Protecting Women's Hearts: Preeclampsia and Heart Disease

Heart disease is often thought of as a "man's problem," but the reality tells a very different story. Heart disease is the leading cause of death in women, and the ways it develops, presents, and harms women are often distinct from men — and frequently overlooked.

Women and Heart Disease: A Different Kind of Danger

Men are more likely to be diagnosed with coronary artery disease than women (8.3% vs. 6.2%), and they tend to have heart attacks about seven years earlier on average. But here's the sobering truth: women are more likely to die after their first heart attack than men, particularly true at younger ages.

Part of the reason outcomes are worse for women is that their heart disease often looks different. Men tend to develop blockages in larger, more central arteries — the kind that are easier to find and treat with procedures like stents or bypass surgery.  Women may also develop similar blockages in the larger arteries as seen in men, but women are more likely than men to develop diffuse disease in smaller vessels and dysfunction of the tiny arteries that supply the heart muscle called microvascular disease. A graphic representation of these differences is shown below.

To make matters more challenging, most of our standard diagnostic tools were developed and validated primarily in men, making them less accurate at detecting the patterns of disease more common in women. Advanced imaging like cardiac PET scanning can help evaluate microvascular disease, though has limited availability. This means that for many women, disease goes undetected until it causes serious harm.

Given these limitations in detection and treatment, prevention becomes even more critical for women.

Pregnancy as a Window Into Heart Health

One of the most important — and underappreciated — cardiovascular risk factors specific to women is high blood pressure during pregnancy. Hypertensive disorders of pregnancy, which include conditions like gestational hypertension, preeclampsia, and eclampsia, develop after 20 weeks of pregnancy and are responsible for approximately 14% of maternal deaths worldwide, making them the second leading cause of maternal mortality globally.

Preeclampsia, defined by high blood pressure accompanied by signs of kidney injury, has become dramatically more common over the past three decades. In 1993, it affected approximately 5% of pregnancies. By 2016–2017 that figure had doubled to 10%, and more recent data suggest that hypertensive disorders of pregnancy now complicate nearly 20% of live births. Much of this rise has been attributed to increasing rates of obesity, diabetes, multiple pregnancies, and pregnancies at older ages.

These disorders matter beyond pregnancy itself. Women who experience preeclampsia face a significantly elevated risk of developing heart disease later in life, making it a critical early warning sign for long-term cardiovascular health.

Racial and Socioeconomic Disparities Are Stark

The burden of preeclampsia does not fall equally. Non-Hispanic Black women face a disproportionately high risk, with roughly two-thirds experiencing severe disease compared to fewer than half of white women, and a risk of death from preeclampsia complications that is five times higher than in white women. American Indian and Alaska Native women also face more than double the pregnancy-related mortality rate of white women. Hispanic women have a similar preeclampsia burden to white women after adjusting for contributing risk factors such as obesity.

Structural racism, implicit bias in healthcare, and unequal access to prenatal care are all believed to contribute to these profound disparities. Closing these gaps is not just a matter of medical care — it is a matter of equity.

A Promising Step in Prevention: Higher-Dose Aspirin

Low-dose aspirin (81 mg daily) has been recommended by the American College of Obstetricians and Gynecologists for women at high risk of preeclampsia, as well as some at moderate risk. However, research from international groups has suggested that a higher dose may be more effective.

A compelling new study presented at the Society for Maternal-Fetal Medicine meeting in February 2026 examined this question directly. Researchers at a Texas hospital administered 162 mg of aspirin daily to all pregnant patients, regardless of individual risk level, across more than 36,000 pregnancies — a population that was 82% Hispanic and 12% Black. Pharmacy data suggested that more than 80% of patients actually took the aspirin as directed. The results showed a nearly 30% reduction in preeclampsia with severe features, and among those who did develop severe disease, it occurred later in pregnancy — which itself can improve outcomes for both mother and baby (Duryea et al., 2026). These findings are consistent with international recommendations favoring higher aspirin doses than what has traditionally been used in the United States (Horgan et al., 2023).

While more research is needed before universal high-dose aspirin becomes standard practice, this study adds meaningful evidence to an evolving conversation.  Ideally, a randomized, controlled trial could examine this question in a large population to determine if using higher doses of aspirin universally will become the new standard.

What Women Can Do Now

Preventing cardiovascular disease in women requires awareness at every stage of life. If you experienced high blood pressure during a pregnancy, make sure your primary care physician and cardiologist know — it is a relevant part of your cardiac history, not just your obstetric history. You can use the Evexeya Health's 12 Essential Questions form to help inform your doctors.

More broadly, the American Heart Association's Life's Essential 8 framework offers a practical roadmap for heart health at any age: maintaining a healthy diet, staying physically active, avoiding tobacco, getting adequate sleep, and managing blood pressure, blood sugar, cholesterol, and weight.

Women's hearts deserve attention, research, and care. Understanding the unique ways heart disease affects women — and taking advantage of every preventive opportunity — is how we begin to improve heart care in women.

References

Duryea, E. L., et al. (2026, February 8–13). Universal aspirin administration for prevention of preeclampsia [Conference presentation]. Society for Maternal-Fetal Medicine Annual Meeting, Las Vegas, NV. https://doi.org/10.1002/pmf2.70204

Horgan, R., et al. (2023). Low-dose aspirin therapy for the prevention of preeclampsia: Time to reconsider our recommendations? American Journal of Obstetrics & Gynecology, 229(4), 410–418. https://doi.org/10.1016/j.ajog.2023.03.003

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This post is for educational purposes only and does not constitute medical advice. Please consult a qualified healthcare provider for personalized guidance.

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