How Weight And Inflammation Affect Women’s Heart Health

Weight gain in middle age — the “middle-age spread” — is a normal part of getting older. As your metabolism slows and your hormones shift, you may add a few pounds. But that extra fat, called adipose tissue, impacts more than your waist size. It also affects your heart and increases your risk of heart disease.

According to Anthony Bashall, MD, FACC, a board-certified cardiologist with Franciscan Health, excess weight triggers inflammation that can harm your heart health. Early assessments can evaluate your risk and help you take steps to improve your long-term well-being.

Key Takeaways: The Weight And Heart Health Connection

• Excess fat can damage blood vessels and increase the risk of heart disease.
• Women experience different symptoms of heart disease that may be easily dismissed as signs of normal aging.
• New testing options can provide early risk assessments and open the door to timely heart disease prevention methods.

The Good And Bad Of Adipose Tissue

Your body’s relationship with adipose tissue is tricky. You need some fat. It’s a great source of energy, and it helps keep your metabolism in balance. A healthy amount of fat also supports good inflammation — the kind that kills bacteria and promotes healing when you have a wound.

“When you cut yourself, bacteria jump into that cut,” Dr. Bashall said. “It’s inflammation that kills the bacteria and prevents you from getting a nasty infection. Inflammation also brings healing properties to your wound to help it heal.”

But when you gain weight, the scale tips toward the negative impacts of inflammation. As you add pounds, inflammation spills over into your bloodstream. And, over time, he said, it damages the lining of your blood vessels.

How Inflammation Damages Blood Vessels

Long-term inflammation can scar and narrow your blood vessels. It also weakens them, which can create small cracks and holes that cholesterol can fill in.

“When the lining of a blood vessel is damaged, cholesterol often jumps in and starts to plug up the vessel. This happens even if you have a fairly normal cholesterol level,” Dr. Bashall said, noting that cholesterol can continue to build up and form blockages. “This is what leads to the bad and ugly outcomes like heart attacks and strokes.”

In addition to blood vessel damage, inflammation causes your heart muscle to stiffen. As a result, you may develop heart failure, a condition where your heart isn’t strong enough to pump blood throughout your body.

Heart Symptoms Women Experience

Men and women share many symptoms of heart disease. The most common signs include: . The most common signs include:

• Chest pain and pressure
• Pain in the arms, jaw and neck
• Shortness of breath

But women also experience more atypical symptoms that tend to occur together, Dr. Bashall said. For example, women have new onset exertional fatigue as a warning sign for heart disease.

“Women may feel nauseated with activity. They can feel dizzy and lightheaded. They may struggle to exert effort,” he said. “When we carry excess weight or we’re older, tired, busy, working, caring for kids or parents — it’s easy to dismiss the signs as being caused by something other than heart disease.”

That’s where early assessments come in, he said. Franciscan Health offers a full range of tests that can measure your inflammation and evaluate your risk of developing heart disease.  

High Sensitivity CRP And New Testing

If you’re in your 30s, 40s or 50s, Dr. Bashall said it’s a good idea to talk with your primary care physician and assess your risk. While these tests aren’t a crystal ball that shows you the future, they provide good predictions about your likelihood of developing heart problems.

“The heart can be very sneaky. So, get assessed early. Don’t wait for symptoms to appear,” he said. “When you start to develop signs, it’s easy to blame them on a lot of other things. Things like fatigue and shortness of breath — it’s easy to think that you’ve gotten a little old or that you’ve gained some weight. But these symptoms can be the early building blocks of heart disease.”

Alongside monitoring your blood pressure and cholesterol, Dr. Bashall suggested these new (and traditional) tests that can identify inflammation in your bloodstream.

High-sensitivity C-reactive protein (CRP)

In late 2025, the American College of Cardiology recommended high-sensitivity C-reactive protein (CRP) testing to assess your risk. This blood test detects chronic inflammation. If you have a high cholesterol level — above 3 mg/dL — your doctor may recommend medication to lower it.

Calcium score

When cholesterol fills in the gaps of your blood vessel walls, calcium builds up over it. It hardens your arteries and increases your risk of heart attack. The calcification also shows up on a heart scan,  a CT exam of your heart. A high calcium score means you have some coronary artery disease, so your doctor may recommend medication to lower your cholesterol.

Exercise treadmill test

A simple, six-minute walking test or a treadmill test can help your doctor determine how much physical activity you can handle. They monitor you as you walk and ask you about any chest pain, fatigue, nausea or shortness of breath. Based on your assessment, they may suggest additional testing.

Lipoprotein(a)

Lipoprotein(a) is an inherited form of cholesterol. It’s a newly identified risk factor for heart attack and stroke, and a high level (above 10 mg/dL) can cause inflammation and buildup in your blood vessels. Some injectable medications can lower your cholesterol. But doctors are studying the best ways to treat elevated lipoprotein(a).

Urine albumin creatinine ratio (uACR)

This test detects protein in your urine caused by diabetes or high blood pressure. Protein in your urine (10mg/g or higher) indicates you have inflammation that can cause both kidney and heart damage, Dr. Bashall said.

“If you have a little protein in your urine, it’s a sign of inflammation and potential kidney damage,” he said. “If you have damage in your kidneys, you have that damage in your heart — and it points to an increased risk of heart disease.”

Advice For Better Long-Term Heart Health

When you eat a healthy diet and exercise regularly, it helps reduce inflammation and protect your long-term health, Dr. Bashall said. Weight loss medications can help, too. In addition to helping you drop a few pounds, these tools support your metabolic health and reduce inflammation.

But the fundamental key is to be proactive to control inflammation and boost your heart health.

“Advocate for yourself with your primary care physician,” he said. “Ask them to check your inflammation levels, test your urine protein, get a heart scan and monitor your blood pressure at home. These are all things that go a long way.”

It’s also important to know the classic signs of heart disease. Seek help if you have these symptoms:

• Chest pain or pressure
• Difficulty with activity
• Intense fatigue
• Nausea
• Pain between the shoulder blades
• Sweating

“That’s a good old-fashioned list of heart disease symptoms, and they often cluster together,” he said. “If you struggle with exertion and you have some risk factors, please get an evaluation.”

A Franciscan Health cardiologist can evaluate your risk, check your inflammation levels and help you build a plan to protect your heart for the long term. Find a specialist near you or schedule an appointment online.