For years, doctors have been fighting the perception that heart disease is a mainly male affliction.

In fact, cardiovascular disease is the number one killer of women: Two of every five women in the US die from heart disease or stroke—more than from all types of cancer combined.

But because heart disease affects women differently than men, it is harder to detect and treat. So health officials are now rethinking how to educate women about their risks—and what they can do to prevent problems.

Translate Knowledge Into Action

One problem: Getting information is one thing; applying it is another.

"The problem I see is that women are much more knowledgeable, but they aren't translating that knowledge into action," says Dr. Jennifer Mieres, director of nuclear cardiology and associate professor of clinical medicine at New York University School of Medicine, and a national spokeswoman for the American Heart Association. "That's where the disconnect is."

So the AHA has launched its "Go Red for Women campaign, which includes an on-line self-survey to evaluate an individual woman's specific risk factors.

"That way, women can increase their thought process about their risk factors," says Dr. Nieca Goldberg, a cardiologist and associate professor of medicine at New York University, and medical director of the university's Women's Heart Program. "We still have to get women to take the plunge to personalize it. If you ask the average woman on the street, she will not say, 'It's going to affect me.'"

A big part of the problem is that women often don't experience a heart attack the same way men do.

Women’s Symptoms Different From Men’s

"Women's symptoms can be more subtle," Goldberg says. "It can be shortness of breath without any chest pain. Some suddenly feel very exhausted with minimal activity. Pain of ten is felt lower in the chest and mistaken for a stomach problem."

Because the symptoms are less obvious, women often wait too long to get treatment.

"If you look at statistics of women who've died suddenly of heart attack, two-thirds died before they could reach the hospital, notes Goldberg.

The Gender Gap

Heart disease also often takes place in women differently than it does in men.

In men, plaque forms on the walls of blood vessels in specific places, eventually causing a "kink" in the vessel that stops blood flow. To treat it, doctors will often implant a stent—an artery-opening mesh tube—at the point of blockage to reopen the blood vessel.

But as many as 30% of women suffer from microvascular coronary disease, Goldberg says. The plaque distributes more evenly throughout the blood vessels, slowing blood flow without creating a flow-stopping kink.

In those cases, arteries have difficulty dilating during exercise or exertion, causing extreme fatigue in women.

"When women go to have an angiogram, there have been situations where doctors don't see any blockages, even though the patient has symptoms and a bad stress test," she adds.

Since there's no specific blockage, treating microvascular coronary disease is much harder.

"When doctors go in to look, there are no kinks, so they can't be stented," Goldberg says. "Women are given drugs to thin the blood and take care of symptoms, as well as reduce cholesterol levels."

Prevention Is The Key

Since heart disease is often harder to detect and harder to treat in women, prevention is the key to saving most women's lives, say experts. Women need to take a hard look at their risk factors.

"If they can't recite their cholesterol levels or blood pressure, they need to schedule a visit with their doctor because that shows those probably haven't been checked in a while," says Goldberg.

Women also should consider whether or not a relative has had heart disease. There is a genetic risk involved, and family members often share the same lifestyle risks, such as drinking, smoking or eating unhealthy foods.

Once that risk is known, women can take steps to improve their health, adds Mieres.

She recommends taking small steps that lead to bigger ones—walking 10 minutes a day and increasing that to 30 minutes, or eating an apple for a snack instead of a candy bar.

"Everyone thinks it's so overwhelming in terms of making lifestyle changes," Mieres says. "Doctors want women to realize that simple steps can make a world of difference in terms of your heart health."

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