The hidden signs of middle-aged heart disease that every woman needs to know: From cholesterol deposits around your eyes to jaw pain mistaken for stress. Here’s how to identify your risk

Hayley Martin has never drunk alcohol or smoked cigarettes, eats healthily and leads a fit and active lifestyle – enjoying yoga, cycling, horse-riding and running marathons.

Yet two years ago, during a routine check, she discovered she had sky-high cholesterol levels, putting her at risk of heart disease.

Specifically she had raised levels of harmful LDL cholesterol, the ‘bad’ type that furs up arteries and can impede blood flow to the heart.

‘I’ve never eaten junk food so doctors said it must just be genetic,’ says Hayley, 56, a full-time carer for her elderly parents, who is married to Peter, 61, a retired truck driver.

It was also found she had developed atrial flutter – intermittent episodes of erratic heartbeats, which can raise the risk of a stroke.

‘Normally, my heart rate is very low, at about 37 beats per minute,’ says Hayley, from Congleton in Cheshire.

‘But suddenly it shot up to 300. It was terrifying.’

It’s a story that chimes with that of TV presenter Davina McCall, 59, who revealed earlier this week that she too has high cholesterol and has been diagnosed with cardiovascular disease. This is despite a healthy lifestyle that revolves around intermittent fasting, a 3km daily morning run and a largely sugar-free diet.

The mother-of-three, who has already endured breast cancer and a benign brain tumour, has previously revealed she was warned to watch her cholesterol levels when she first got pregnant 20 years ago – describing it as ‘a hidden danger – you can’t see it and you don’t know it’s there’.

If nothing else, Davina’s story is being seen as a huge wake-up call to millions of women across the UK – that heart disease isn’t just something that affects mainly men.

In fact, it kills twice as many women in the UK each year as breast cancer – around 23,000.

And while more men develop heart problems, some studies suggest women are more likely to die from them – partly because their symptoms are often blamed on other things.

Yet the British Cardiovascular Society warns women are being underdiagnosed, under-treated and under-represented in clinical trials for heart disease.

‘There’s a real gender gap,’ adds Professor Raj Thakkar, past president of the Primary Care Cardiovascular Disease Society.

Hayley’s cholesterol has since been lowered with a daily statin, while her atrial flutter episodes (there have been two) are being monitored but do not currently need treatment.

But she is adamant women everywhere must be more aware of their heart risks.

‘It’s not thought of as a female condition – plus women tend to put themselves last when there are others who need looking after. We’ve got to take heart disease in women more seriously.’

So why is heart disease such a big danger – even in outwardly healthy women – and what can you do to reduce your chances of developing it?

Slim and fit? You can still be at risk

Like Davina, many seemingly healthy women are shocked to find they have one or more heart disease risks – such as high cholesterol or blood pressure.

Having raised cholesterol can block arteries while high blood pressure means the constant strain from high blood pressure damages the inside of artery walls – causing inflammation which can narrow the vessel and restrict blood flow to the heart.

‘You cannot simply look at someone who is slim and assume their risk factors are low,’ says Dr Laura Corr, a consultant cardiologist in London.

‘And the data shows heart disease is recognised much less rapidly in women.’

There is a huge genetic influence when it comes to heart disease, in both women and men, she adds.

How the risks rise after menopause

Oestrogen produced by the ovaries has a protective effect on a woman’s heart by controlling cholesterol levels and keeping blood vessels flexible and smooth, according to the British Heart Foundation.

After the menopause, when oestrogen supply shuts down, heart disease is more common as women often gain weight, their cholesterol and blood pressure increase and the body becomes less effective at processing sugar levels – heightening the risk of type 2 diabetes (which contributes to heart disease by damaging blood vessels).

A US study of more than 10,000 women, published in May in the Journal of the American College of Cardiology, found those going through an early menopause (before 45) are 40 per cent more likely to develop heart disease than those who go through it later.

But giving hormone replacement therapy (HRT) specifically for heart disease is not the answer, experts warn, as it can raise the risk of blood clots. (Although this is more likely to happen with pills, rather than the patches of gels which seep through the skin rather than circulate around the bloodstream.)

‘There may be some protection from pre-menopausal hormone exposure,’ says Dr Corr. ‘But we don’t prescribe HRT for heart disease in women.’

