“Too often, when a young woman has heart disease symptoms, a physician will ignore those symptoms and tell her that she needs to lose weight,” said Bairey Merz, director of the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai. “That’s because heart disease symptoms in women can be very different from what men experience. So it’s crucial that women know what to look for.”

Although heart disease is the leading cause of death among women in the U.S., according to the Centers for Disease Control and Prevention, most heart disease research has been conducted on men. And even though rates of heart disease and heart attacks are increasing among women 35 to 54 years old, they are less likely to receive evidence-based treatments such as statins and more likely to be told they are “too young” to have heart disease, Bairey Merz said.

“These delays and dismissals have had serious consequences,” she said. “The Women’s Ischemia Syndrome Evaluation [WISE] study that I led for the National Heart, Lung, and Blood Institute helped us better understand that heart disease doesn’t always look the same in women. That insight ultimately pushed the field to rethink and improve how we diagnose and treat it.”

Despite these advances, women with heart disease are still more likely to be misdiagnosed, underdiagnosed or undertreated—sometimes delaying care that could save their lives.

“The good news is that heart disease is largely preventable,” Bairey Merz said. “And for women in particular—who may not experience obvious symptoms or whose symptoms are subtle—knowledge is a powerful prevention tool.”

To explain what women should watch for, the Cedars-Sinai Newsroom spoke with Bairey Merz about what women can do to protect their hearts and advocate for the healthcare they need.

What are some of the biggest myths about heart disease?

Many people believe that heart disease primarily affects men, that heart attacks always involve crushing chest pain, or that cancer is the top cause of death. In reality, heart disease kills more women than all cancers combined, yet fewer than half of women recognize it as their greatest health threat.

While men tend to develop cardiovascular disease earlier, women are more likely to experience poorer outcomes.

Why are heart attack rates increasing among younger women?

For decades, heart attack death rates declined sharply, thanks to improved research, standardized treatment guidelines, and widespread use of effective medications and procedures. While heart attack deaths are still much lower than they once were, the increase in heart problems among younger adults is concerning.

Researchers are looking into exact causes for the increase, but we know that contributing factors include low levels of physical activity and prolonged sedentary behavior, rising rates of diabetes and obesity, chronic stress, and environmental exposures such as air pollution.

What does a heart attack feel like for women?

The so-called “Hollywood heart attack”—tingling in the left arm that leads to sudden, crushing chest pain—is common in men and can occur in women as well. But many women experience subtler symptoms, including shortness of breath, nausea, unusual fatigue, back or jaw pain, or chest discomfort that doesn’t feel severe or dramatic.

Because these symptoms don’t match common expectations of a heart attack, they may be overlooked or dismissed. Anyone experiencing them should seek medical care immediately.

What causes heart attacks in women?

An increasing number of heart attacks are occurring in people without significant blockages in the major coronary arteries, a pattern seen more often in women. While men’s heart disease more commonly involves blockage in large arteries, women are more likely to experience dysfunction of the heart’s smaller blood vessels. This condition—called ischemia with no obstructive coronary artery disease [INOCA]—can cause reduced blood flow to the heart even when major arteries appear clear.

Even women who are physically fit can develop INOCA. In the past, if a woman had heart attack symptoms but a “normal” angiogram showing clear major arteries, her condition might not have been recognized. Continued awareness and ongoing education around INOCA are helping clinicians better diagnose and treat these patients.

What is a normal heart rate for women?

A normal resting heart rate for most adults is between 60 and 100 beats per minute, according to the American Heart Association. Because women’s hearts are typically smaller, their resting heart rate may run slightly higher than men’s. Women should consult their doctor if their resting heart rate is below 60 or above 100 beats per minute when not exercising.

How can women protect heart health and prevent heart disease?

Heart disease develops silently over decades. While heart disease can be managed with highly effective treatments, prevention is the most powerful strategy.

An estimated 80% of heart disease cases are preventable with lifestyle modifications. These include staying current with annual screenings and knowing cholesterol, blood pressure and blood sugar levels; exercising at least 30 minutes daily; breaking up prolonged sitting because a sedentary lifestyle is considered as strong a risk factor as smoking; managing stress; getting seven to nine hours of sleep; avoiding smoking; and following a nutritious diet.

