In these stressful times, it is easy to overlook our health. But with February designated as American Heart Month, there’s no better time to shine a light on a critical—and often misunderstood—issue: women and heart disease.

While heart disease is often perceived as a predominantly male health issue, it is, in fact, the leading cause of death for women in the United States. This misunderstanding has led to a troubling legacy—one in which women have been under-diagnosed, under-treated, and underrepresented in cardiovascular research.

In the 1960s, the American Heart Association held a conference titled “How Can I Help My Husband Cope with Heart Disease?” and distributed a pamphlet called “The Way to a Man’s Heart.” In other words, women were seen as caretakers of men with heart disease—not as patients at risk themselves.

This cultural bias has had unfortunate consequences. Many women are not aware of their unique risk factors for heart disease or how their symptoms may differ from men. I wish I could say this disconnect was only historical—but it hit my own family with full force.

Shoveling Snow & the Widow-Maker

Shortly after my wife Marion and I bought our first home in the suburbs of New York in the late 1970s, she came across an article warning that middle-aged men were at increased risk for fatal heart attacks while shoveling snow. She suggested that might be a job I should skip. Being a dutiful husband—and a card-carrying couch potato—I agreed. I was more than happy to cheer her on from the window with a cup of hot cocoa in hand. It clearly worked! I have never had a heart attack and some fifty years later my coronary arteries remain disease free.

But, all kidding aside, it was Marion who developed severe coronary artery disease, ultimately requiring triple bypass surgery to address a 95% blockage—what her surgeon bluntly called a “widow maker.”

This came as a complete shock. Marion had no family history of heart disease. She stopped smoking decades ago. Her cholesterol, blood pressure, and glucose levels were all normal. And yet she nearly died of something we never saw coming. It wasn’t until a follow-up visit with her cardiologist that we got our first clue. In the exam room, a poster listed “female-specific” risk factors for cardiovascular disease. It turns out the clue was hiding in her past: preeclampsia.

Back in 1973, when Marion was pregnant with our son, she developed a serious case of preeclampsia (we called it “toxemia” back then). She spent the last six weeks of her pregnancy in the hospital in bed. At the time, we were focused solely on delivering a healthy baby. No one told us that preeclampsia significantly increases a woman’s long-term risk of heart disease, stroke, and heart failure. No one told us, because no one knew!  The connection between preeclampsia and cardiovascular disease in later life became widely recognized in the early 2000s, leading the American Heart Association to formally list it as a major heart disease risk factor for women in their 2011 guidelines.

This is exactly the kind of hidden risk that still flies under the radar for many women and their health providers. Researchers now believe that complications like preeclampsia, gestational diabetes, early menopause, autoimmune disease, and even chronic stress may contribute significantly to a woman’s lifetime risk—but they aren’t always factored into traditional cardiovascular assessments. The good news? Awareness is finally starting to catch up. Medical schools are doing a better job teaching sex-specific cardiovascular medicine and more women are enrolling in clinical trials..

Here are five things every woman—and every man who cares about the women in their lives—should know:

1. Heart disease is the #1 killer of women in the U.S. Not cancer.

2. Symptoms can look different in women. You might not feel crushing chest pain but are more likely to have shortness of breath, fatigue, nausea, or even pain in the back or jaw, especially during a heart attack.

3. Your pregnancy history matters. Things like preeclampsia or gestational diabetes can raise your heart risk later on—even if everything turned out fine at the time.

4. Prevention works. A heart-healthy diet (like the Mediterranean or plant-based diet), regular exercise, blood pressure and cholesterol control, and not smoking can dramatically reduce risk.

5. Listen to your body—and speak up. If something feels wrong, trust your instincts and insist on proper evaluation. Advocate for yourself or your loved ones.

Marion’s story had a good ending, but it easily could’ve gone the other way. Looking back, we wish we had known more. Maybe her condition could have been spotted earlier. Maybe we could have done something sooner. If there’s one thing I hope you take away from this, it’s this: women need to take their heart health seriously. And we need to get rid of the myth that heart disease is just a “man’s problem.”

During the recent snow storm, Marion and I, hot cocoa in hand, watched a delightful young man named Chris shovel our driveway! 

For more information about women and heart disease visit the Go Red for Women Initiative from the American Heart Association.