One woman dies of heart disease and stroke in the United States every 80 seconds, which isn’t surprising considering the fact that 90 percent of women have at least one cardiovascular risk factor.

But although heart disease is an equal opportunity killer—it’s the number one cause of death in both women and men—there are certain risk factors that are unique to women.

While it’s very important to be aware of general risk factors such as being overweight, having a family history of heart disease, smoking or having high blood pressure, high cholesterol or diabetes, the following four risk factors are specific to women only.

  1. Menopause

    While risk factors for heart disease increase for both men and women with age, there is an increase in heart attacks among women about a decade after they go through menopause, according to the American Heart Association. This may be due at least in part to the loss of estrogen, which is believed to have a protective effect on artery walls by keeping blood vessels flexible.

    With the hormonal changes of menopause come metabolic changes including weight gain. As a result, women are more likely to develop elevated blood pressure and diabetes, which in turn can impact heart disease risk.

    But it’s important not to assume that you’re in the clear just because you’re in your 30s or 40s.

    Increasing numbers of women are being diagnosed with heart disease in this younger age group due in large part to an increasing prevalence of obesity and sedentary lifestyle, as well as an associated rise in diabetes and continued tobacco use.

    Regardless of your age, it is important to maintain a healthy weight and eat a heart-healthy and well-balanced diet that’s rich in fresh fruit and vegetables, whole grains and healthy fats such as fatty fish, nuts and olive oil.

  2. PCOS

    Polycystic ovary syndrome—a hormonal disorder in which your body produces too much of the male hormone testosterone—affects up to 12 percent of reproductive-aged women, according to the Centers for Disease Control and Prevention.

    While many women with this condition are worried about side effects such as acne, facial hair and weight gain, PCOS also carries an increased risk of heart disease. Women with PCOS are more likely to develop high blood pressure and to have elevated levels of LDL, or “bad” cholesterol, and low levels of HDL, or “good” cholesterol. They’re also more likely to have type 2 diabetes.

    If you have PCOS, it’s important that your doctor screen you for type 2 diabetes. It’s also a good move to lose weight if you’re overweight and stay physically active to help lower your risk of both diabetes and heart disease.

  3. Pregnancy complications

    It’s important to make sure your primary care physician is aware if you’ve had gestational diabetes, pregnancy-induced hypertension or pre-eclampsia. These conditions are associated with increased cardiovascular risk down the road and you will therefore need to be closely monitored.

    If you’ve had preeclampsia, your risk of high blood pressure may be up to four times higher and your risk for heart disease and stroke may be twice as high, according to the Preeclampsia Foundation.

    Women who have had gestational diabetes have a 43 percent increased risk of developing heart disease compared to those who didn’t have the condition, according to a 2017 study published in JAMA Internal Medicine.

    If you have had gestational diabetes, you are much more likely to go on to develop full-blown type 2 diabetes, which increases your heart disease risk.

  4. Smoking

    It’s well known that smoking is linked to heart disease. What is not as well known is that it can be even more dangerous for women than it is for men.

    Women over 35 who smoke have a slightly higher risk of dying from heart disease compared to male smokers over 35. While it’s unclear why women are more vulnerable, smoking in general raises your risk by causing your blood to thicken (so it’s more likely to clot) and damaging your blood vessel walls.

    The good news is, if you quit smoking today, you’ll see results quickly. Heart attack risk drops dramatically in the first year and within five years your stroke risk will have dropped to that of someone who has never smoked.

Managing your heart disease risk factors

If you have any risk factors, it’s important to make sure that you’re up to date on all your heart-healthy screening tests. This includes checking blood pressure at every healthcare visit, along with cholesterol testing every four to six years and blood glucose screening every three years after age 45.

You can help keep heart risk factors in check by maintaining a healthy weight (or losing weight if you are overweight or obese), eating a heart-healthy diet low in saturated fat and salt, exercising at least 30 minutes most days of the week and not smoking. Depending on your profile, your doctor may also prescribe medication in addition to lifestyle changes.

It’s also important to be aware that women who have coronary heart disease may not present with the typical “elephant sitting on the chest” symptoms.

Instead, they may have a more atypical presentation, including extreme shortness of breath, profound fatigue, pain across the upper back and shoulders or even terrible indigestion.

If you have signs like these, get medical attention right away. And if you feel like your healthcare provider isn’t taking your concerns seriously, be persistent.

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