For Your Health - Affairs of the Heart - An older woman’s main health threat-heart disease and what to do about it.

When friends learned about Jeanette Faulconer’s heart attack, they figured they heard the story wrong. It must be her husband, they thought.

"Of all the people they expected not to have a heart attack, I was the one," says Faulconer, a trim, athletic women in her mid-sixties. Like many women, she worried more about her husband’s heart than her own.

"Women have not been taught that they are vulnerable to heart disease,’ says cardiologist Nanette Wenger, MD, professor of medicine at Emory University in Atlanta. "They just don’t see themselves as at risk."But they are. Cardiovascular disease is the number one killer of American women. More that 236,000 women die each year from heart attacks-more that from breast cancer and lung cancer combined.

So why is heart disease thought of as a man’s problem? It may be because men start having heart attacks in their thirties and forties. For owmen the risk is low until menopause.

Ten years after menopause, women are just as likely as men to have heart attacks. And they are more likely to die of them. According to the American Heart Association (AHA), 44 percent of women who sustain heart attacks die within a year, compared with 27 percent of afflicted men.

"We’re not really sure why," Dr. Wenger admits. But, she adds, "women are on average 10 to 20 years older than men when they have their heart attacks, and are more likely to be diabetic and hypertensive."

Women may also ignore chest pain because they think only men have heart attacks. "We often see women in the office the next morning instead of the emergency room the night before, "says Dr. Wegner. Clot busters, one effectived treatment for heart attacks, are most effective within eight hours of the attack, she says. "If you come in 12 or 24 hours later, they just don’t work."

Two big questions: What protects most women from heart disease before menopause? And, why do the risks jump so substantially afterward? The answers may in part lie withe feminizing hormone estrogen, which women produce at high levels before menopause. As estrogen levels drop after menopause, heart attack risk rises. Interestingly, according to the AHA, women who undergo estrogen replacement therapy after menopause reduce their risk of heart attack by one-third to one-half.

The best thing a woman can do for her heart is to not smoke. Regular exercise (inactivity doubles the risk of heart disease), a balanced, low saturated-fat diet, medication when appropriate, and good stress management techniques also help. Though some experts question whether stress in itself causes heart disease, it often compounds risky behavior such as smoking or overeating.

Before her heart attack, Jeanette Faulconer used to let little things tie her up in knots, but no more. "Now I hang loose and mentally say, ‘Relax, it’s not worth it." I’ve learned to go with the flow.

Call 911 or go to the emergency room immediately if you feel:

Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest lasting more than a few minutes.
Pain spreading to the shoulders, neck, or arms.
Chest discomfort with lightheadedness, fainting, sweating, nausea, or shortness of breath.

More on the Subject
For more information, call your local chapter of the American Heart Association or 1-800-242-8721 to request copies of their pamphlets: Silent Epidemic: The Truth About Women and Heart Disease, and Heart Attack and Stroke: Signals and Action