A Mediterranean-style, largely plant-based diet rich in fruits, vegetables, nuts, beans, whole grains, olive oil and lean proteins is recommended. Parents are encouraged to help ensure their children make healthy food choices, too.

Heart health isn’t about deprivation. It’s about building lifelong habits that prevent disease before it starts.

Read more on the Cedars-Sinai Blog: High Blood Pressure—What Women Need to Know

The new, five-year grant to examine sex-based differences in multiple age-related diseases supports the Microvascular Aging Effects—Women’s Evaluation of Systemic Aging Tenacity in Heart, Brain and Frailty study, commonly called MAE-WEST HBF. The acronym is a nod to the late actor, who reportedly once said, “You’re never too old to become younger.”

MAE-WEST HBF is funded as a Specialized Center of Research Excellence (SCORE) on Sex Differences through the NIH Office of Research on Women’s Health. It builds on prior research from Cedars-Sinai’s Barbra Streisand Women’s Heart Center that showed small blood vessel disease, chronic inflammation and iron buildup in women are linked to impaired heart, brain and kidney function, and declining physical strength.

“Armed with this funding, we are eager to continue uncovering biological mechanisms behind sex-based differences in aging and heart health,” said C. Noel Bairey Merz, MD, the principal investigator of MAE-WEST HBF and director of the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute. “A better understanding of the causes of common age-related conditions in women could lead to more effective prevention and treatment strategies.”

For more than two decades, Bairey Merz and her team have made landmark discoveries in women’s heart health, particularly in coronary microvascular disease—a condition that occurs more often in women and results from damage to the heart’s smallest blood vessels. Symptoms of the condition, which can be subtle, were previously often dismissed, misdiagnosed or undertreated. But improved diagnostic tools and treatments resulting from Bairey Merz’s discoveries have contributed to significant reductions in cardiovascular deaths among women.

The new study brings together a multidisciplinary team of experts, including Pascal Sati, PhD, director of the Neuroimaging Program in the Department of Neurology at Cedars-Sinai. Collaborators at UCLA will oversee biostatistical analysis, while those at the University of Texas at Arlington will lead frailty research.

“We now have effective treatments for small vessel dysfunction in the heart,” Bairey Merz said. “If we can better understand its effects on the brain and musculoskeletal system, we may be able to find ways to prevent or slow multiple age-related diseases—including declines in cognition and mobility—in both women and men.”

Although women generally live longer than men do, women experience higher rates of chronic conditions and so spend more years in poor health. Ultimately, investigators hope the new study will pave the way for a future in which healthy aging for women includes earlier screenings, advanced technology, and preventive care that identifies risks and stops diseases before they begin.

“After more than 25 years of progress in women’s cardiovascular research, this grant helps advance whole-person care that supports heart health, brain function and physical strength,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute. “All three are equally essential to healthy aging.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Michelle Kittleson, MD, PhD, director of Post Graduate Medical Education in Heart Failure and Transplantation, received the American College of Cardiology 2025 Distinguished Teacher Award. Richard Wright, MD, an advanced heart failure and transplant cardiologist and board chair of Pacific Heart Institute, an affiliate of Cedars-Sinai, received the Master of the ACC Award. And postdoctoral researcher Andrew Lin, MBBS, PhD, under the mentorship of Damini Dey, PhD, professor of Biomedical Sciences at Cedars-Sinai, is the co-recipient of the Jagat Narula Award for Outstanding Scholarship from JACC: Cardiovascular Imaging.

“Congratulations to Dr. Kittleson, Dr. Wright and Dr. Lin on this notable recognition from the ACC and JACC,” said Christine Albert, MD, MPH, chair of the Department of Cardiology and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology. “We are proud of their substantial contributions to all aspects of cardiovascular medicine that encompass education, research and clinical care. It’s gratifying to see them receive recognition from their peers for their pioneering leadership in the field.”

The Distinguished Teacher Award recognizes a fellow of the ACC who has demonstrated innovative, outstanding teaching characteristics and compassionate qualities and has made major contributions to the field of cardiovascular medicine.

