Dr Francesco Lo Monaco, a preventative cardiologist and founder of The National Heart Clinic in London, has outlined four essential health checks that every woman should have upon reaching the age of 40. These tests aim to identify underlying cardiovascular conditions that may otherwise go unnoticed. The British Heart Foundation (BHF) highlights that coronary heart disease, the leading cause of heart attacks, kills twice as many women as breast cancer each year in the UK, yet many women dismiss or downplay heart attack symptoms.
Blood Pressure Monitoring
Dr Lo Monaco emphasises that blood pressure should be checked at least annually, or more frequently if readings are elevated. High blood pressure, or hypertension, often presents no obvious symptoms but can cause arteries to stiffen or narrow, increasing the risk of heart attacks and stroke. He states: 'Blood pressure is an important reading to take because it tells us the pressure of blood in your arteries. If the reading is high it can indicate hypertension, which is when blood pressure remains high even when at rest.'
Lipid Profile Test
A lipid profile, or cholesterol panel, measures cholesterol levels. High cholesterol significantly raises the risk of heart attack or stroke. Dr Lo Monaco recommends this test every five years if results are normal, and more often if results are abnormal or the patient is high-risk.
Fasting Glucose and HbA1c Tests
These blood sugar tests help diagnose diabetes or prediabetes. Dr Lo Monaco advises they be done every three years if normal, or annually if the patient is prediabetic or high-risk. 'Fasting glucose and HbA1c tests measure the levels of sugar in the blood and are common ways to determine whether someone has diabetes,' he explains.
BMI and Waist Circumference
Body mass index (BMI) is a standard measure, but Dr Lo Monaco notes it is not always accurate. He recommends also measuring waist circumference annually. A waist measurement greater than 35 inches (88 cm) indicates increased cardiovascular risk. 'A waist circumference greater than 35 inches (88 cm) can indicate increased risk of cardiovascular disease, so it’s also an important number to look at,' he says.
Risk Factors and Symptoms
Dr Lo Monaco stresses that women with traditional risk factors—such as hypertension, high cholesterol, diabetes, smoking, obesity, sedentary lifestyle, or family history—should undergo screening earlier and more frequently. Women-specific risk factors often overlooked include pregnancy complications (e.g., preeclampsia, gestational diabetes), early menopause, Polyendocrine Metabolic Ovarian syndrome (PMOS), autoimmune diseases, and history of breast cancer treatment. Psychological factors like chronic stress, depression, anxiety, poor sleep, and chronic inflammation also warrant attention.
He advises women not to dismiss persistent symptoms even if initial tests are normal. 'You are your best advocate. Persistent symptoms deserve thorough evaluation, not dismissal,' he says. Heart attack symptoms in women may differ from men's: unexplained, persistent fatigue, breathlessness, nausea, or discomfort in the upper body should prompt a call to the doctor or a visit to A&E if severe. Other warning signs include pain in the jaw, neck, shoulders, back, or upper abdomen, dizziness, cold sweats, and a sense that something is seriously wrong.
