Which one of the following statements is true?
- Each year, heart disease claims the lives of more women then breast cancer and lung cancer combined.
- A greater percentage of women die within one year of a heart attack than men.
- The death rate of African-American women due to cardiovascular disease is greater than white women.
- Diabetes is a risk factor for heart disease.
The answer: All of them. And experts say they represent only the tip of the iceberg when it comes to the facts that many women, and even some doctors, don't realize about women and heart disease.
"Women tend to think that breast cancer is their biggest health threat. And while it's important, heart disease remains the No. 1 killer of women, even young women. But that message just hasn't been fully recognized," says cardiologist Nicea Goldberg, MD, director of the Women's Heart Program at NYU Medical Center and author of the new book Complete Woman's Guide to Women's Health.
Dave Woynarowski, MD, agrees. "If you look [at] how many women get heart attacks and how many women die of heart attacks, you would be stunned; still, many women just don't seem to realize how great a threat heart disease really is," says Woynarowski, an internal medicine specialist from West Reading, Pa.
The American Heart Association (AHA) reports that 42.1 million women had cardiovascular disease in 2004, resulting in some 461,000 deaths.
Moreover, Woynarowski says too often the symptoms and risk factors of heart disease go unnoticed, sometimes even by doctors.
"Even in the emergency room, many times doctors will attribute a woman's symptoms to something other than heart disease. There is simply not enough awareness on either side of the stethoscope," he says.
To help get up to speed, take WebMD's Women's Heart Health Quiz. Find out what you need to know about the symptoms and risk factors of heart disease in women, and what steps you and your doctor can take to protect you.
The WebMD Women's Heart Health Quiz
1. True or False: As long as my cholesterol and blood pressure are normal, I don't have to worry about having a heart attack.
Answer: False. While both cholesterol and blood pressure are contributing factors to heart disease, Goldberg says there's clearly not enough emphasis on the other factors that can also play a role.
"Family history is of major importance. So is weight and blood sugar. I don't see enough women who are overweight or who have diabetes getting their hearts checked, when these are leading risk factors for heart disease," says Goldberg.
2. True or False: Estrogen and other hormones protect women from heart disease, so young women don't have to worry.
Answer: False. "One of the biggest misconceptions out there right now is that young women don't get heart disease or heart attacks, or that they don't have to worry about the risk factors linked to heart disease. But nothing could be farther form the truth," says J. Julia Shin, MD, a cardiologist at Montefiore Medical Center in New York City. Young women do get heart attacks, says Shin, and they are often fatal.
According to the AHA, women under age 55 account for up to 16,000 heart-related deaths and 40,000 cardiac-related hospitalizations each year.
Answer: True. "Preeclampsia, gestational diabetes, high blood pressure during pregnancy -- it was always taught that these conditions go away after birth. But now we know that the impact and the effects linger, increasing the risk for heart disease," says Goldberg.
Preeclampsia causes a woman to have twofold increased risk of heart disease at midlife; gestational diabetes often paves the way for glucose intolerance and other prediabetic conditions that contribute to obesity and other risk factors for heart disease later in life.
"Because it could be 10, 15, 20 years or more since these things occurred, a woman who's 45 or 50 may not think to mention that part of her health history to her current doctor or cardiologist, but she should -- it's vital," says Goldberg.
This is particularly true, she says, if you find yourself in an emergency room with heart attack symptoms. "Knowing your full health history could help ensure you get the correct diagnosis and treatment -- and it may even save your life," says Goldberg.
Answer: True. While the "classic" signs of a heart attack -- like crushing chest pain and pain down the left arm -- can still occur in women having a heart attack, Woynarowski says women are more likely to present with "atypical" symptoms -- including gastrointestinal upset, pain in the jaw, shoulder, or upper back, or sometimes just extreme fatigue.
"Women don't necessarily have the 'classic' symptoms of heart attack -- one reason it sometimes gets overlooked, even by doctors," says Woynarowski.
In terms of symptoms of heart disease, Shin says look for signs such as unusual shortness of breath or sudden changes in your level of activity. "If you're a regular exerciser and run 5 miles a day and suddenly you can only run 1 mile a day, that's something to pay attention to. If you find yourself getting nausea and having an upset stomach and vomiting every time you exert yourself, that's something you need to talk to your doctor about," says Shin.
5. True or False: Heart palpitations, flutters, or rapid heartbeat can sometimes be a sign of heart disease -- but not always.
Answer: True. While any heartbeat-related problems could be an indication of heart disease, experts say this is not a hard-and-fast rule. Sometimes they can also be clues to other ailments or problems not related to heart health.
"What I find is that symptoms from the heart can also give you clues to other conditions, particularly when it comes to palpitations, or skipped or fluttering heartbeats. The problem could be linked to an overactive thyroid, to hormonal changes in menopause, to signs that you are experiencing increased stress, or that you're overcaffeinated. It may not be heart disease, but looking into the health of your heart may help you find and solve other problems that are causing your heart symptoms," says Goldberg.
6. True or False: A hot flash is always a sign of menopause and never the sign of a heart problem.
"It depends on how and when they occur. If you get hot flashes when you're just sitting around watching television or talking on the phone, then it's probably hormonal. If you only get them when you exert yourself, then it could be a symptom of angina," says Shin. Angina is a heart-muscle-related problem that is a form of heart disease.
When should you see a doctor? Shin tells WebMD: "Anytime a symptom is really bothering you. But more important is how your symptom fits within the picture of your overall health screenings and risk factors for heart disease, including high blood pressure, high cholesterol, and a family history of heart disease."
7. True or False: To prevent heart disease all women should take one baby aspirin a day.
Answer: False. Not all women need -- or will benefit from -- daily aspirin use, says Woynarowski.
While studies show that aspirin's anti-inflammatory effects can help prevent heart attacks in those with a history of heart disease, regular use of nonsteroidal anti-inflammatory drugs -- including aspirin -- has also been shown to dramatically increase the risk of both gastrointestinal and brain bleeding. For women who have no risk factors for heart disease, Woynarowski says the risks of a daily aspirin far outweigh the heart-health benefits.
"If you have no personal risks factors for heart disease, if you have no strong family history of heart disease, then you should not be taking aspirin every day," he says
8. True or False: Smoking increases your risk of a heart attack.
Answer: True. According to the AHA, on average, women who smoke have heart attacks 19 years earlier than nonsmokers. "Smoking is a major cause of heart disease and stopping, at any age, will help reduce those risks," says Shin.