Kittleson, a professor of Cardiology, also is associate editor of the JACC. She is widely known as a participant in national educational efforts, including helping develop evidence-based cardiomyopathy and heart failure guidelines. She also is known for fostering an active and engaged social media community, sharing cardiology-related discussion points, questions and pearls of wisdom with followers.

“I’m humbled and grateful to be among the cardiovascular physicians and researchers nominated for and receiving this recognition from the American College of Cardiology,” Kittleson said. “Teaching is of great interest to me, and I consider it a privilege to teach new physicians as well as the public. As an academic medical center, we want our teaching to go far beyond the walls of Cedars-Sinai.”

The Master of the ACC Award honors fellows of the ACC who are consistent contributors to the goals and programs of the college and who have provided leadership in important college activities, serving with distinction for at least 15 years and providing leadership on various programs and committees.

Wright has served as president of the California Chapter of the ACC. He is a highly regarded lecturer and was co-author of the U.S. guidelines on management of patients with heart failure. He also is a previous recipient of the Specialist of the Year Award from the California Chapter of the ACC.

“The ACC is known for its pronounced focus on setting new standards in cardiovascular medicine,” Wright said. “I’ve enjoyed and learned much from my peers as part of the ACC over many years.”

Lin’s research focuses on coronary plaque phenotyping using coronary computed tomography and artificial intelligence techniques.

The Jagat Narula Award for Outstanding Scholarship was awarded to Lin and Márton Kolossváry, MD, PhD, based on their manuscript, “Coronary Plaque Radiomic Phenotypes Predict Fatal or Nonfatal Myocardial Infarction: Analysis of the SCOT-HEART Trial,” published in 2024 in JACC: Cardiovascular Imaging.

“I pursued cardiovascular research to be at the forefront of innovation and help advance evidence that improves care for patients with coronary heart disease,” Lin said. “I’m especially grateful to JACC for recognizing our research into ways to better predict heart attack risk.”

As the mentor for Lin and Kolossváry, Dey also expressed gratitude to JACC for recognition of their research and added, “We are committed to continuing important investigations into new ways of predicting and preventing heart attacks.”

ACC President Cathleen Biga, MSN, extended congratulations, saying, “These heart experts have each demonstrated exceptional work that will further the ACC’s mission to transform cardiovascular care and improve heart health for all.”

In addition to the awards presented at the ACC’s Annual Scientific Session, the California Chapter of the ACC named C. Noel Bairey Merz, MD, director of the Barbra Streisand Women's Heart Center, the 2024 Elliot Rapaport Cardiologist of the Year. Bairey Merz received the award at a Chapter meeting in January.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“To see this level of investment in women’s heart health is remarkable,” said Arthur J. Ochoa, JD, senior vice president of Advancement and chief advancement officer at Cedars-Sinai. “Philanthropists like Erika Glazer are changing the face of healthcare and bringing advanced care to so many of our patients.”

Glazer’s journey into heart care began in 2013, when she established the Erika J. Glazer Chair in Women’s Heart Health. The funds generated by the chair’s endowment supported the work of Jennifer Van Eyk, PhD, an expert in the study of proteins whose research focuses on sex differences in heart disease. Van Eyk is director of Basic Science Research in the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai, director of the Advanced Clinical Biosystems Institute and professor of Cardiology, Biomedical Sciences and Pathology and Laboratory Medicine.

“Science is an uncharted territory,” said Glazer. “I wanted to help ensure that women were not left behind when it comes to heart health and research.”

Glazer further widened her philanthropic focus in 2016 when she established the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science, currently occupied by Susan Cheng, MD, MPH, MMSc, director of the Institute for Research on Healthy Aging and division director of Population Health Sciences in the Smidt Heart Institute at Cedars-Sinai.

Then in 2023, Glazer funded her third chair at Cedars-Sinai—the Erika J. Glazer Chair in Women’s Cardiovascular Research, Education and Innovation. The inaugural chairholder is Janet Wei, MD, FACC, associate medical director of Cedars-Sinai’s Biomedical Imaging Research Institute, director of the Cardiovascular Disease Fellowship program in the Smidt Heart Institute, and associate professor of Cardiology and Biomedical Sciences at Cedars-Sinai. 

