Think high cholesterol is the only major risk factor for heart disease? Think again. Many women develop serious heart conditions—even with normal cholesterol levels. This silent threat often goes unnoticed, increasing the risk of heart attacks, strokes, and long-term cardiovascular issues.
Unlike men, women face unique heart disease risks that go beyond cholesterol, including hormonal changes after menopause, which increase blood pressure and arterial stiffness. Pregnancy complications like preeclampsia and gestational hypertension, which raise future heart risks. Coronary Microvascular Disease (CMD), a condition affecting small blood vessels that doesn’t always show up on traditional heart tests.
These lesser-known risk factors make it crucial for women to prioritise heart screenings and lifestyle changes—even if their cholesterol levels seem normal.
In the UAE, where stress, sedentary lifestyles, and rising obesity rates impact women’s health, cardiologists at Dubai Heart Centre and Cleveland Clinic Abu Dhabi recommend proactive heart monitoring. Early screenings, blood pressure checks, and lifestyle interventions can prevent life-threatening cardiovascular events.
According to the American Heart Association (AHA), women with a history of pregnancy-related complications are at a 67% higher risk of heart disease later in life. Additionally, Coronary Microvascular Disease affects women more than men, leading to unexplained fatigue, breathlessness, and subtle heart attack symptoms.
This blog (can women get heart disease without high cholesterol?) explores the connection between heart disease and cholesterol levels in women, uncovering key risk factors beyond high cholesterol and providing insights into heart health management.
Understanding Heart Disease Without High Cholesterol
Not all cases of heart disease in women link to high cholesterol. Many develop conditions like coronary microvascular disease, where small blood vessels rather than larger arteries are damaged.
Causes may include high blood pressure, stress, and autoimmune diseases that affect blood flow.
The condition might not cause chest pain but can trigger shortness of breath and fatigue. The American Heart Association states that stress plays a major role too. Emotional stress or broken heart syndrome can mimic symptoms of a heart attack without blockages in the coronary artery.
Key Risk Factors for Women
Women face unique risks for heart disease that differ from men. These factors can increase the chances of developing cardiovascular issues even without high cholesterol.
Stress and mental health conditions
Stress can strain the heart and raise risks for cardiovascular disease. Emotional stress causes high blood pressure, which harms blood vessels. Over time, this leads to coronary artery disease or even a silent heart attack.
Stress-induced cardiomyopathy affects many women after extreme stress. It weakens the heart muscles temporarily. Poor mental health also disrupts sleep, increases harmful habits like smoking, and lowers physical activity—all affecting cardiovascular health negatively.
Pregnancy-related complications
Preeclampsia and gestational hypertension during pregnancy can harm a woman’s heart health later. These conditions cause high blood pressure, which raises the risk of coronary artery disease and heart failure.
Pregnancy can reveal hidden cardiovascular problems. Experts like Dr Christopher Angus link these issues to long-term risks for women. Monitoring blood pressure during and after pregnancy is crucial for preventing future complications.
Early menopause or hormonal changes
Hormonal shifts during early menopause affect the heart. Oestrogen levels drop, which impacts blood flow and raises risks of cardiovascular disease in women. This change often leads to higher LDL cholesterol (bad cholesterol) and lower HDL-C (good cholesterol).
Blood pressure may rise due to less vascular protection from oestrogen.
Weight gain during this phase also increases strain on the heart. Studies reveal a link between reduced hormones and coronary microvascular disease, affecting small arteries of the heart.
Women experiencing menopausal symptoms should monitor their blood sugar, manage stress, and adopt a heart-healthy diet rich in lean protein and low trans fats.
“A healthy lifestyle is your strongest defence against cardiovascular conditions.”
Symptoms of Heart Disease in Women
Heart disease symptoms in women can feel subtle but may include unusual discomfort or tiredness—read more to spot the warning signs early.
Chest discomfort or pain
Chest discomfort can signal serious heart problems. Women often feel heaviness, pressure, or burning sensations instead of sharp chest pain during a heart attack. These signs are sometimes mistaken for indigestion or stress.
Unlike men, women might also experience aches in both shoulders and jaw pain with activity. This discomfort may come and go, especially in cases of variant angina or coronary microvascular disease.
Even without high cholesterol, such symptoms could mean blocked blood flow to the heart.
Ignoring chest discomfort increases risk of permanent damage or death from cardiovascular disease. Act quickly if these symptoms appear alongside shortness of breath or back pain. Seek medical help immediately to prevent complications like heart failure or worse outcomes.
Shortness of breath and fatigue
Shortness of breath and unusual fatigue are warning signs of heart disease in women. These symptoms may occur even without chest pain or high cholesterol. Tasks like walking or climbing stairs might suddenly feel harder.
Fatigue that doesn’t improve with rest can also signal reduced blood flow caused by cardiovascular diseases.
