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Hal Higdon's 7-7-70 Quest - The Hearts of Women

While women, understandably, are concerned about the threat of breast cancer, more than eight times as many women die of heart disease. And even though women are less likely to suffer a heart attack than men--at least until menopause--they are more likely to die from that attack. According to the American Heart Association, 44 percent of women die within a year after their first heart attack, compared to 27 percent of men. Four years after their first attack, 20 percent of women will suffer a second, compared to 16 percent of men. They are twice as likely to die during heart bypass surgery. They get fatal strokes more often. "The perception that women don't die of heart disease is a myth," says Pamela S. Douglas, M.D. of Harvard Medical School. "In fact, one out of every two women do so."

The risk factors for women also are slightly different than for men. Diabetes, for example, is more likely to trigger a heart attack in a woman. A low HDL level seems to be more a threat for women than men. A sedentary lifestyle confers more risk for females. Stress, however, may be less a problem. Women in high-stress jobs, who nevertheless learn to control those jobs, are less at risk than homemakers frustrated with their roles.

The female hormone estrogen serves to protect younger women, boosting levels of HDL cholesterol. But after menopause (about age 55), estrogen levels decline and women's risks increase to the same as men the same age. While estrogen replacement therapy can offer protection against heart disease, it increases certain cancer risks. (If you're female, you need to check your family history and also check with your doctor.)

When women do get a heart attack, they also suffer slightly different symptoms than men, offers Hannah A. Valantine, MD of Stanford Medical School. Rather than chest pain, women may simply feel weak or exhibit less-specific symptoms such as pains in the neck, jaw, arm or back. They may become nauseous and vomit without realizing why. "Women need to be more aware of these symptoms," warns Dr. Valantine. "Being late in recognizing a heart attack can negatively affect your chance of survival."

Indeed, studies show that women arrive later at emergency rooms than men and are also late getting proper treatment. A standard treadmill test that might pinpoint heart disease in a male may not do so in women. "Women are less likely to receive drug therapy and less likely to undergo catheterization," adds Dr. Douglas. Once they do survive, women frequently receive less aggressive treatment than men. Only by recognizing that they are different can women prevent heart disease.

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