Righting a Wrong

Glazer’s philanthropic inspiration was sparked by her growing awareness of the underrepresentation of women in heart research, coupled with the need for greater gender equity in the United States.

“Women’s heart disease impacts everyone, in that all of us have a mother, a sister, a daughter, and/or a wife,” said Glazer, who at age 16 spent time interning at Cedars-Sinai—known then as Cedars of Lebanon—in the cardiology laboratories. “We must do more, we must do better, and we must do it now.”

While she considered a career in healthcare, Glazer opted to join her father, Guilford Glazer, in real estate development.

Glazer has made a name for herself in the male-dominated fields of construction and sports. A successful equity investor, she currently is a co-owner of the NBA’s Golden State Warriors.

“If it’s your passion, nothing should stand in your way,” Glazer said.

In addition to aiding Cedars-Sinai’s mission to attract and retain exceptional investigators, in 2016, Glazer also pledged $7.2 million for the Erika J. Glazer Women’s Heart Research Initiative at the Barbra Streisand Women’s Heart Center to support investigations into heart failure with preserved ejection fraction (HFpEF), a type of heart failure that primarily affects women.

“We are increasingly thankful to Erika Glazer—our colleague, our friend and our partner—for helping us to uncover the secrets of women’s heart health and disease,” said C. Noel Bairey Merz, MD, FACC, director of the Barbra Streisand Women’s Heart Center, and the Irwin and Sheila Allen Chair in Women’s Heart Research. “She is a doer, and she is changing the face of heart disease for women and men.”

A Champion for Women

Wei, the newest chairholder supported by Glazer, is awed by the woman behind its creation.

“I’m honored to join an inspiring group of women leaders who have benefited from the vision and generosity of Erika Glazer,” Wei said. “She is a champion for women’s heart health and is providing opportunities for my colleagues and me to advance the research, education and innovations that will save lives.”

 Read more from Discoveries: Women’s Health and Sex Differences—Research Update

Although heart attacks in people 18 to 44 are rare, they have increased more than 66% since 2019. However, heart attacks have decreased in all other adult age groups.

Bairey Merz told Yahoo! Life the uptick in heart attacks among younger adults could be traced in part to unhealthy lifestyle trends, such as a poor diet and physical inactivity.

“Nutrition habits are pretty well-formed in childhood,” Bairey Merz said. “I still eat pretty much the way I was raised. This was before fast food, before all the highly processed and snacking foods.”

Bairey Merz, director of the Linda Joy Pollin Women’s Heart Health Program in the Department of Cardiology, told Yahoo! Life she is studying why heart attack rates are spiking among women 35 to 54.

“The ‘diabesity’ epidemic is clearly contributing to a rising rate of heart disease,” she said, referring to increases in both diabetes and obesity. “And diabetes is a stronger risk factor [for cardiovascular problems] for women than for men, but we don’t know why.”

Bairey Merz told Yahoo! Life smoking and vaping also contribute to heart attack risk.

“We clearly are seeing a demographic of college-educated women who are more likely to start smoking when they go away to college … for what they say is weight management,” she said. “Don’t smoke; e-cigarettes are the same, vaping is the same, smoking cannabis is the same. There is no safe tobacco or cannabis [smoke].”

Bairey Merz told Yahoo! Life the connection between stress, low estrogen levels and heart disease also is being investigated.

Click here to read the complete article from Yahoo! Life.

Biden visited Cedars-Sinai because of the organization’s longstanding commitment to research and clinical care aimed at improving women’s health. While women comprise half the world’s population, most medical research has focused on men, leaving women-focused research underfunded.

“Today, we heard about the amazing progress that can happen when we focus on women. And you told me that in some ways, the work has only just begun,” First Lady Jill Biden said during her visit. “That’s why we have to start now – because women deserve better, today. And through this new White House initiative, we will help women’s health research catch up to where it should have been all along. We will write new stories about women’s healthcare.”

