Heart disease in women - the numbers are staggering. Cardiovascular disease, which includes heart disease, hypertension and stroke, is the number one killer of women, according to the American Heart Association. It kills half a million American women each year. That figure exceeds the next seven causes of death combined. Moreover, women are 15% more likely than men to die of a heart attack. And they are twice as likely to have a second heart attack in the six years following the first.

Yet in a 2000 national heart association survey, only 34% of women correctly identified heart disease as a leading cause of death.

And "only 8% of women saw it as their biggest health threat," says cardiologist Sharonne Hayes, MD, director of the Mayo Clinic Women's Heart Clinic in Rochester, Minn. "There's a disconnect. They know it's a major disease, but they think they're going to die of breast cancer."

Major issues surrounding women's heart health and medical care were brought to light in a survey of 204 women with heart disease reported in the January/February 2003 issue of Women's Health Issues. Hayes, who is Director of Mayo Clinic Women's Heart Clinic in Rochester, Minn., co-authored the report, funded by WomenHeart: The National Coalition for Women With Heart Disease. Among the issues women raised were:

Mental illness resulting from heart disease
Failure to diagnose heart disease
Problems related to physicians' attitudes
Dissatisfaction with medical care, including major hurdles in getting support for recovery

Hayes says that awareness about women's heart health is gradually growing among women and healthcare professionals, but there's much room for improvement.

Mental Health and the Heart

One survey result has already changed how Hayes conducts her practice. She was surprised by the high percentage of women -- 57% -- who said they suffered depression, anxiety or both as a result of heart disease. "Following the survey, our women's heart clinic got a psychologist much more integrated in terms of evaluating patients and giving us cardiologists some insight into mental illness that we're not trained for."

That insight may help explain why only 14% of women made lifestyle changes following a heart attack. "If you're depressed, you're unlikely to be able to make the lifestyle changes that you need to prevent another heart attack," says Hayes. But the knowledge should now help healthcare professionals see and treat mental health problems brought on by heart disease.

Kathy Kastan was diagnosed with post-traumatic stress disorder following heart bypass surgery. (This condition is a form of anxiety brought on by a traumatic or life-threatening event.)

In spite of being a psychotherapist herself, the 44-year-old wife and mother didn't recognize the signs of the condition until the second year after her surgery. "The first year I was in shock," she says. "When you go through trauma like that, you stay numb." She relates the trauma to the surgery itself, pain and humiliation caused by a nurse, and continued poor health after the surgery. "I worked through it, but these experiences change your life."