Heart failure, coronary microvascular disease, or circulatory issues could cause these signs. Emotional stress can worsen them too. The National Heart, Lung, and Blood Institute highlights how subtle these symptoms can be, especially for women over 50 experiencing silent heart attacks.
Women often experience different heart attack symptoms than men—don’t ignore persistent fatigue or breathlessness. – Office on Women’s Health
Discomfort in the jaw, arms, or upper body
Jaw pain or arm discomfort can signal heart disease in women. Pain may spread to both shoulders, the neck, or upper body during physical activity. This type of discomfort is often overlooked but could point to coronary artery disease or a silent heart attack.
Aches in these areas sometimes feel mild and are mistaken for muscle strain. Women should pay attention if jaw pain occurs with exertion or emotional stress. Sudden chest pain paired with upper body soreness needs urgent medical care as it may indicate a heart attack.
Recognising Symptoms of Silent Heart Disease in Women Over 50
Fatigue that feels unusual is a common sign. Women may feel tired even after resting or doing little activity. This can signal reduced blood flow from coronary heart disease.
Shortness of breath during normal tasks, like climbing stairs, might occur. Mild chest pain or discomfort can also arise but may be mistaken for indigestion. Discomfort in the jaw, neck, arms, back, or throat might appear due to poor blood flow caused by coronary microvascular disease.
It helps to stay alert to these signs and seek medical advice early.
Prevention Strategies for Women
Taking care of your heart can lower the chances of problems. Making small changes daily can protect women from serious risks.
Managing stress and mental health
Stress harms the heart. Emotional stress can damage blood vessels, raising risks of coronary artery disease and heart attacks. Women facing prolonged stress may develop high blood pressure or unhealthy habits like overeating or smoking.
Mental health conditions, such as anxiety and depression, often worsen heart disease symptoms.
Lowering stress is crucial for a healthy heart. Practise mindfulness through yoga or meditation to stabilise emotions. Sleep at least 7-8 hours nightly for recovery and balance. Therapy also helps manage mental health concerns effectively.
Regular heart screenings
Regular heart screenings assist in identifying problems at an earlier stage. The American Heart Association recommends adults check cholesterol every 4–6 years. Individuals with high blood pressure, diabetes, or on medication might require more frequent tests.
These tests evaluate LDL cholesterol, blood sugar, and general heart health. In the UAE, healthcare providers are also able to monitor risk factors such as family history of heart disease or symptoms like chest pain and fatigue.
Early detection helps prevent severe conditions such as coronary artery disease or silent heart attacks in women.
Maintaining a healthy lifestyle
Eating a heart-healthy diet can lower the risk of heart disease. Focus on lean proteins, fruits, vegetables, whole grains, and healthy fats. Limit red meat, saturated fats, trans fats, and high-fat dairy products.
These changes help control blood pressure and bad cholesterol (LDL).
Stay active with 150 minutes of moderate exercise weekly or 300 minutes for more benefits. Physical activity improves blood flow and keeps the heart strong. Walking, interval training workouts or swimming are good choices.
Avoid smoking and limit alcohol to support cardiovascular health further.
Conclusion
Women can face heart disease even without high cholesterol. Stress, hormonal changes, and pregnancy complications are key risks. Regular check-ups and a healthy lifestyle can make a big difference.
Taking small steps like staying active or lowering stress keeps the heart strong. Focus on your health—it’s worth it!
For more detailed information on identifying less obvious signs, visit our page on symptoms of silent heart disease in women over 50.
Also, Read:
FAQs for Women’s Cholesterol-Free Cardiorisk
Dr. Aisha Rahman is a board-certified internal medicine specialist with over 12 years of clinical experience in chronic disease management and preventive healthcare. She has worked at leading hospitals across the UAE, helping patients manage conditions such as diabetes, hypertension, cardiovascular diseases, and metabolic disorders.
A strong advocate for preventive medicine, Dr. Rahman emphasizes early diagnosis, lifestyle modifications, and patient education to reduce chronic illness risks. She is an active member of the Emirates Medical Association and has contributed to health awareness programs and medical research initiatives. Her expertise has been featured in The National UAE, Gulf Health Magazine, and leading medical journals. As a keynote speaker at healthcare conferences, she shares insights on evidence-based treatments, patient-centered care, and advancements in internal medicine.
Dr. Omar Al-Farsi is a clinical nutritionist and medical researcher with over 15 years of experience in dietary science, metabolic disorders, and preventive healthcare. He has served as a senior consultant for UAE healthcare authorities and contributed to public health initiatives focused on nutrition education and disease prevention.
Dr. Al-Farsi has collaborated with leading hospitals, research institutions, and universities in the UAE, ensuring that health information is scientifically accurate and evidence-based. His research has been published in Gulf Medical Journal, Dubai Health Review, and WHO Nutrition Reports, making significant contributions to nutrition science and public health awareness.