Cedars-Sinai President and CEO Thomas M. Priselac welcomed Biden and guests, including U.S. Secretary of Health and Human Services Xavier Becerra, U.S. Rep. Ted Lieu and wife Betty Lieu, and journalist Maria Shriver.

“When President Biden announced that you and the White House Gender Policy Council would lead the first-ever White House Initiative on Women’s Health Research, a very loud cheer came from our Barbra Streisand Women's Heart Center, our Center for Research on Women’s Health Sciences, our Smidt Heart Institute and so many others throughout Cedars-Sinai who know that biomedical research can change the world—when the right forces align,” Priselac said.

The Women’s Guild Simulation Center for Advanced Clinical Skills was the first stop on Biden’s tour. The facility uses the latest healthcare technology and robotic surgical tools—including lifelike mannequins—to train physicians, nurses and other healthcare professionals and to improve healthcare outcomes and patient safety. 

Biden also visited the Van Eyk Laboratory in the Smidt Heart Institute. Its director, Jennifer Van Eyk, PhD, is an expert in proteomics, the study of proteins, and her work focuses on understanding how protein alterations are different in women with heart disease than men with heart disease.

Biden was joined on the tour by C. Noel Bairey Merz, MD, director of the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute. The women’s heart program is playing a leading role in identifying female-pattern heart disease, developing new diagnostic tools and advancing specialized care for women. Bairey Merz' research has deepened the understanding that a second “X” chromosome influences heart disease. This knowledge informs more tailored treatments for women who are at risk of cardiac conditions. 

Bairey Merz also co-leads Cedars-Sinai’s Center for Research in Women’s Health Science, which seeks to understand how diseases affect women differently than men. The center’s goal is to increase health equity by conducting research on a range of conditions affecting women, including autoimmune diseases, cancer, cardiovascular health, maternal-fetal medicine, neurology, OB-GYN and reproductive health, and orthopedics.

“We recognize the tremendous honor it is to have Dr. Biden highlight her women’s health initiative at Cedars-Sinai,” Bairey Merz said. “Our institution has spent decades studying how women are affected by various diseases and conditions, and we are eager to see such a vested interested in this work from the White House.”

Read more in Discoveries Magazine: Research Highlights Sex-Related Health Differences

Gulati told Voice of America host Crystal Dilworth that heart disease is the leading cause of death for women, who don’t always experience the same symptoms as men. Though 90% of men and women report having chest pain or pressure before a heart attack, Gulati said women are more likely to experience three or more additional symptoms, including profound fatigue, shortness of breath, jaw pain and shoulder pain.  

Gulati, associate director of the Preventive and Rehabilitative Cardiac Center in the Smidt Heart Institute at Cedars-Sinai and the Anita Dann Friedman Chair in Women’s Cardiovascular Medicine and Research, said she and her colleagues are “finding that there’s a difference in the underlying pathophysiology of cardiovascular disease. Certain types of diseases we’re seeing more frequently in women compared with men.”

Women also account for 90% of Takotsubo cases and 60% of heart failure with preserved ejection fraction, said Merz, a professor of Cardiology and the Irwin and Sheila Allen Chair in Women’s Heart Research. She gave Dilworth examples of differences in male and female bodies, both of which can lead to heart attack. Women have proportionately smaller coronary arteries that can be too small to effectively deliver blood to the heart. Whereas men have larger arteries that are prone to clogging. Because of these differences, a heart attack in a woman won’t appear the same as in a man or require the same treatment.

Merz and Van Eyk—the Erika J. Glazer Chair in Women's Heart Health—studied blood samples collected from women with Takotsubo syndrome up to 10 years after the initial diagnosis. They compared these samples with blood collected from healthy individuals and found different protein patterns in the blood of Takotsubo patients, a lasting marker of the disease.

“What we know with Takotsubo is that if you’ve had it once, you’re at a higher risk of getting it a second time,” Van Eyk said.    

Click here and here to watch the complete segments from Voice of America. 

Heart disease is the leading cause of death among women in the U.S., and a type of heart attack called myocardial infarction with non-obstructive coronary arteries (MINOCA), which predominantly affects women, is garnering increased attention.

