On February 28, 2004, the American Heart Association launched the "Go Red for Women" campaign – a turning point: For the first time, a major initiative brought heart disease, the leading cause of death among women, into public awareness. Since then, we have learned that women do not primarily die from "typically female" diseases, but from cardiovascular diseases. Nevertheless, their symptoms are still too often misinterpreted or underestimated – by themselves and within the system. It’s time to change that.

A heart attack is not always chest pressure and left arm numbness. In women, warning signs are often more subtle: pressure or tightness, shortness of breath, nausea, unusual fatigue, pain in the back, neck, or jaw. The problem often begins before the emergency. Risk factors such as visceral fatfat tissue around internal organs, arterial hypertensionpersistently elevated blood pressure, and dyslipidemiaadverse blood lipid levels can go unnoticed for a long time. Psychosocial burdens – chronic stress, depression, lack of sleep – further impact the autonomic nervous system and the inflammatory axis, significantly increasing cardiovascular risk in women. A second hurdle: communication patterns. Many women report that they downplay or describe their symptoms differently than men. This creates room for misinterpretation, delays in diagnosis, and therapy – with consequences for prognosis and daily performance.

The consequences are measurable. Qualitative analyses of women with acute heart attacks describe delays caused by time loss in triage, communication problems, and gender-related bias – barriers that can lead to delayed treatment ^[1]. Pre-hospital behavior also matters: studies show that women misinterpret symptoms and postpone seeking help – a manageable risk driver ^[2]. Lifestyle factors amplify the picture. Smoking significantly increases the risk of cardiovascular events and mortality in women; even a few cigarettes a day are harmful, while quitting reduces risk early and sustainably ^[3][4]. Conversely, physical activity serves as protection: even short, accumulated intervals of moderate to vigorous activity are linked to lower overall mortality and fewer severe cardiovascular events ^[5]. Mental health is not a "soft factor": stress, depression, and autonomic dysregulation increase heart risk in women, while mindfulness-based approaches can positively influence blood pressure, heart rate variability, and stress biology ^[6][7].

Three insights stand out. First: tobacco. A large collaboration of 22 prospective cohorts shows that even low amounts of cigarettes significantly increase the risk of atrial fibrillation up to heart failure. The greatest benefit occurs within the first ten years after quitting smoking, with risk reduction beginning early and lasting for decades. The message is clear: quitting trumps reduction ^[3]. Second: activity without a gym. An analysis of accelerometer data from the UK Biobank among individuals not engaged in leisure sports found that everyday bouts of 1 to 10 minutes of moderate to vigorous activity are associated with significantly lower mortality and fewer severe cardiovascular events – even if they occur randomly throughout the day. This makes prevention more practical ^[5]. Third: perception and access. Surveys from the emergency room to the pharmacy show that women underestimate their heart risks and that structural barriers exist – from communication hurdles in acute situations ^[1] to low risk perception in population-wide screenings, highlighting the need for gender-sensitive education ^[8]. Together, these data create a precise picture: biology, behavior, and system factors interconnect – and can be intentionally influenced.

- Achieve 150+ smart activity minutes: Plan for 5 days of 30 minutes of moderate intensity (brisk walking, cycling, stairs), or utilize "micro-intervals" of 3–10 minutes throughout the day – from a quick walk between appointments to a brisk grocery shop. These short bouts are demonstrably associated with fewer cardiovascular events and lower mortality ^[5].
- Calming stress axes: Incorporate 10–15 minutes of daily breathing exercises (e.g., 4-6 breathing), 2–3 yoga or meditation sessions per week, and short mindfulness breaks between meetings. Studies show beneficial effects on blood pressure, cortisol regulation, and heart rate variability – all relevant for women's health ^[6][7].
- Quit smoking with a plan: Set a quit date, combine behavioral training with nicotine replacement or prescription medication, and utilize digital follow-up programs. The most significant risk reduction occurs in the first years after quitting smoking – even for "light" female smokers, complete cessation counts ^[3]. The increased cardiovascular mortality among female smokers underscores the urgency ^[4].
- Reduce sugar in diet, choose fats wisely: Consistently reduce sugary drinks – they are linked to higher risks of stroke, heart failure, and arrhythmias ^[9]. Prioritize unprocessed foods, fiber, unsaturated fats, and keep added sugars in check.
- Communicate early and clearly: Establish your personal "alarm signs" (new shortness of breath, pressure/tightness, unusual fatigue, back/jaw pain). In acute situations: briefly and factually describe symptoms, onset time, and intensity; explicitly emphasize the suspicion of heart involvement. This addresses documented communication gaps ^[1].
- Awareness with leverage: Participate in local screening and awareness days, such as in pharmacies or workplaces. Such campaigns uncover common risk factors and correct misestimations regarding heart threats in women ^[8]. Share resources within the team – prevention scales when it becomes visible.

In the coming years, precision cardiology will better depict gender-specific risks – from stress biomarkers to AI-supported triage. Those who today integrate movement into their daily lives, regulate stress axes, quit smoking, and communicate clearly will benefit immediately – and be prepared for personalized prevention tomorrow.