How women need more ‘good’ cholesterol than men…

We all know there is good (HDL) cholesterol and bad (LDL) cholesterol.

HDL can protect against heart disease in both sexes by scooping up excess cholesterol particles in the blood and escorting them back to the liver, where they are broken down and removed as waste.

LDL, meanwhile, sticks to the inside of our arteries and causes the formation of deposits, called plaques, that can break away and form blockages that can shut off the blood supply to the heart or brain resulting in a heart attack or stroke.

As a result, the NHS says men and women should keep LDL below 4mmol/litre (a measure of how much is in a litre of blood), to reduce the damage to the arteries.

But when it comes to HDL, the recommendations are different for women.

The NHS says they need a minimum of 1.2mmol/l – compared to just 1mmol for men.

That’s because women naturally have higher levels of HDL than men due to the effects oestrogen, which blocks the activity of an enzyme – called hepatic lipase – that breaks down and clears good HDL from the blood.

Studies suggest the risks start to escalate in women once their HDL dips below the 1.2mmol/l threshold.

There are steps you can take to increase your HDL, such as losing weight if you’re overweight, doing regularly vigorous exercise (where you’re not able to hold a conversation during it), cut down on foods containing trans fats (such as cakes, biscuits and pies) – and swap white carbs for wholegrain versions (e.g. bread).

… But don’t panic if ‘bad cholesterol is high

Experts say as long as women have no other cardiovascular risk factors – such as a strong family history of heart disease at a young age, high blood pressure or type 2 diabetes – raised LDL alone is unlikely to radically alter their chances of a heart attack or stroke.

‘If a woman is a healthy weight, a non-smoker, eats a balanced diet and takes regular exercise, we probably would not even treat a raised LDL level,’ says Naveed Sattar, a professor of cardiometabolic medicine at the University of Glasgow.

‘The fact is, they may be less at risk [of a heart attack or stroke] than someone else who has a healthy LDL but numerous other cardiac risk factors. Looking at LDL in isolation is not that useful.’

The other fats to watch for

There are other harmful blood fats besides LDL.

Triglycerides (which are measured when you have a cholesterol test), for example, are fats which can also damage blood vessels and raise the risk of heart disease.

The British Heart Foundation says a healthy triglyceride level is below 1.7mmol/litre for a fasting test (where you haven’t had anything to eat or drink for at least ten hours) or below 2.3mmol/l for a non-fasting test.

Signs that your cholesterol is too high

Blood tests can accurately measure cholesterol but there can sometimes be external clues that a woman has high levels.

Xanthelasma, yellow bumps that appear on or near the eyelid, is one, according to findings presented to the American Academy of Ophthalmology conference in 2025. These are thought to be the result of cholesterol leaking out of tiny blood vessels around the eye.

Research involving 17,000 patients found nearly 50 per cent of those with xanthelasma had high cholesterol – versus 39 per cent in the control group.

Do women need different blood pressure scores?

A healthy blood pressure reading is defined as anything between 120/80 and 90/60, according to the NHS. But some research suggests the thresholds should be lower in women.

A 2021 study in the journal Circulation, which involved 28,000 men and women over a 28-year period, found that women with systolic (the top reading) between 100 and 109 – i.e. within the ‘healthy’ range – had a cardiovascular disease risk equivalent to men with a systolic reading of 130 to 139, which qualifies as hypertension (high blood pressure).

One reason may be that, since women’s blood vessels are smaller than men’s in diameter, they are less able to withstand the same pressure and problems develop at a lower blood pressure level.

Researchers at the Cedars-Sinai Smidt Heart Institute in Los Angeles said their findings suggested the ideal upper limit for women should be 110, not 120.

In a second study, in 2023, the same team found women’s risk of dying from heart disease spiked at a systolic blood pressure reading that was 12 points lower than in men.

However, major bodies such as the American Heart Association, say there is insufficient evidence to support sex-specific blood pressure guidelines.

And a spokesman for the British Heart Foundation told the Mail: ‘There is not yet enough evidence to support a change to the recommended blood pressure guidelines for men and women in the UK.’

A healthy diet may not be enough

For either sex, ditching fatty foods in favour of a Mediterranean-style diet rich in olive oil, fish, fruit and veg can reduce levels of ‘bad’ cholesterol.

