As you get older, your risk of heart disease and heart attack goes up.

• Women usually get heart disease about 10 years after men typically do. This is because until menopause, the ovaries make the hormone estrogen. Estrogen gives premenopausal women some protection against heart disease.¹ Estrogen may help keep blood vessels relaxed and open and help the body maintain a healthy balance of good and bad cholesterol. Without estrogen, cholesterol may start building up on artery walls.
• When you are younger, your arteries have smooth linings and flexible walls that allow blood to flow freely. As you age, the linings get stiff and the walls thicken, which can make it harder for blood to flow and increases blood pressure. This is most often caused by plaque buildup in your arteries, a process called atherosclerosis (ath-UH-roh-skluh-ROH-sis). Atherosclerosis begins in childhood.² The older you are, the more likely your arteries will be narrowed or blocked enough to cause problems.

Menopausal hormone therapy

Many women take menopausal hormone therapy to help relieve menopause symptoms such as hot flashes. Results from a large study called the Women's Health Initiative showed that women taking menopausal hormone therapy with estrogen plus progesterone had a higher risk for stroke, serious blood clots, heart attacks, and other serious health problems. The risks were found to be much higher for women 60 years and older.

If you decide to use menopausal hormone therapy, talk to your doctor. The Food and Drug Administration advises women who want to try menopausal hormone therapy to use the lowest dose that works for the shortest time needed.

Read more about menopausal symptoms and hormone therapy in our Menopause section.

Your family history can raise your risk for heart disease:³

• If your father or brother had heart disease before 55, you are at higher risk of getting heart disease yourself.
• If your mother or sister had heart disease before 65, you are also at higher risk.

A family history of heart disease does not always mean that you will have it too. This is especially true if your family member who had heart disease smoked or had other heart disease risk factors, such as high blood pressure or high cholesterol, that were not under control.

If heart disease runs in your family, it may be because your family carries genes that raise your risk. An example would be a gene that makes your blood more likely to clot. Talk to your doctor about your family health history.

African-American and American Indian and Alaska Native women are more likely to have heart disease than white, Hispanic, and Asian-American women.⁴ But heart disease is still the number one killer of white and African-American women.⁵

African-American women:

• Are more likely than other groups to have heart disease risk factors like high blood pressure, obesity, and diabetes^6,7
• May be less likely than others to receive preventive treatment including medicines to lower blood pressure and advice from doctors or nurses about weight control and quitting smoking^8,9
• May be more likely than others to have heart surgery at less-experienced hospitals¹⁰

American Indian and Alaska Native women:

• Are more likely to have high rates of diabetes, overweight and obesity, and high blood pressure, which raise the risk of heart disease^11,12,13
• Are more likely to smoke and not get enough physical activity, which raises the risk of heart disease.¹⁴
• Are more likely than other groups to die from heart disease at younger ages¹⁵

• Gestational high blood pressure (sometimes called gestational hypertension or pregnancy-induced hypertension). High blood pressure during pregnancy can happen in some women who do not normally have high blood pressure. Gestational high blood pressure goes away after birth but raises your risk for high blood pressure and heart disease later in life, after pregnancy is over. Gestational high blood pressure can also develop into preeclampsia.
• Preeclampsia. Preeclampsia is a health problem that can happen during pregnancy. It is unexpected high blood pressure and problems with your kidneys (called "protein in the urine"). Women who have had preeclampsia are more likely to develop high blood pressure and heart disease later in life, after pregnancy is over.¹⁶
• Gestational diabetes. Having gestational diabetes (diabetes that happens only during pregnancy) puts you at higher risk for type 2 diabetes later in life, after pregnancy is over. Diabetes is a risk factor for heart disease.

Learn more about these pregnancy complications in our Pregnancy section.

1. Nadkarni, S., Cooper, D., Brancaleone, V., Bena, S., Perretti, M. (2011). Activation of the Annexin A1 Pathway Underlies the Protective Effects Exerted by Estrogen in Polymorphonuclear Leukocytes. Arteriosclerosis, Thrombosis and Vascular Biology, 31, 2749-2759.
2. McGill, H.C., McMahan, C.A., Herderick, E.E., Malcolm, G.T., Tracy, R.E., Strong, J.P. (2000). Origin of atherosclerosis in childhood and adolescence. American Society for Clinical Nutrition; 72(5): 1307s-1315s.
3. National Heart, Lung, and Blood Institute. (2014). What Are the Risk Factors for Heart Disease?
4. Centers for Disease Control and Prevention. (2016). Table A-1a. Age-adjusted percentages (with standard errors) of selected circulatory diseases among adults aged 18 and over, by selected characteristics: United States, 2014. National Health Interview Survey, 2014.
5. Heron, M. (2016). Deaths: Leading Causes for 2014. National Vital Statistics Reports; 65(5). Hyattsville, MD: National Center for Health Statistics.
6. CDC National Center for Health Statistics. (2016). Health of Black or African-American non-Hispanic Population.
7. Centers for Disease Control and Prevention. (2015). Age-Specific Rates of Diagnosed Diabetes per 100 Civilian, Non-Institutionalized Population, By Race and Sex, United States, 2014.
8. Wright, E., Perry, B. (2010). Medical sociology and health services research: past accomplishments and future policy changes. Journal of Health and Social Behavior;51(S):S107–19. 
9. Pullen, E., Perry, B., Oser, C. (2014). African American Women's Preventative Care Usage: The Role of Social Support and Racial Experiences and Attitudes. Sociology of health & illness; 36(7): 1037-1053.
10. Khera, R., Vaughan-Sarrazin, M., Rosenthal, G., Girotra, S. (2015). Racial Disparities in Outcomes After Cardiac Surgery: the Role of Hospital Quality. Current cardiology reports; 17(5): 29.
11. Centers for Disease Control and Prevention. (2014). Summary Health Statistics for U.S. Adults: 2012. Table 2.
12. CDC. (2016). Summary Health Statistics: National Health Interview Survey: 2014. Table A-4.
13. CDC. (2016). Summary Health Statistics: National Health Interview Survey: 2014. Table A-15
14. National Center for Health Statistics. (2016). Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD.
15. Oh, S.S., Croft, J.B., Greenlund, K.J., Ayala, C., Zheng, Z.J., Mensah, G.A., et al. (2004). Disparities in Premature Deaths from Heart Disease—50 States and the District of Columbia. MMWR; 53:121–25. 
16. American College of Obstetricians and Gynecologists. (2013). Hypertension in Pregnancy.