Ask American women what disease they're most scared of, and the vast majority will answer without hesitation: breast cancer. They may even cite the ominous statistic that 1 in 8 women will develop breast cancer at some point in her life. But what most women don't realize is that they actually have far more to fear from heart disease, which will strike 1 out of every 3. More than 500,000 women die in the U.S. each year of cardiovascular disease, making it, not breast cancer (40,000 deaths annually), their No. 1 killer.
Women and heart disease? Better believe it. For while most people still think of cardiovascular trouble as mainly a man's problem, the reality is that heart disease has never discriminated between the sexes. In fact, for a variety of complex reasons, the condition is more often fatal in women than in men and is more likely to leave women severely disabled by a stroke or congestive heart failure. True, women don't usually start showing signs until their 60s--about 10 years after men first develop symptoms. And hormones seem to play a protective role in women before menopause. But the common belief that premenopausal women are immune to heart problems is just plain wrong. Heart attacks strike 9,000 women younger than 45 each year.
The more scientists learn about a woman's heart and what can go wrong with it, the more they realize that females aren't just small males. There are subtle but important differences in how women's cardiovascular systems respond to stress, hormones, excess saturated fat and toxins like tobacco. There are also some pretty big differences in how aggressively doctors treat women with heart trouble--even in the emergency room when they are in most desperate need of help.
All those publicity campaigns that have focused attention on breast cancer may be part of the problem. The pink ribbons, the docudramas and the races for a cure have inadvertently left women with the impression that breast cancer is the only thing they need be worried about. So when public-health officials at the National Heart, Lung and Blood Institute (NHLBI) decided to spread the word about women's risk of heart disease with a campaign called Heart Truth, they took a page from the cancer advocates' manual, designed their own lapel pin--in the shape of a bright red dress--and sought help from some very highly placed women, starting with the First Lady. "Women take care of all the people in their family--their children, their husbands--but they sometimes don't take care of themselves," says Laura Bush. "The goals of this campaign are just to really make sure that women know that heart disease is their No. 1 killer and that they can change their lifestyles to prevent it."
The new push couldn't come at a more critical juncture. Many women were stunned last year when the famous Women's Health Initiative discovered that pills providing a combination of estrogen and progestin do not protect the hearts of postmenopausal women. (Tests on estrogen alone are still under way.) Suddenly, what had seemed to be the simplest, most elegant solution to the aging female heart--replacing the hormones a woman makes before menopause--had vanished.