One in three women dies of heart disease — and many die needlessly, simply because they don't know the symptoms of a heart attack.

Nearly every woman in the United States knows she's at risk for breast cancer. Not so with heart disease — even though cardiovascular disease causes more deaths in women than all forms of cancer combined.

Why are so many women unaware of this crucial fact? "Heart disease in women isn't what you'd call a sexy topic," explains Pamela Serure, author of Take It to Heart: The Real Deal on Women and Heart Disease.

You'll seldom see a female being stricken by a heart attack in the movies or on television. It's often portrayed as a man's disease, Serure notes, "with an older man drinking a martini and then clutching his chest and keeling over. It's not about women in the vitality of their lives being attacked by chest pain, jaw pain, back pain, nausea — and all the other symptoms of a heart attack that women may get, but that too often are attributed to anxiety or stress."

As a result, many women are dying because they don't receive treatment in the crucial minutes after a heart attack.

Breaking Denial
Serure first learned of her own illness at age 47. She considered herself the picture of health, but she kept having a burning sensation in her chest.

Tests confirmed these were symptoms of unstable angina, a common precursor to a heart attack. It turned out Serure had 95 percent blockage in three arteries. Her doctors scheduled her for immediate triple bypass surgery, giving her two days to get her affairs in order and bring her family in.

She lived to tell the tale. Still, it was another five years after surgery, when she suffered a minor heart attack while taking a treadmill test, that Serure finally broke denial.

"I realized only then that I truly had heart disease, that the previous incident hadn't been a fluke," she says. "All I could ask was, how could this have happened? I had never known of any other women with heart disease."

The reality is, one in three American women dies of heart disease. And while men's rates of heart attack are on the decline, women's are on the rise.

What's a Woman to Do?
To help shed light on heart disease:

Practice prevention. Quit smoking. Engage in regular physical activity. Control your weight. Eat a healthful diet low in fat and calories. Keep your cholesterol and blood pressure in check. Control stress. All these habits are a woman's best protection against heart disease.

Ask your doctor to test you for heart disease if you're at higher risk. Factors such as these raise your risk:

• Increasing age
• Family history of heart disease
• A previous stroke or heart attack
• Tobacco use
• High blood pressure
• High blood cholesterol
• Physical inactivity
• Being overweight
• Having diabetes

Learn the symptoms by heart. Be familiar with the symptoms of a heart attack (see "Women's Warning Signs") because if heart attack happens, you'll need to seek immediate emergency treatment. Treatment is most effective when given within an hour after symptoms begin. Even better, be aware of any clues before a heart attack can happen.

"When a voice inside says, ‘I don't feel like myself,' and you have persistent symptoms, such as severe fatigue or depression, don't ignore them," says Serure.

Have your heart tested if you have symptoms. Demand it, if necessary. For the most part, the medical establishment has faced the reality of heart disease in women, but some physicians still haven't gotten the message.

"I've heard so many stories of women being sent home from the emergency room with muscle relaxers. ‘You have a muscle spasm; here's a muscle relaxer,' they're told. They die in two or three days because it was really a heart attack," Serure says. "I know of a 30-year-old woman, a marine, who went to the emergency room with chest pain. The doctor told her, ‘You're tired; get some rest.' She demanded an EKG (electrocardiogram) — it turned out she was having a heart attack."

In speaking with other women, what surprised Serure the most was their reluctance to talk about their heart disease.

"Not all the women who told their stories wanted to come out with it," she says. "There's still a stigma and shame around women and heart disease. Even in my own case, my initial thought was, ‘What did I do wrong — why didn't I take care of myself?' I blamed myself. I think most women tend to do the same."

Try not to let fear keep you from facing the truth, Serure advises. "The good news is, if you correct what's wrong with your heart, you can actually have a better life than you had before. For one thing, you'll tell the truth more often, and happiness rather than regret becomes the priority."

Some women seem to gain even more heart after heart surgery, Serure claims. "For me it was completely true — all my experience since then seems to have bypassed my brain and gone directly to my heart."

Women's Warning Signs
In women, as in men, most heart attacks begin slowly with mild pain or discomfort; others come on quickly and intensely. The American Heart Association (AHA) advises if you or someone else has chest discomfort, particularly accompanied by one or more of these other signs, call 911 and get to a hospital right away.

• Chest discomfort. It may be felt as pressure, squeezing, fullness or pain in the center of the chest. It may last more than a few minutes, or it may go away and then return.
• Discomfort in other areas of the upper body. Pain or discomfort may be felt in one or both arms, the back, the neck, the jaw or the stomach.
• Shortness of breath. This can happen with or without chest discomfort.
• Other signs can include nausea, lightheadedness and breaking out in a cold sweat.

Like men, women are most likely to experience chest pain or discomfort, according to the AHA. But women are somewhat more likely to experience some of the other common symptoms, especially shortness of breath, nausea/ vomiting, and back or jaw pain.

For more information related to preventing, treating and controlling heart disease in women, visit the AHA's Web site at www.americanheart.org. Or, call the AHA at 800-242-8721.

Polly Turner spoke with Pamela Serure, author of Take It to Heart: The Real Deal on Women and Heart Disease, Morgan Road, 2006, $19.95.

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