More young women are dying from heart disease — and people are missing these warning signs

You know what a pink ribbon signifies. Breast cancer, right? Now what about a red dress?

Did you come up with heart disease? No? Don’t worry: You’re not alone.

Heart disease is the leading killer of cisgender American women — and that trend shows no signs of slowing. New projections estimate the share of US women with heart disease will keep rising through 2050, affecting more than 22 million women, with the sharpest increases among younger women ages 20 to 44. Heart attacks are already becoming more deadly for adults under 55 — again, particularly for younger women who don’t have the traditional risk factors. The prevalence and deadliness of heart disease for women specifically has been a public health problem for a long time, and it’s getting worse.

Yet awareness of that crisis seems to be shrinking, not growing. An American Heart Association survey published in 2020 found that US women’s awareness that heart disease is the No. 1 cause of death and that women can experience unique heart symptoms fell sharply, from 65 percent in 2009 to 44 percent in 2019. Knowledge about the symptoms of a serious cardiac event also declined. More recent data isn’t much more encouraging: In a 2025 survey of cardiologists by the Women’s Health Alliance, 84 percent said that they had treated a female patient whose heart condition was misdiagnosed by another doctor.

In that 2020 AHA survey, a growing number of women thought it was breast cancer, not heart disease, that killed the most women. Cardiologists look at their oncologist colleagues with a hint of envy.

“I’m just jealous of them. They’ve done a good job at getting out the message. We have not,” said Dr. Martha Gulati, a cardiologist at Houston Methodist Hospital.

It’s not for lack of trying. Groups like the AHA have made admirable efforts to raise awareness, including The Heart Truth campaign and Go Red for Women. But the stagnating progress suggests that a new approach might be needed. Gulati said she wears a red dress pin at work all the time, but her own patients rarely know what it signifies.

“These are people that are living with heart disease, and they don’t even know what it means,” Gulati said. “The problem is that we are not reaching women. It is not resonating with women… I actually really believe that a rebrand is required.”

Why it’s been so hard to make women’s heart health a priority

What makes the lack of awareness about women’s heart disease so perplexing is the fact that scientists have known about their unique risk for years.

In the 1980s and 1990s, researchers first noticed that while men were seeing marked improvements in outcomes from heart disease and heart attacks, women were not. In the years since, scientists have found there are important physiological changes that put women at unique risk for heart disease and could lead to them experiencing different symptoms and pathologies that physicians in the mid-20th century failed to notice. Researchers have been racing to catch up and improve our collective knowledge ever since.

But they have been working at a disadvantage — starting with the preclinical animal experiments that often set the stage for later breakthroughs. According to a June 2024 report from the AHA and McKinsey, 72 percent of animal studies from 2006 to 2016 used only male mice. In human trials from 2010 to 2017, just 38 percent of participants were women; post-menopausal women, who are at the most risk from cardiovascular disease, had an even lower participation rate (26 percent). Even after all of this time, according to a 2025 study in the American Heart Journal, there have still not been any randomized controlled trials for a number of heart conditions that disproportionately affect women.

At the same time, the health system has failed to make women’s heart health a priority. According to the AHA/McKinsey report, less than one in four primary care doctors say they feel well equipped to gauge cardiovascular disease risk in women. The problem starts in medical school: A 2024 survey of medical schools in the US and Canada found that more than 70 percent did not feature any gender-specific content in their curriculum.

If a woman develops heart disease, the way it functions can look different than it does in a man. Unfortunately, this can confound doctors who haven’t received proper training and lead to the worst outcomes. For example, women are more likely to experience blockages in their small arteries, but not necessarily in the large arteries that are usually the focus for clinicians and for most diagnostic tests. (And in an emergency, EKGs can sometimes be unreliable due to incorrect placement near breast tissue.)

“We have to do better. I think it has to come from training up. I can only teach so many medical students, but the ones I teach, I try to integrate it from the start,” said Dr. Harmony Reynolds, a cardiologist at NYU-Langone who has co-authored influential research on women and their unique experience of heart issues. “I think that has to be true for paramedics, for nurses, for doctors, for every level of the medical establishment and patients.”

