Women Most Vulnerable to Heart Disease Risk Factors.

Emerging evidence underscores a troubling disparity: certain heart disease risk factors—think poor nutrition, high blood pressure, elevated cholesterol—appear to carry a significantly greater weight for women than for men.

In a compelling presentation at the American College of Cardiology’s Annual Scientific Session, researchers revealed that although women are nearly twice as likely to lead overall healthier lifestyles, when they do fall short—be it in diet, lipid control, or blood pressure regulation—the cardiovascular consequences hit harder than they do for their male counterparts.

Heart disease, the long-standing and ruthless leader in causes of death for both genders across the United States, is an equal-opportunity killer. Yet the journey to diagnosis, treatment, and prevention seems far from equal.

"Women are often overlooked when it comes to identifying and addressing heart disease risk," explained Dr. Rachel Bond, a system director of women’s heart health at Dignity Health in Arizona. Although she wasn't directly involved with the study, she emphasized that women frequently receive less guidance and support when it comes to lifestyle interventions—an oversight with potentially fatal consequences.

According to Dr. Maneesh Sud, the study’s lead author and a cardiologist at Sunnybrook Health Sciences Centre in Toronto, the research calls for a more refined, individualized approach to cardiovascular risk assessment. “There’s no universal blueprint for heart health,” he told Health. “What works for one demographic may not apply across the board.”

Unpacking the Risk Landscape

Drawing on data from over 175,000 individuals who took part in the Ontario Health Study from 2009 through 2017, the researchers mapped out an extensive health profile for each participant. None had a prior history of heart disease at enrollment.

From diet quality and sleep hygiene to physical activity levels, smoking status, blood sugar, cholesterol, blood pressure, and obesity—each factor was logged meticulously. Over time, outcomes such as heart attacks, strokes, heart failure, and cardiovascular-related deaths were tracked, with data collection continuing through March 2023.

On average, the women in the study were 47 years old; the men, slightly older at 50. But that minor age gap belied a striking pattern of gendered health behavior.

More than half of the women—54%—consumed an “ideal” diet (defined here as five or more daily servings of fruits and vegetables). Among men, only 35% hit that mark. Similarly, 73% of women maintained healthy blood pressure compared to 68% of men. Glucose levels followed suit: 92% of women versus 89% of men were in the healthy range.

Across the board, both groups showed similar statistics in terms of nicotine use, sleep duration, cholesterol levels, and obesity rates. But when it came to exercise, the tables turned: 73% of men were meeting physical activity recommendations, whereas just 70% of women were.

And here's the kicker—while poor scores on these risk metrics predicted higher rates of cardiovascular events in both sexes, the association was nearly twice as strong for women. The very same red flags waved brighter and louder when it came to women's hearts.

What This Means for Women

So where does this leave us? Dr. Sud and his team are setting their sights on the next layer: hormones. Specifically, they plan to investigate how menopause—and the hormonal shifts it brings—might amplify women’s vulnerability to heart disease.

Estrogen, a hormone that declines during perimenopause (typically occurring in a woman’s 40s or 50s), has long been suspected to offer a protective effect on heart health. But the exact mechanism? Still murky. “It’s challenging to disentangle hormonal changes from age-related ones,” Dr. Sud said.

Nonetheless, what is clear is this: women are more acutely affected by certain cardiovascular risk factors. That reality demands a shift in how clinicians approach prevention and treatment, said Dr. Bond. “Counseling must be gender-responsive,” she urged. “It’s not just a medical recommendation—it’s a necessity.”

She also pointed to earlier studies with sobering findings: when women smoke the same number of cigarettes for the same duration as men, their risk of developing heart disease is a staggering 25% higher.

And although the current research focused on Canadian participants, the results hold global relevance. “The population demographics in Canada closely mirror those of the U.S.,” Dr. Bond noted. “These insights are broadly applicable.”

She also addressed a social undercurrent that might be contributing: women, especially in Western cultures, tend to deprioritize their own well-being. “Too often, women put their families, their jobs, and even their communities ahead of themselves—and their health suffers for it.”

Dr. Annapoorna Kini, a cardiologist and director at Mount Sinai Fuster Heart Hospital in New York, echoed this sentiment. “In the U.S., the pressure to excel is relentless. We glorify being overworked. In contrast, cultures in Europe or South America often move at a slower, more balanced pace.”

Stress, she explained, acts as a stealthy saboteur. “If you’re constantly anxious or exhausted, you're less likely to cook nutritious meals, squeeze in a workout, or get quality sleep. Everything falls apart from there.”

Yet there’s hope woven into this warning. While negative factors like high blood sugar or poor diet may hit women harder, the inverse is also true—positive lifestyle choices can offer extraordinary protection.

“We need to double down on prevention for women,” Dr. Kini urged. “Because when healthy habits are in place, their impact can be even more powerful.”