On February 13, Canadians across the country mark Wear Red Canada Day, a reminder that heart disease remains the leading cause of death for women. Yet despite the scale of the problem, many women still do not recognize their risk or their symptoms.“We’re learning more and more each day about how heart disease uniquely affects women,” said nurse practitioner and researcher Rachel Ollivier in an interview with CTV News. She emphasized that awareness is still lagging, both among patients and within health-care systems.According to the World Health Organization, cardiovascular disease accounts for roughly one in three deaths among women globally. In Canada, heart disease and stroke continue to be leading causes of death among women, and women are less likely than men to receive timely diagnosis or treatment.Symptoms Can Look DifferentChest pain remains the most common heart attack symptom in both men and women. But Ollivier explained that women’s symptoms can often be subtler or feel different.“For women, they often uniquely experience chest pain that seems like more of a discomfort or a tightness in the chest,” she said. Some women may feel pain in the left arm or jaw, unusual fatigue, nausea, vomiting, or discomfort between the shoulder blades.Because these symptoms can be less specific, they are sometimes dismissed as stress, anxiety, indigestion, or exhaustion. Social factors also play a role. Women often juggle multiple responsibilities at home and work, and may delay seeking care. In some cases, their concerns may also be minimized within health-care settings.Medical differences matter too. Women typically have smaller hearts and arteries, and plaque buildup behaves differently compared to men. Conditions such as spontaneous coronary artery dissection and microvascular dysfunction are seen more commonly in women, making diagnosis more complex.Hormones and the Hidden Risk WindowBeyond symptoms, experts are urging greater recognition of the role hormones play in lifelong heart health.“Endogenous estrogen is cardio protective,” Ollivier explained. As women enter the perimenopausal transition, estrogen levels fluctuate and gradually decline, and that protection is lost. This shift can lead to higher cholesterol levels and changes in fat distribution, increasing cardiovascular risk, particularly between the ages of 40 and 60.Colleen Norris, a nursing professor at the University of Alberta and research lead of the CKHui LHHW Women’s Heart Health Research Collaborative who wrote on Yahoo Canada, believes the conversation needs to go even deeper.She argues that ovaries have long been viewed only through the lens of reproduction. “The ovaries are not just reproductive organs. They are architects of women’s health across the lifespan,” she noted. Estrogen influences the heart and blood vessels, but also the brain, bones, kidneys, metabolism, and immune function.Most women are never told that ovarian reserve and estrogen levels begin declining in their late 30s. By the time noticeable symptoms appear, biological changes may have already been underway for years.Menopause itself is just one day, Norris explained. The larger reproductive transition surrounding it is what significantly increases vulnerability to chronic disease. Yet the health-care system often waits until disease develops before intervening.Moving From Awareness to ActionBoth experts stress that education is critical. Women with conditions such as polycystic ovary syndrome, pregnancy complications like preeclampsia or gestational diabetes, and those entering midlife should be particularly mindful of their cardiovascular risk.Wear Red Canada Day is meant to spark awareness, but symbols alone are not enough. Experts are calling for better research funding focused on midlife women, improved medical education around ovarian aging, and more proactive screening during the reproductive transition.Heart disease in women is not inevitable. But recognizing that symptoms can differ, and that hormonal shifts matter, could be lifesaving.