In observance of American Heart Month in February and Cedars-Sinai’s 18th annual National Wear Red Day event on Feb. 3 to raise awareness of women’s heart health, the Cedars-Sinai Newsroom sat down with Janet Wei, MD, and Noel Bairey Merz, MD, cardiologists in the Smidt Heart Institute at Cedars-Sinai, to learn more about MINOCA.

Wei is associate medical director of the Biomedical Imaging Research Institute at Cedars-Sinai and co-director of the Stress Echocardiography Lab at the Smidt Heart Institute. Bairey Merz is director of the Barbra Streisand Women’s Heart Center and director of the Linda Joy Pollin Women’s Heart Health Program at the Smidt Heart Institute.

What is MINOCA?

MINOCA is a heart attack caused by poor blood flow to the heart, despite no evidence of major blockage in the arteries. A troubling aspect of MINOCA is that often when we diagnose a heart attack, we rely on a single imaging method—invasive coronary angiogram—to tell us if there’s a big blockage in the coronary arteries. With MINOCA, the angiogram can look normal because we don’t see a blocked artery, and then patients don’t know why they had a heart attack.  

MINOCA primarily affects women—tell us more about this. 

Compared to heart attacks with obstructive coronary artery disease, MINOCA patients are more likely to be female and younger, and they’re also more likely to be Black or Hispanic/Latino. Prior studies have shown that Black or Hispanic patients—in particular, young Black women—have a lower prevalence of obstructive coronary artery disease than white/non-Hispanic patients when they come to us with chest pain or are being evaluated for heart attack. It’s unclear if this difference is due to disparities in healthcare referral patterns for testing or racial/ethnic differences.

What causes MINOCA? 

There can be different causes. Even with no obstructive coronary arteries, MINOCA can still occur because of atherosclerosis (plaque buildup). But instead of the plaque rupturing and blocking the whole artery, with MINOCA, it’s due to an erosion rather than a rupture. So, the surface of the plaque may be disrupted, but there’s no big clot blocking the blood vessel and therefore, we can’t see it on routine angiography.

There are other causes of MINOCA that are more common in women than men. These include coronary artery spasms, which cause poor blood flow to the heart. Also, a spontaneous coronary artery dissection, which is when the blood vessel tears. This is the most common cause of heart attacks in pregnant and postpartum women.

What are the symptoms and risk factors?

The signs and symptoms are the same as a heart attack in someone who has blocked arteries—chest discomfort (pain, pressure, tightness), shortness of breath, nausea, lightheadedness. There are some shared risk factors—high blood pressure, high cholesterol, diabetes, smoking—but they are less frequent in MINOCA patients than in patients who’ve had heart attacks with obstructive coronary disease. We’re still trying to understand what contributes to MINOCA, mainly because it could be caused by many different things—spasm, dissection or even an embolism.  

How is MINOCA treated? 

The same way as other heart attacks: antiplatelet therapy, statins, ACE-inhibitors/angiotensin receptor blockers and beta-blockers. However, we think these therapies should be tailored in patients with MINOCA, particularly in those without atherosclerosis. Large trials are needed to help us determine how to best treat MINOCA patients.

What research is underway to better understand MINOCA?

We previously participated in the Heart Attack Research Program, supported by the American Heart Association, in which advanced imaging techniques were tested to help us better understand MINOCA in women. We found that a combination of imaging techniques allowed us to diagnose the cause of MINOCA in over 80% of cases. The study has since expanded to include men.

We need more research into treatments. Because we don’t fully understand why MINOCA may have happened, we can’t tailor our treatment. The Women’s Heart Center at Cedars-Sinai is currently leading the WARRIOR clinical trial (designed by Bairey Merz), testing whether standard therapy used for obstructive coronary artery disease is effective for women with chest pain and no obstructions. Some of the women enrolled have experienced MINOCA.

What do you wish more people knew about MINOCA?

That heart attacks can occur for a variety of reasons, and the absence of obstructive coronary artery disease does not mean it’s not a heart attack.

Read more on the Cedars-Sinai Blog: Finding the Right Care for a Racing Heart