Nationally Ranked in Cardiology

UT Southwestern Medical Center is recognized by U.S. News & World Report as one of the nation's top 20 hospitals for cardiology, heart, and vascular surgery.

Heart disease is equally common in both men and women, but differences in anatomy, hormones, risk factors, and symptoms make some aspects of heart disease unique in women compared to men. These differences can influence how heart conditions develop, how they are diagnosed, and how they respond to treatment.

As a premier center of excellence for cardiovascular medicine, UT Southwestern provides advanced, specialized care for women with heart disease. Our cardiologists, surgeons, and specialized care teams offer personalized evaluation, prevention strategies, and treatment plans that address the unique aspects of women’s heart health.

What Is Women’s Heart Health?

Cardiovascular disease has been the leading cause of death for women in the United States for decades. Conditions such as heart attack and stroke affect millions of women each year, and about one in four deaths among women in the U.S. is related to heart disease.

Research now shows that heart disease can develop and present differently in women than in men. Differences in anatomy, hormones, and risk factors can influence how symptoms appear, how conditions progress, and how patients respond to treatment. Increased awareness has helped improve early diagnosis and more personalized prevention and care.

What Types of Heart Disease Affect Women?

Heart disease is the leading cause of death for both men and women, but certain conditions are more common in women or may appear differently in women.

The most common type, coronary artery disease (CAD), occurs when plaque builds up and narrows or blocks the coronary arteries, which are the blood vessels that supply blood to the heart muscle.

Women are also at risk for abnormal heart rhythms, heart failure, and valvular heart disease. The management of these conditions can be more effective when they’re tailored to women’s needs.

The following conditions are more likely to affect women:

• Coronary microvascular disease, which is when the small arteries in the heart are unable to adequately provide blood flow to the underlying heart muscle
• Coronary artery vasospasm, which is when the heart arteries spontaneously close, decreasing blood flow to the underlying heart muscle
• Takotsubo cardiomyopathy, commonly called broken heart syndrome, a temporary weakening of the heart muscle often triggered by extreme emotional or physical stress
• Spontaneous coronary artery dissection (SCAD), a tear in the wall of a coronary artery
• Myocardial infarction with nonobstructive coronary arteries (MINOCA), a type of heart attack that occurs without significant blockage in the coronary arteries
• Heart failure with preserved ejection fraction (HFpEF), a condition in which the heart pumps normally but cannot relax and fill properly because the heart muscle becomes stiff

What Causes Heart Disease in Women?

Many of the underlying causes of CAD are the same in men and women, but certain risk factors and biological differences can affect how heart disease develops in women.

CAD results from damage to the lining and walls of the coronary arteries. Certain factors lead to this damage in both men and women:

• Smoking, even secondhand smoke
• High blood pressure (hypertension)
• High blood sugar levels caused by diabetes or prediabetes
• Inflammation in blood vessels
• High blood levels of cholesterol, certain fats, calcium, and other substances

Other factors that are specific to women can increase their risk for future heart disease. These include:

• Pregnancy-related complications such as preeclampsia (high blood pressure during pregnancy)
• Early menopause

Cholesterol and other substances in the blood can build up inside artery walls, causing atherosclerosis, also known as hardening of the arteries. Plaque can begin building up in coronary arteries as early as childhood.

As plaque accumulates, it can narrow the coronary arteries and restrict blood flow to the heart. Plaque can also rupture, damaging the artery wall. Platelets in the blood stick to damaged areas and can form a clot that partially or completely blocks the artery.

When coronary arteries narrow, they can cause angina (chest pain). Complete blockage of the coronary arteries causes a heart attack.

Not all heart disease is caused by blocked arteries. For example, SCAD can cause a heart attack when a tear forms in a heart artery without a cholesterol blockage. SCAD often has no clear trigger but can be linked to stress or pregnancy-related hormone changes.

How Is Heart Disease Diagnosed in Women?

Many of the same diagnostic tests are used for both men and women, though doctors may use additional testing when evaluating conditions that occur more often in women.

At UT Southwestern, our experienced heart specialists conduct a thorough evaluation to confirm a diagnosis of heart disease and identify the specific cause of a patient’s symptoms while ruling out other conditions with similar symptoms.

During the evaluation, patients can expect a:

• Physical exam
• Review of personal and family medical history
• Discussion of symptoms and risk factors
• Review of test results

Depending on each patient’s case, our doctors might recommend one or more tests, such as:

• Blood tests: These tests check blood levels of cholesterol, triglycerides, sugar, and other substances that could increase the risk of heart disease.
• Cardiac catheterization: This minimally invasive procedure uses a catheter (long, thin, flexible tube) inserted through a small incision into an artery to visualize blood flow in the heart’s coronary arteries. For some patients, additional testing during the procedure can help diagnose microvascular dysfunction or coronary artery spasm.
• Cardiac computed tomography (CT) scans: This imaging test uses X-rays to create 3D pictures of the heart and blood vessels.
• Cardiac magnetic resonance imaging (MRI): MRI uses magnets and a computer to show moving and still images of the heart and its blood vessels to assess blood flow.
• Chest X-ray: This imaging test examines organs and other structures inside the chest, which can show signs of heart failure or causes of other, unrelated conditions.
• Coronary artery calcium score: This type of CT scan measures calcium buildup in the coronary arteries to help estimate a patient’s risk of CAD.
• Echocardiogram: This ultrasound test of the heart evaluates its structure, function, and blood flow and can show evidence of prior injury to the heart muscle.
• Electrocardiogram (EKG): An EKG is a noninvasive test that records the heart’s electrical activity to check for abnormal heart rhythms.
• Stress test: An EKG and sometimes additional imaging are performed while the patient exercises or receives medication to increase the heart rate to evaluate how the heart functions under stress.

What Clinical Trials Are Available for Women’s Heart Health?

UT Southwestern conducts clinical trials focused on improving the prevention, diagnosis, and treatment of heart disease, including conditions that affect women. Eligible patients may have the opportunity to participate in studies evaluating innovative treatments and care strategies.

Current clinical trials include:

The Heart Outcomes in Pregnancy Expectations for Mom and Baby Study (HOPE)

The HOPE Study follows pregnant patients with heart disease during pregnancy and after delivery. The study aims to help doctors improve care for women with high-risk pregnancies and heart conditions.

International Spontaneous Coronary Artery Dissection (SCAD) "iSCAD" Registry

The iSCAD Registry collects information from patients who have had SCAD, a less common cause of heart attack that often affects women. By joining, patients can help researchers better understand what causes SCAD, how it affects people over time, and which treatments may work best.

Patients can talk with their care team to learn whether a clinical trial is right for them.