Cardiovascular disease is the No. 1 killer of women worldwide and a leading cause of illness and death. Each year it affects more than half a million Australian women, twice as many as breast cancer, according to the Heart Research Australia. According to the American Heart Association, heart disease and stroke cause 1 in 3 deaths among women each year – more than all cancers combined.

Despite its impact, heart disease in women is largely under-recognized, under-diagnosed and under-researched. One reason for this is that it does not affect all women alike, and the warning signs for women are not the same in men. In addition, women with hypertension often have no symptoms until they experience a major cardiovascular event.

To help women better understand their risk, below are three things they should know about their heart health:

1. Women have risk factors for heart disease that men do not.

Hormone and metabolic changes from pregnancy, aging and menopause can negatively affect women’s cardiovascular health. Women who experience hypertension, preeclampsia or gestational diabetes during pregnancy are also at greater risk for future hypertension and cardiovascular disease, such as coronary heart disease and stroke. In the pre-menopausal years of women’s lives, estrogen can protect the heart by relaxing the arteries and promoting good cholesterol. However, as estrogen declines, new cardiovascular risk factors such as hypertension and high cholesterol can develop even in women who previously had normal or even low cholesterol and blood pressure. Rates of heart disease in women typically increase near age 65, approximately ten years later than in men, likely because of the protective effects of estrogen.

2. Women have lower normal blood pressure ranges than men.

New research has found that women have lower “normal” blood pressure ranges than previously thought. Hypertension – or high blood pressure – is defined as 140/90 mmHg or higher and is one of the leading causes of stroke and heart attacks as well as other vascular diseases such as diabetes, chronic kidney disease and dementia. In a recent study in Circulation, researchers from Cedars-Sinai examined more than 27,000 blood pressure measurements from participants with no history of cardiovascular disease. Though 120 mm Hg has long been considered the normal upper limit for adult systolic blood pressure (SBP), they found that a SBP higher than 110 mm Hg in women meant the individual was at an increased risk of cardiovascular disease and that incidence of cardiovascular disease proportionately increased beginning at a lower range of SBP in women compared with men.

Many factors contribute to hypertension including family history, obesity, stress, sleep, alcohol and tobacco use, but one important early indication is arterial stiffness. Blood pressure is most commonly measured on the upper arm using a brachial cuff. However, specialized devices can also capture a brachial waveform which can then be analyzed to obtain a central aortic waveform. This measurement can reveal an individual’s central aortic blood pressure – the pressure experienced at the heart – which gives clinicians vital insight into the stiffness or flexibility of arteries. It is useful because several studies have found high central aortic blood pressure is a strong independent predictor of cardiovascular disease.

3. The signs for heart disease in women are different than in men.

According to the Heart Foundation, a woman’s symptoms are often different from a man’s, and she’s much more likely than a man to die within a year of having a heart attack. Many women do not experience the classic symptoms of crushing chest pain; only about one in eight women report chest pain during a heart attack. Instead, they may experience tiredness, dizziness, shortness of breath, nausea and abdominal, neck, and shoulder pain. In one study, women reported deep fatigue, anxiety, and disturbed sleep as much as a month or two before a heart attack.

While February Heart Health month may be over, it is important whatever the month, for women to understand their risks and signs of heart disease. Many things can put you at risk for heart disease – some you can control, and others that you cannot, but it is never too late to adopt healthier habits. Quitting smoking, reducing alcohol use, eating a healthy diet, losing extra weight and increasing physical activity all go far towards reducing risk of heart disease.

To learn more about heart health in women and in men, visit the Heart Foundation and the American Heart Association.

The information in this article should not be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Craig Cooper is CEO and Managing Director of both CardieX and ATCOR, global health technology companies focused on hypertension, cardiovascular disease, and other vascular health disorders.