sugar now?

If you've never been pregnant, your family history, symptoms, and current health still deserve this same attention.

What September’s blood-pressure study found

Here's the new research I want you to know about. In September twenty twenty six, researchers reported blood-pressure patterns in more than six thousand women in the Framingham Heart Study.

They looked at pulse pressure. That means the gap between the top and bottom numbers. A reading of one twenty over eighty has a gap of forty.

On average, that gap began shifting upward in women's late thirties, years before their final period. The timing didn't simply follow when menopause happened.

This study doesn't mean every woman in her thirties has heart disease. It doesn't prove that hormones don't matter. Most participants were white, and the study couldn't establish cause and effect.

The practical point is that you don't have to wait for menopause to ask about your blood pressure. Bring both numbers and how they've changed over time. This study doesn't create a new treatment cutoff.

Know what your blood-pressure numbers mean

The top blood-pressure number is the pressure when your heart squeezes. The bottom is the pressure between beats. High blood pressure often gives you no warning symptoms.

Readings that average a top number of one thirty or higher, or a bottom number of eighty or higher, deserve a conversation and a plan. One reading alone usually doesn't make the diagnosis.

If your clinician recommends home checks, use a validated upper-arm monitor with a cuff that fits. Ask your clinician or pharmacist if you're unsure. Sit quietly for five minutes, with your back supported, feet flat, and arm supported at heart level. Take two readings a minute apart and record them.

Bring those numbers. Ask: What is my goal, and when should we review this again?

The blood test your usual cholesterol panel may miss

Now, blood tests. Start by understanding the results you already have.

LDL cholesterol tells us about cholesterol carried in particles that can contribute to buildup in artery walls. Your target depends on your overall risk. A lab's normal range isn't a complete prevention plan.

And here's a twenty twenty-six update. The new American heart and cholesterol guidelines recommend checking lipoprotein(a), often written Lp(a), at least once in adulthood.

It's an inherited type of cholesterol-carrying particle. A high level can raise heart attack and stroke risk, even when your usual cholesterol numbers look reassuring. It usually needs a separate blood test.

Ask: Have I had this checked, and would the result change my plan? At least once doesn't mean a repeat test is never useful.

Also ask whether you need a blood-sugar check. One option is A1C, which estimates your average blood sugar over about three months. The right test and timing depend on your health history.

Turn the information into a plan

So what do you do with all of this?

Write down one change you've noticed, any important pregnancy complications, and heart problems in your family. Bring your blood-pressure readings and your blood-test results.

Then ask four questions.

What in my history changes my heart risk?

Which numbers should we check, and what should my goals be?

What is one change or treatment most likely to help me now?

When will we check whether the plan is working?

Food, movement, sleep, avoiding tobacco, blood pressure, cholesterol, blood sugar, and weight are the American Heart Association's eight areas for heart health. Work with your team on the areas that need attention. Some people need medicine as well as changes in daily habits.

You deserve to understand the reason for your plan.

You can organize your questions in the free Heart Story at heart reserve dot blog. Follow Heart Reserve for more medicine you can understand. Our hormone episode looks at estrogen, progesterone, and testosterone, and what each is actually meant to help.

This is general education. Your care team can help you make personal medical decisions. I'm Lisa. Know your story. Build your reserve.