What Every Woman Needs to Know

By Jamie Bussin, featuring Dr. Colleen Hartwick ND

In all the years I’ve hosted health conversations, we’ve never dedicated a full discussion specifically to women’s cardiovascular health. That changed in my recent interview with Naturopath Dr. Colleen Hartwick, on Episode #423 of The Tonic Talk Show Podcast, and what emerged was a powerful reminder that heart disease in women is different, often misunderstood, and frequently overlooked. This is a digest of that conversation.

When most people think about heart health, they picture cholesterol numbers, blood pressure readings, stress tests, and exercise. That framework, while important, is incomplete, especially for women.

Heart Disease in Women Looks Different

Historically, most cardiovascular research has been conducted on men. As a result, the “classic” model of heart disease is based largely on male physiology. In men, cardiovascular disease often involves atherosclerotic plaque; significant blockages in the major coronary arteries that can be clearly detected through conventional testing.

Women, however, tend to develop heart disease differently.

Rather than large plaque build-ups, women are more likely to experience microvascular damage; microscopic injury to the delicate lining of blood vessels. This type of dysfunction doesn’t always show up on standard cardiovascular tests such as stress EKGs or calcium scoring. In other words, a woman can be struggling with real cardiovascular risk even if her test results appear “normal.”

Symptoms differ as well. While men often experience the textbook crushing chest pain during exertion, women may present with far more subtle or “nebulous” signs, including:

• Nausea
• Heartburn-like discomfort
• Lightheadedness
• Anxiety
• Unusual fatigue
• Poor exercise recovery

Because these symptoms can seem vague or unrelated to the heart, they are often dismissed, by patients and sometimes even by practitioners.

The Ontario Health Study Wake-Up Call

A major shift in thinking came from findings in the 2025 Ontario Health Study, a 15-year study of more than 200,000 healthy adults. The research examined genetics, environment, and lifestyle factors in relation to chronic diseases, including heart disease. The findings were striking.

While women overall tend to have slightly better cardiovascular health than men, when women do fall into poor cardiovascular health categories, their risk skyrockets. Women with poor cardiovascular health had a fivefold increased risk of future heart attack or stroke. In comparison, men with similar risk profiles had about a two-and-a-half-fold increase.

In other words, the same risk factors translate into significantly worse outcomes for women.

Why Risk Factors Hit Women Harder

Several mechanisms appear to drive this heightened vulnerability.

Women often have a more sensitive response to:

• Insulin resistance
• Inflammation
• Central weight gain
• Sleep disruption
• Chronic stress

Hormonal differences also play a critical role. Fluctuations during perimenopause and menopause can amplify inflammation, worsen blood sugar regulation, and increase arterial stiffness.

Sleep, in particular, has a profound impact on women’s cardiovascular outcomes. Poor-quality sleep can:

• Worsen insulin sensitivity
• Increase cortisol (the stress hormone)
• Elevate inflammation
• Reduce blood vessel flexibility

During perimenopause and menopause, when sleep often becomes more disrupted due to night sweats and hormonal shifts, these risks can intensify.

Diet and Blood Sugar Balance

When it comes to cardiovascular health in women, diet is foundational.

Stable blood sugar is critical. Diets high in ultra-processed foods and simple sugars increase inflammation and insulin resistance, which are both key drivers of heart disease risk in women.

A heart-healthy dietary approach for women should prioritize:

• Adequate protein intake (especially as we age)
• Omega-3 fatty acids
• High-fibre whole foods
• Minimally processed ingredients

Protein becomes particularly important with age, as women’s tissues become less responsive to dietary protein. Maintaining muscle mass supports metabolic health and insulin sensitivity—both protective against cardiovascular disease.

Fibre also plays a crucial role by supporting the gut microbiome, which influences inflammation, insulin regulation, and lipid metabolism.

The Right Exercise for Women’s Heart Health

Exercise is one of the most powerful tools women have to protect their hearts. But balance matters. The most effective approach includes:

• Regular walking or moderate cardio
• Resistance training (critical for muscle and bone health)
• Short bursts of high-intensity interval training (HIIT)

Strength training deserves special emphasis. Muscle is metabolically active tissue and plays a major role in maintaining insulin sensitivity. Elevated insulin levels are strongly associated with increased cardiovascular risk in women.

Interestingly, there is some emerging evidence suggesting that chronic, extreme endurance training (such as ultra-marathons or intense triathlon training) may elevate cortisol and inflammation in women. While the data is still developing, balance appears to be key.

Supplements That Support Women’s Cardiovascular Health

While diet and lifestyle are foundational, certain supplement categories may provide additional support:

Magnesium
Magnesium helps relax blood vessels, regulate blood pressure, lower inflammation, and moderate the stress response. Deficiency can contribute to elevated cortisol and vascular constriction.

Omega-3 Fatty Acids
These essential fats support healthy lipid metabolism, increase protective HDL cholesterol, and reduce inflammation.

Antioxidants
Compounds such as Coenzyme Q10, Vitamin C, and Vitamin E help protect the lining of coronary arteries and reduce oxidative stress.

As always, supplementation should be personalized and guided by a qualified healthcare professional.

The Habit to Stop Immediately

If there’s one habit women should eliminate for better heart health, it’s sacrificing sleep, especially due to late-night screen time.

“Doom scrolling” before bed disrupts sleep quality, raises stress hormones, and impairs metabolic function. Sleep is not optional; it is foundational to cardiovascular health.

The Most Important Takeaway

Heart disease is not an overnight event. It is a decades-long process. The subtle signs such as fatigue, irritability, sugar cravings, poor stress tolerance and slower recovery from exercise, may be early indicators of deeper imbalance.

The most powerful message from my conversation with Dr. Hartwick is this: Be proactive.

Don’t dismiss symptoms as “normal.” Don’t assume heart disease only looks one way. And don’t wait for a crisis to prioritize prevention.

The earlier women listen to their bodies, the better their outcomes will be.