But in most cases, there is a limit to how much this can achieve – usually no more than about 10 per cent, says Professor Sattar.

Further reductions almost always require taking cholesterol-lowering drugs – usually statins.

‘You can make a dent in your cardiovascular risk by eating a more fibre-rich diet and less sugar and fat,’ says Professor Sattar.

Porridge oats contain a soluble fibre, called beta-glucan, which forms a gel in the gut that reduces the amount of cholesterol absorbed into the blood.

But studies show you need 3g a day of beta-glucan to get the right effect on the heart – and a standard 40g serving of porridge contains around 1.4 to 2g, roughly half what’s needed.

Other good sources include shiitake mushrooms, oat milk or beta-glucan supplements.

Stress is a bigger red flag for women than men

Chronic stress – such as worrying about work or finances – is bad for everybody’s wellbeing.

But studies suggest that, when it comes to heart health, it’s more damaging for women.

A 2014 study at Duke University in the US studied 310 adults with heart disease in stressful situations and, according to results published in the Journal of the American College of Cardiology, the women were more likely to suffer reduced blood flow to the heart and an increase in platelet aggregation – or clotting of the blood.

Both of these are risk factors for a potentially fatal heart attack.

Stress can also trigger an often fatal heart condition called spontaneous coronary artery dissection (SCAD) – where heart muscle ruptures as a result of a sudden tear or trauma (there are around four cases every day in the UK).

Intense physical or emotional stress – such as lifting weights or losing a loved one – triggers a sudden surge in stress hormones that can put huge pressure on fragile artery walls.

Women, often young or middle-aged, account for up to 90 per cent of SCAD cases, as blood vessels in and around the heart can be smaller and more delicate than in men.

It’s the biggest cause of heart attacks in women who have no other major risk factors, such as high blood pressure, raised cholesterol or type 2 diabetes.

The symptoms are very similar to a normal heart attack – a crushing, sharp or burning pain in the chest and arms.

Hayley suffered a SCAD when she was just 39.

‘I didn’t have any chest pain – instead, it was like someone was squeezing my jaw tightly and I was sweating profusely, with what I can only describe as a sense of impending doom.

‘I called 999 and when the paramedics arrived to find a 39-year-old woman on the floor, I think they assumed I was just having a panic attack – they told me to stand up.’

But once they attached her to their ECG machine – which measures the electrical activity of the heart – their priorities changed.

‘It was suddenly obvious that this was a total emergency,’ says Hayley. ‘I was blue-lighted straight to A&E.’

Doctors said the cause was a mystery.

Turning 40? It’s time to start having cardiac checks

The British Heart Foundation recommends that all women over the age of 40 ask their GP or practice nurse for an NHS Health Check. This is a 20-to-30-minute screening appointment (which currently only runs in England) that includes checking blood pressure, cholesterol and blood sugar readings to assess the risk of heart disease and type 2 diabetes.

It will also record whether you have a strong family history of heart disease as this can influence any calculation of your future risk. This may be higher if you have a mother or sister diagnosed with heart disease before 65, or a father/brother diagnosed under 55.

The results are then fed into an algorithm which calculates your risk of having a heart attack, stroke, type 2 diabetes or kidney disease within the next ten years.

Every five years after this, you will be invited for a follow-up check.

The heart attack signs only seen in women

‘Chest pain which may feel like crushing or squeezing on your chest’ – that’s how the NHS website describes the main symptom of a heart attack. But some studies suggest more than 40 per cent of women don’t get this sensation.

Instead, many get discomfort – pain, aches or tightness – in the jaw, neck, shoulders, upper back. Even tummy pain can mean a heart attack is happening, as the brain misinterprets where the pain signals are coming from (as sensory nerves for the heart and stomach are very close together). This is one of the ‘silent’ heart attack symptoms more often seen in women than men – though it’s not clear why.

And while the classic profile of a heart attack in a man is the sudden onset of severe pain, studies show that for some women, the first symptoms can appear several weeks before it becomes an emergency.

A 2003 study of 500 women by the University of Arkansas, reported in the journal Circulation, found 80 per cent of them had at least one symptom four weeks or more before being treated for a heart attack.

‘Men get more pain in the chest and the arm but in women it’s often in the back and shoulders,’ says Professor Sattar.