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By Melissa Tennen, HealthAtoZ writer
This is part one of a two-part series on women and heart disease.
Lying on a hospital bed, Nancy Loving mentally ran through her grocery list just as a doctor approached her.
"You're having a heart attack," he said.
The words couldn't have smacked harder.
"I was in such a state of shock," she said. Loving was 48.
Like too many other women, Loving did not know women could have heart attacks or coronary illnesses. In fact, when her heart attack hit, she thought she had food poisoning or, maybe, the flu. That's how benign her symptoms of nausea and back pain seemed.
Today she is executive director of WomenHeart, a national patient advocacy group representing 8 million American women living with heart disease.
"My own ignorance and that of my doctors nearly killed me," Loving said. "My cholesterol had not been checked in 10 years. It was 313 when I had the heart attack."
But the cold, hard truth is that coronary artery disease (CAD), one type of heart disease, is the leading cause of death among American women, killing a half million women each year.
If there is any good news, it is that this health crisis is getting more attention. For the first time ever, the American Society of Nuclear Cardiology focused its annual scientific session on women and heart disease.
Also, the National Heart, Blood, and Lung Institute created a program called "The Heart Truth" to heighten awareness about women's heart disease and motivate them to take control of their health.
The silent killer
"Women are surprised," said C. Noel Bairey, M.D., medical director for the Preventative and Rehabilitative Cardiac Center in Los Angeles. "They say, 'How can this happen to me?' But once their consciousness is raised, they are championed to go and tell other women."
The misconceptions are broad among women and their families. The main problem is that women, for the large part, simply do not know this danger exists. Rather, the belief is that men are the only victims, clutching their chests and collapsing to the floor.
In fact, most women believe they will die of breast cancer when, in fact, one in two women dies of cardiovascular disease compared with one in 25 women succumbing to breast cancer.
Also, a recent American Heart Association survey shows only 8 percent of women say heart disease is the greatest health threat for women and only 18 percent said they learned about the illness from their doctors. And among women ages 25 years to 35, only 4 percent know about the risks.
"A lot of finances go into spreading the word about breast cancer," says Jennifer Mieres, M.D., director of nuclear cardiology at North Shore University Hospital in New York, a nationally recognized expert on heart disease in women.
She notes that not only do major corporations such as Avon fund research for breast cancer, but many female celebrities also publicly talk about breast cancer. The problem is that not one says anything about their own heart health issues, although male celebrities such as talk show hosts David Letterman and Larry King publicize their own battles. And even that is a recent move. The money just isn't as plentiful for CAD research in women.
"This is a society that takes its cue from celebrities," Mieres said.
Menopause
Women's risk for heart disease climbs after menopause and they have a higher risk for heart disease at that point. Experts believe that the increased risk might be attributable to a drop in estrogen levels, which may have a protective benefit. Post-menopausal women are 10 times more likely to die of CAD than breast cancer. And even women going through menopause may mistake heart attack symptoms, such as fatigue and insomnia, as menopausal symptoms.
Another problem is the lack of early detection. On average, women get diagnosed at least 10 to 15 years later than men. For the most part, many women just don't mind their own health as much as they should.
"The woman in the house is always the caregiver. The kids, the husband, the house - women put themselves behind in the pecking order," Mieres said. "We need to educate and empower women to take care of their own health."
This article was reviewed and updated June 2007.
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