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    What You (and Your Doctor) Don't Know Can Kill You


    Mingham's heart attack was diagnosed as a cocaine overdose. She was only 40 years old, and ambulance drivers refused to transport her. She ended up with an emergency bypass operation.

    Addressing the annual Congress on Women's Health and Gender-Based Medicine in Hilton Head, S.C., earlier this month, Elsa-Grace V. Giardina, MD, called cardiovascular disease an equal-opportunity killer. She says that while about the same number of men and women get heart disease and die from it, death from the disease has risen sharply in women since 1979, even as it has dropped in men.

    That would probably be news to many women. Giardina cited a 1997 poll by the National Heart, Lung and Blood Institute that found 61% of women polled said cancer posed the greatest threat to their health, versus just 7% who said the same thing about heart disease. Giardina is professor of clinical medicine and director of the Center for Women's Health at Columbia University College of Physicians and Surgeons in New York.

    The typical heart attack victim has long been thought of as a white man over 60 or a very elderly woman, Loving says. And many physicians aren't trained to look for heart disease in women or to recommend strategies to guard against it.

    The reason for this is that heart disease hasn't been studied much in women. Nearly all the early studies of heart disease excluded women, Sharonne Hayes, MD, tells WebMD. It was thought that the heart-friendly action of estrogen kept women immune to heart disease until well after menopause. So a woman under 50 who has heart attack symptoms may be told she's too young to have a heart attack and misdiagnosed with flu -- or something as bizarre as shingles. Hayes is a cardiologist at the Mayo Clinic in Rochester, Minn., and assistant professor of medicine at the Mayo Medical School.

    Another reason physicians often miss women's heart-attack symptoms is that they do not usually manifest as the crushing chest pains that men experience. The symptoms women heart-attack victims tend to suffer can also be caused by a variety of other disorders.

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