How many people realize women’s coronary arteries are understudied, underdiagnosed, and undertreated? The Cleveland Clinic, a leading cardiology center, says heart disease is seven times deadlier for women than breast cancer. Buildup of plaque in the heart’s arteries contributes to the death of one in every three women, more than all cancers, chronic respiratory diseases and accidents combined.

But heart disease kills even more men. This fact and the historical focus on heart disease in men means most people are unaware of the risk factors for heart disease in women.

A report from the American Heart Association says there have been stunning improvements in death rates of both sexes from coronary heart disease since 1980. But women have not shared the benefits equally.

Maurice Chevalier, the French actor-singer, was not thinking about coronary arteries when he remarked, “vive la différence.” But the difference makes heart attack the number one killer of women.

Heart attack has been considered a male disease, as it occurs in men earlier in life. But after menopause the gender gap disappears. But many remain unaware that coronary heart disease is on the attack in women.

Can coronary heart disease risk be spotted in women by their loved ones? Chest pain is the most common symptom in both sexes. But at least one-third of women do not show this classic symptom during coronary attack. Rather, they complain of shortness of breath, fatigue, nausea, palpitations, dizziness, intense anxiety or pain in the jaw, neck, upper back or arm. These problems may be mistaken for a panic attack, with a fatal delay in diagnosis.

Suppose a family member or friend is a good diagnostician and immediately calls 911. Even then, studies show that an immediate electrocardiogram or stress test is less likely to reveal the typical indicators of heart attack.

Even if a woman has an early diagnosis of coronary attack and survives, a bypass operation may be required. But she has twice the risk of dying during the surgery or shortly thereafter.

Heart surgeons can explain why. Coronary arteries are smaller in females. This makes the surgery technically more challenging when vessels the diameter of a piece of spaghetti are joined together.

What should we do to decrease the risk of coronary heart disease? First, a woman should see a psychiatrist if she smokes, as the risk of heart attack is seven times greater among women who smoke.

Know your family history. If your father or brother had a heart attack before age 55, or your mother or sister before age 65, this substantially increases your risk. It’s a red flag that warns “start taking preventive measures.”

If there is a history of cardiovascular disease, a daily 81 milligram dose of aspirin may help. But since aspirin can cause gastrointestinal bleeding, always discuss this medication with your doctor.

Remember that obesity leads to type 2 diabetes, which in turn increases the risk of heart attack. Gaining weight alone is easy; losing weight alone is hard. But if obese, losing weight will improve health. Good strategies and support groups help. Sheer will is probably not enough. Family and friends need to work on weight reduction together.

Have your blood pressure checked. One-third of heart attacks in women could be prevented by controlling blood pressure.

If blood cholesterol is elevated, most cardiologists will recommend cholesterol-lowering drugs. But discuss this with your physician, as there are effective and safer natural options.

If you have read this column for years, you’ll know that high dose vitamin C with lysine has kept this doctor alive for 25 years after severe heart attack.

Dr. W. Gifford-Jones, aka Ken Walker, is a graduate of the University of Toronto and Harvard Medical School. You can reach him online at his website, docgiff.com, or via email at info@ docgiff.com.

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