Further, breast cancer is named most often as the number one killer of women, though nearly six times as many women die from heart disease as from breast cancer. In 1996, women's deaths from heart disease outpaced men's - 505,930 to 453,297. One in nine women over age 45 and one in three over 65 have coronary heart disease. About half of all women eventually develop some form of heart disease.

Causes for misconceptions about women and heart disease include the focus in recent years on breast cancer research and prevention, fueled by media, high profile attention and fund-raising. And, since heart disease is primarily studied in men, more is known about how and when it strikes men.

The relatively few studies done on women indicate that it usually strikes them after age 65, though certain factors may cause earlier development, and that risk factors differ slightly for men and women.

Studying women over age 35 by ethnicity and geographic region, from 1991 to 1995, the Center for Disease Control and the University of West Virginia recently released "Women and Heart Disease: An Atlas of Racial and Ethnic Disparities in Mortality". In this county-by-county study, where a woman lives and her race are key indicators of heart disease risk.

The study found that rural Southern women are at higher risk of death from heart disease than those in most of the West and upper Midwest. Among states, Louisiana ranks 4th highest for deaths from heart disease, with 469 deaths per 100,000. Of racial and ethnic groups studied, black women are at the greatest risk, with 553 deaths for every 100,000 women. Among white women in general, the rate was 388 deaths per 100,000 women. While most major cities had moderate to lower death rates, New Orleans was among those with higher rates.

While a number of heart disease risk factors are well documented, see below, the study identified additional factors that make up geographic and ethnic indicators of heart disease risk. These factors include regional economic development, socioeconomic status, education, profession, regional cuisine, availability of medical care and access to affordable healthy food.

The following risk factors are known to contribute to both men and women's chances of developing heart disease; the more factors, the greater the risk.

• Elevated cholesterol, especially with elevated LDL and low HDL,
• Elevated triglycerides,
• Smoking,
• High blood pressure,
• Diabetes,
• Sedentary lifestyle,
• Obesity, especially where fat is concentrated above the waist,
• Stress,
• Family history of heart disease,
• Gender and age; risk starts earlier for men, increases for women post-menopause.

These factors appear to influence heart disease development differently in men and women. Diabetes and smoking may be more significant risks factors for women than for men. Hormonal changes cause a 20-fold increase in heart disease in menopausal women, which is one reason why physicians often recommend hormone replacement therapy for them.

Forewarned plus action is forearmed. You can reduce your risk. You control all heart disease risk factors listed, except family history, gender, and age.

Your doctor can help you assess your overall risk, but common sense tells everybody to improve diet, increase physical activity, and avoid all forms of tobacco, including second hand smoke. Several nutritional factors are important. Fat intake should be moderate, 20-35% of your diet, consisting mostly of mono-unsaturated and omega 3 fats. Minimize saturated fats. Consume 25-30 fiber grams a day from whole grains, legumes, fruits and vegetables. If you're eating enough servings to get adequate fiber, you're consuming an absolute minimum of five servings of fruits and vegetables daily. A variety of fruits and vegetables will also increase your beta-carotene, vitamin C, folic acid, vitamin E, and other anti-oxidants and flavonoids, such as quercitin. Regularly add oat bran, soy, fish, nuts and seeds, and garlic to further strengthen your disease-prevention diet.

An additional difference between men and women in heart disease deserves mention here. Women's heart disease symptoms are not exactly like men's, so it is sometimes goes unrecognized or under treated. Women with heart disease are far less likely than men to experience angina, or chest pain, often considered the primary warning signal.

Symptoms common among women include difficulty breathing, especially with exertion; waking up breathless at night; nausea or indigestion; frequent dry, hacking cough; and general weakness, dizziness or lack of energy. These symptoms are often related to other medical conditions, or seem unimportant to report to the doctor, contributing to heart disease going untreated and unrecognized until it has further developed.

Talk to your doctor about your risk and how to manage any risk factors you have. Nutrition, exercise, lifestyle, and medication when appropriate will keep you from becoming a statistic. Celebrate your ability to be the healthiest you can be!