And if the system is biased from the start, it puts patients at a huge disadvantage when it comes to understanding their own bodies and advocating for themselves. Women are almost twice as likely as men to report that their chest pain was likely the result of stress rather than an underlying heart condition. Women of color are at higher risk and less aware of heart disease than white women.

And so, despite some real progress in science’s understanding of how heart disease manifests in women, women are still disproportionately dying. From 1990 to 2011, young women saw only marginal improvements in their mortality rates from coronary artery disease. As documented in the AHA survey, awareness among the general public fell off in the following decade.

How can we raise heart disease awareness among a new generation of women?

Part of the problem is it’s always hard to convince people to care about their long-term health. Young people think they’re going to live forever. Even as the evidence grows that more young women are at risk and even suffering catastrophic outcomes, many people still think of heart disease as a problem for older people — particularly for older men. Trying to frighten people into caring more about it, even if they should be worried, does not seem to be having the desired effect.

Dr. Mary Cushman, a cardiologist at the University of Vermont who co-authored the 2020 AHA study on public perceptions of women and heart disease, said she recently spent a day walking around campus, trying to engage students on heart disease.

“I just feel like younger people aren’t thinking deeply about these topics. With the students that we talked to, it was really apparent that they just didn’t know,” she said. “You look at wonderful programs, like Go Red for Women, but where are they? Are they in the right places? I don’t know. I don’t know the answer.”

Cushman, in her own practice, has noticed that more positively framed messages seem to make more headway with individual patients — particularly messages framed around brain health as opposed to heart health specifically. Scientists have learned over time that vascular problems are not only the cause of heart conditions, but also of dementia and cognitive decline. People may be less responsive to repeated grim warnings about death, but telling them they have a better chance of staving off dementia seems to help the message penetrate.

“Heart attack is the thing that happens to old guys. But when you say dementia, they’re like, ‘Oh my God, I don’t want that,’” Cushman said.

Women have unique heart disease risk factors

As cardiologists and public health experts contemplate the best ways to reach the public at large, this is what they want you to know right now. First, women do have many of the same heart disease risk factors as men: chiefly obesity, smoking, and diabetes.

But cisgender women face unique risks that are rooted in their physiology:

The heart attack symptoms women should be aware of

Women can certainly experience chest pain, pressure, and discomfort, the most well-known heart attack symptoms, but Reynolds said it is not always as severe as you might expect. Women can also have less commonly recognized symptoms:

Some doctors are actively working toward a better future — one in which medical students receive gender-specific training; in which OB-GYNs (who often function as primary care doctors for women, especially young women) are more alert to cardiovascular risks; and in which doctors take their female patients more seriously when they talk about unusual pain or other symptoms they’re feeling. And preventative treatments will hopefully continue to improve: Many cardiologists are optimistic about the new GLP-1 drugs and their ability to address heart health.

And perhaps some day, there will be a universally recognized symbol for women’s heart health.

“I really think we have the ability to change things,” Gulati said. “But I do think that we have to change our branding, too.”

In the meantime, in an imperfect world of low awareness and medical misogyny, patients unfortunately have to be their own advocates. The AHA has an online tool to assess your own risk — set a calendar reminder to bring it to your annual doctor’s visit. If you are experiencing symptoms, call your doctor or go to the emergency room right away. It’s better to be examined and learn you’re fine than to not go at all and regret it; sometimes, Reynolds told me, the signs can be as subtle as a twinge of pain you feel overnight. If the physician treating you seems dismissive or uncertain, press further.

“It’s asking questions. ‘What is my risk? Should I be treated? How would you decide if I need to be treated? If you don’t think this symptom is heart disease, what do you think it is?’” Reynolds said. “Everybody recognizes that they don’t become a doctor just by searching Google. But it can empower you to ask the right questions.”