![[WSJ.com]](../images/print-wsjie.gif){kind=small}
June 1, 2001
By TARA PARKER-POPE
Staff Reporter of THE
WALL STREET
JOURNAL
A RECENT SURVEY of more than 1,000 U.S. women found that nearly two-thirds of them think cancer is their greatest health risk.
They're wrong. Cancer kills about 250,000 women each year, including 44,000 who die of breast cancer. Those are scary statistics until you consider that cardiovascular disease -- which leads to heart attack and stroke -- kills more than 505,000 women a year. That means one out of every two female deaths are from heart disease or stroke, compared with 1 in 25 who will eventually die of breast cancer.
Despite overwhelming evidence that heart disease is the greatest threat to women's health, doctors are finding that fact a tough sell. Women who wouldn't dream of skipping an annual mammography or PAP smear often don't have a clue about their basic cholesterol levels, doctors say.
"Women fear breast and cervical cancer, but while they fear all these, they die of heart disease," says Carlos Ayers, director of vascular medicine and preventative cardiology at the University of Virginia Medical Center. "It's a tremendous problem, yet we can't get the enthusiasm of doctors to treat it, and the patients don't get that concerned about preventing it."
THE FACT THAT heart disease tends to set in about 10 years later for women than for men (age 55 compared with age 45) may be a key reason that women are more lax than men about their heart health. One year after a heart attack, 44% of women will die, compared with 27% of men, in part because women wait too long to go to the hospital. "It has somehow come to be seen as a man's problem," says James Cleeman, coordinator of the National Institutes of Health's national cholesterol education program.
![[health art]](../images/2f_health05312001212055.gif)
One of the biggest problems is that the symptoms of heart attack in women can be subtle and vastly different from those experienced by men. Both women and men can experience pain and tightness in the chest, pain in the arms and shoulders, and shortness of breath.
But often in women, the symptoms of heart attack are more likely to mimic the flu. Women on the verge of heart attack often have pain so low in their chests that it's mistaken for stomach pain. Nausea, extreme fatigue and back pain also can occur. It's not clear why heart problems show up so differently in women and men.
One New York woman had what she described as a "bad day" of feeling nauseous and weak. A few days later she finally went to a doctor and discovered she had already had a heart attack. Later, when her doctor wanted to perform some tests, the woman balked.
"She said, 'I had to delay seeing you because I'm preparing my daughter's wedding shower and if you plan to do any other tests it will have to wait until after the wedding,' " says Nieca Goldberg, chief of women's heart program at Lenox Hill Hospital in New York. "The problem that happens to women is they put everyone ahead of themselves."
Heart disease is caused by a narrowing of the arteries that lead to the heart, a process caused by cholesterol and fat buildup. If an artery suddenly becomes clogged, the person has a heart attack. The process also can occur in the arteries that supply the brain, resulting in stroke.
SOMETIMES SYMPTOMS of heart disease, such as tightness in the chest, only show up during exercise. As a result, doctors often perform stress tests on men, putting the patient on a treadmill to help gauge how much the arteries have narrowed. But doctors rarely prescribe stress tests for women because a woman's breast tissue can interfere with results.
Dr. Goldberg says doctors need to go beyond routine treadmill testing when dealing with women. She often combines a stress test with an ultrasound exam or an injection of a radioactive isotope to get a more meaningful result.
Although cholesterol is not the only indicator for heart-disease risk, it can help identify those people who can most benefit by lifestyle changes and drug therapies. New guidelines recently issued by the NIH recommend that women start monitoring their cholesterol at age 20.
It's best if your total cholesterol score is below 200. The LDL score, which indicates bad cholesterol, should be below 129, although less than 100 is ideal. For HDL, or good cholesterol, a score less than 40 is too low and puts you at higher risk. A level of 60 or greater is believed to help protect against heart disease.
Women should pay special attention to their triglyceride levels, which are a more significant risk factor for women than men. The number should be less than 150.
Having a family history of early heart disease increases risk. Lack of exercise, smoking, high blood pressure, diabetes, obesity and, for women, having an apple shaped body (thick around the middle) rather than a pear shape (thick around the hips) also increase risk.
The NIH has developed a calculator that can help both men and women determine their risk for a heart attack over the next 10 years. To find the calculator, go to http://www.nhlbi.nih.gov/guidelines/cholesterol1 and click on patient information.
Reducing the risk for heart attack is the same for both sexes. Healthy diet, exercise, losing weight, quitting smoking, and getting diabetes and high blood pressure under control all help, as can cholesterol-lowering drugs.
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(1) http://rover2.nhlbi.nih.gov/guidelines/cholesterol/
(2) mailto:healthjournal@wsj.com
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