Understanding the Gender Divide in Heart Disease in Montana
Kyra Eddy Piñango, MD, Family Medicine, Board Certified Obstetrics
Livingston HealthCare
While heart disease is the leading cause of death for both men and women in Montana, it certainly doesn’t behave the same way in everyone. In fact, when it comes to cardiovascular health, men and women often seem to be operating from entirely different playbooks. The way heart disease develops, presents, and is treated differs significantly between the sexes—a reality that too often goes unrecognized. Cultural attitudes further complicate the picture. Men often pride themselves on toughness and self‑reliance, which can lead to ignoring early warning signs or skipping routine checkups. Women, meanwhile, frequently prioritize family needs over their own health, delaying care until symptoms become severe. Both patterns contribute significantly to preventable heart disease deaths.
The American Heart Association shows that men tend to develop heart disease earlier in life, often experiencing their first heart attack around age 65, while women typically face heart events later, around age 72. At this age, women often develop symptoms while also managing caregiving responsibilities or chronic conditions and are more likely to fall back on the belief that their symptoms are “just stress” or “just getting older”. Men may be even less likely to seek timely evaluation due to hesitation to ask for help.
One of the most striking differences between men and women’s cardiac events is how symptoms appear. Men are more likely to experience the “classic” heart attack signs: crushing chest pain, arm discomfort, heartburn or indigestion, and shortness of breath. Women, however, often present with subtler symptoms such as indigestion or gas-like pain, unexplained fatigue and sleep disturbances, nausea, or uncomfortable pain between the shoulder blades. These atypical signs can be easily dismissed as stress, aging, or gastrointestinal issues.
Biology also plays a large in role in heart disease. Women generally have smaller arteries and present with different plaque patterns than men, which can make diagnostic tests less accurate and interventions more complicated. Men’s plaque calcifies and hardens over time, making it easy to see in imaging. Women are disproportionately affected by heart attacks that show no blockages on angiography, a pattern driven by higher rates of microvascular disease and the complex influence of the autonomic nervous system—factors that often obscure symptoms and challenge conventional diagnostic tools. These anatomical differences contribute to higher rates of misdiagnosis and poorer outcomes for women nationwide.
Risk factors also differ between men and women. Men are more likely to develop heart disease earlier due to higher rates of hypertension and lifestyle factors. Women, however, face unique risks tied to hormonal changes, pregnancy complications, and autoimmune diseases. After menopause, women’s risk accelerates sharply. Yet many women, especially in rural and tribal communities, are missing regular preventive screenings that could catch rising blood pressure or cholesterol before they become dangerous.
Here’s the good news: Early detection and treatment of high blood pressure, high blood sugar, and high cholesterol leads to improved heart health for all Montanans, both men and women.