You’re less likely to get heart disease at any early age than men, but you may have more trouble getting it diagnosed. Here’s why:

Estrogen helps—to a point

Women tend to develop heart disease about a decade later than men, usually in their sixties, because of the protective effects of estrogen. When estrogen levels drop after menopause, however, the protective HDL does, too, and harmful LDL goes up.
 

Angiograms may be misleading

Studies show that 25 to 50 percent of women with heart disease don’t fit the typical male pattern of obstruction in major blood vessels. While men with heart disease get clumpy, concentrated buildups of plaque, for this group of women, the artery-clogging muck is often more diffuse, so arterial walls can seem smooth and damage doesn’t show up on angiograms. As a result, women who complain of symptoms such as chest pressure and shortness of breath are often incorrectly classified as being at low risk of a heart attack and don’t receive therapies, such as statins or blood pressure medications, that could save their lives. If these kinds of symptoms persist, says Noel Bairey-Merz, MD, director of the Women’s Heart Center at Cedars-Sinai Heart Institute, in Los Angeles, “consult with a cardiologist.”
 

High blood pressure may be more dangerous

Growing evidence suggests that high blood pressure is as dangerous as high LDL levels for women. In a Harvard study of women who died suddenly from a heart attack, 69 percent had no reported history of cardiovascular disease. The key predictors were smoking, diabetes and high blood pressure.
 

Standardized treadmill stress tests may not be as accurate for women

“Estrogen has a direct effect on the ECG reading, making it more unstable and more prone to look abnormal even when it is normal,” says Sharonne N. Hayes, MD, director of the Women’s Heart Health Clinic at the Mayo Clinic. In other words: “We think there’s a problem when there’s not.” Women who need further evaluation of chest pain are better off getting an echo or nuclear stress test, which is more accurate than standard exercise stress tests.