Most women in Canada have at least one risk factor for heart disease and stroke. Women who have diabetes, come from certain ethnic backgrounds or are menopausal are even more at risk.
It is important for every woman to know about their risk factors so that you can prevent heart disease and stroke, and recognize the signs so you can get help immediately.
Women tend to be safeguarded from heart disease prior to menopause because of the protective effect of estrogen. However, this is not always the case. For example, pregnancy is the first increased risk time for women, and pre-menopausal women with diabetes have similar risk to men of the same age because diabetes cancels out the protective effect of estrogen.
The role of estrogen
During a woman's reproductive life cycle, from about age 12 to 50, the naturally occurring hormone, estrogen, provides a protective effect on women's heart and brain health. However, estrogen's protective effect can change depending on a variety of factors and conditions.
Gender-affirming hormone therapy puts trans women at increased risk for stroke, blood clots and heart attacks.
Women who are taking estrogen as part of Hormone Replacement Therapy (HRT) have an increased risk of stroke and heart attack. If you are on HRT, discuss with a healthcare professional what this means for you and what your options are.
Birth control pills (oral contraceptives)
Modern oral contraceptives are much safer than the forms used decades ago as they are lower in estrogen. Oral contraceptives, especially high-dose estrogen or estrogen only, can increase the risk of high blood pressure and blood clots – both of which are stroke risks. The risk is greater if you: smoke, already have high blood pressure, are over the age of 35, experience migraine with aura, have other risk factors for heart disease or stroke, or already have a blood clotting problem.
Talk to your healthcare provider about the risks and benefits of oral contraceptives for you.
Pregnancy
Over the nine months of gestation, women may develop certain conditions that put them at higher risk of heart disease and stroke.
- Pre-eclampsia is a condition that typically starts after the 20th week of pregnancy. It is related to increased blood pressure and protein in the mother's urine (the protein indicates that there is a problem with the kidneys). Although there is no proven way to prevent pre-eclampsia, you may be prone to the condition if you have high blood pressure or are obese prior to becoming pregnant. Other risk factors include being younger than 20 or older than 40, are pregnant with more than one baby, or have diabetes, kidney disease, rheumatoid arthritis, lupus or scleroderma. All women should be routinely monitored by their healthcare provider throughout their pregnancy. Have your blood pressure checked often. Pre-eclampsia is treatable under the supervision of a doctor.
- Gestational diabetes While pregnant, a woman's body must produce extra insulin because increasing levels of pregnancy hormones interfere with the body's ability to use insulin efficiently. If the woman's body can't produce the additional insulin sufficiently, her blood sugar levels may rise, causing gestational diabetes. There are no warning signs so it is important that women have their glucose levels monitored as part of their prenatal care and continue to be monitored throughout their pregnancy. Gestational diabetes can increase the risk of the mother and baby developing diabetes later in life. Diabetes is a risk factor for heart disease and stroke.
- The risk of a pregnancy-related stroke can happen at any stage of pregnancy. A high risk time is during childbirth and the first few months after birth. It is usually the result of an underlying problem such as a pre-existing blood vessel malformation or eclampsia. Read about the signs of stroke.
- Peripartum cardiomyopathy (PPCM) is a rare form of cardiomyopathy that occurs in pregnant women and recent mothers, and is often misdiagnosed. PPCM causes your heart to become larger around the time of your delivery. This enlargement weakens your heart muscle and makes pumping blood more difficult. When your blood can’t circulate well enough to support vital organs, it can lead to heart failure. Learn more about PPCM.
Menopause
Menopause is a time when a woman stops having menstrual cycles. Your risk of heart disease and stroke increases after menopause. If you have early onset menopause, your risk is higher. Before and after menopause, you may experience:
- An increase in total blood cholesterol, low density lipoprotein cholesterol (LDL or ‘bad’ cholesterol) and triglyceride levels
- A decrease in high density lipoprotein cholesterol (HDL or ‘good’ cholesterol)
- A tendency toward higher blood pressure
- An increase in central body fat, which can be harmful to your body because you may be more prone to blood clots and blood sugar problems.
- Symptoms such as severe sweating or sleep disturbances
Cholesterol
You may have heard or read that natural estrogen helps to keep cholesterol levels in a healthy range. After menopause, as natural estrogen levels drop, more and more women tend to develop high cholesterol. Talk with your doctor about how often you should have your cholesterol checked. Read How to manage your cholesterol.
Triglycerides
Triglycerides are the most common type of fat in the body. A high triglyceride level often goes with higher levels of total cholesterol and LDL, lower levels of HDL and an increased risk of diabetes. Research suggests that having high triglycerides may increase the risk of heart disease and stroke for women. Talk to your doctor about your risk.
Making heart and brain-healthy changes in your life
A woman’s overall risk of heart disease or stroke is determined by all of her risk factors. You can control some of these risk factors, but not all of them.
Risk factors that you can control include smoking, high blood pressure, high blood cholesterol, diabetes, physical inactivity and obesity.
Risk factors that you cannot control include age, gender, family history, race and ethnicity.
Women can prevent and reduce their risk of heart disease and stroke by:
- Becoming and remaining smoke free.
- If you do not smoke, then avoid starting to vape as well.
- Achieving and maintaining a healthy body weight.
- Being physically active for at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more.
- Reducing sedentary time and moving regularly as you do your daily activities.
- Maintaining a healthy blood pressure through lifestyle changes (such as increased physical activity) and when needed through medication.
- Eating a healthy diet that is lower in fat, higher in fibre and includes foods from each of the four food groups and increased plant based foods. Avoid highly processed foods.
- Using medications to reduce the risk of heart disease and stroke as prescribed by your healthcare provider, for example medications for high blood pressure, high blood cholesterol and diabetes.
Sex and gender: What’s the difference?
Sex and gender are different, and both affect women’s health. Here’s how the Canadian Institutes for Health Research explains the two terms.
- Sex refers to the biology of humans and animals, including physical features, chromosomes, gene expression, hormones and anatomy.
- Gender is the social roles, behaviours, expressions and identities of girls, women, boys, men and gender diverse people.
Related information
System failure: Healthcare inequities continue to leave women’s heart and brain health behind (2023 Spotlight on women’s heart and brain health)
The Beat: What’s putting women at risk? (podcast)
The Beat: Women, stroke and mental health (podcast)
Spontaneous Coronary Artery Dissection (SCAD)