(WebMD) -- Four years ago Nancy Loving had never heard the phrase "women and heart disease," despite having done public relations work for a number of health campaigns. That changed the day she woke up at 4 a.m. feeling light-headed and clammy. She might have passed it off as a bout of the flu if it hadn't been for the tremendous pain in her upper back. Thankfully she read the pain as a warning sign and had her teenage daughter drive her to the emergency room.
When Loving arrived at the hospital, the doctor realized she was having a heart attack and immediately administered a blood clot-busting drug. At 48 she'd had no previous symptoms of heart disease, but all the warning signs were there -- she smoked, was overweight, got little exercise, and had a stressful job and a family history of heart attacks. And at the hospital she found out her cholesterol was at 313, well above the healthy range.
"You would think I would have had red sirens," says Loving, now president of the National Coalition for Women with Heart Disease. " I figured out I was basically a walking risk factor."
No doctor had ever spoken to Loving about her high risk for heart disease. And unfortunately that's not surprising, since the disease is largely considered a man's problem. In reality, heart disease is the No. 1 killer of American women, striking one in three at age 65 or older. But women and their doctors commonly don't suspect the disease and are unprepared for an attack.
The symptoms of a heart attack in women are subtle in many cases. Crushing chest pain -- the hallmark of a heart attack in men -- often isn't experienced by women. It's crucial to know what signs to look for. According to Elizabeth Ross, M.D., a Washington, D.C. cardiologist and author of "Healing the Female Heart," those symptoms include:
Of course these may be signs of something else entirely. For example, chest pain in women can be caused by a number of problems, including gastric reflux and ulcers.
The first step on the road to surviving a heart attack is for a woman to assess her risk factors. The odds of having a heart attack increase with:
If a woman falls into any of these categories, she should talk to her doctor about a heart-disease prevention strategy, and ask about a getting a screening test to see if she's in immediate danger.
"A woman needs to know about blood pressure, blood sugar, and cholesterol," says Ross. "And she needs to know the kinds of things she can do to stay healthy." Many of those things are lifestyle choices, from eating right to exercising and not smoking.
While having a heart attack wasn't the best way for Loving to learn she had heart disease, it helped her make healthy changes in her life. She quit smoking, swims daily, goes on walks, takes cholesterol-lowering medications and aspirin, and has reduced stress in her life.
"Clearly I was heading toward disaster," she says of her life before the attack.
It's an important lesson. Although heart disease tends to strike women 10 years later in life than it does men -- between 55 and 65 for women, as opposed to 45 to 55 for men -- it's just as much of a threat for women because of their longer life expectancy.
"Since women live about eight years longer than men, they are getting their fair share of years of jeopardy," says Ross.
And it's about time women and their doctors pay attention.
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