The No. 1 Killer Of Women

To get a better handle on what's going on inside a woman's heart, many cardiologists perform an echocardiogram during a treadmill test. Echocardiograms can give doctors a detailed picture of the size, shape and pumping action of the chambers of the heart and of how well the valves are working. If the pumping action looks stiff, doctors know the heart is ailing.

Even cholesterol testing is less straightforward in women than in men. Whereas high levels of LDL, the so-called bad cholesterol, are pretty good at identifying men at high risk of heart disease, women seem more vulnerable to high levels of a different fatty substance, called triglycerides. In addition, women with low levels of HDL, the so-called good cholesterol, are more likely than men to develop heart disease later on. National guidelines suggest a minimum HDL level of 40 mg/dL for men and women. "But [low] HDL is a more powerful predictor of risk in women," says Dr. Lori Mosca of New York--Presbyterian Hospital. "So in my practice I recommend keeping an HDL of 50 mg/dL for women."

Add up all the caveats and uncertainties, and it's not surprising that when women finally get to the hospital, it takes longer for doctors and nurses to diagnose their trouble correctly. Unfortunately, the delay may make female patients too sick to qualify for certain lifesaving treatments, such as clot-buster drugs that can stop a heart attack in its tracks. And because most women are older when they develop heart trouble, they are more likely to suffer from other conditions that complicate their care.

Fortunately, the medical community is starting to adapt to the new realities of women and heart disease. Two studies suggest that women may finally be benefiting as much as men from angioplasty, a procedure in which doctors use catheters and balloons to open up dangerously narrowed arteries and insert stents to keep the arteries open. In the past, catheters and stents were all made in one standard size--to fit men's larger arteries. As a result, women suffered more complications and a much higher risk of death from angioplasty. Also, until about three years ago doctors prescribed the same doses of the blood thinner heparin for men and women, leading to greater internal bleeding in women. Smaller catheters and stents and lower doses should give women better results.

There's plenty that women--and men--can do to help protect themselves. There are no guarantees, but adopting a healthier lifestyle, which includes eating right, getting more exercise and quitting smoking, will tip the odds in their favor. Probably the hardest thing for women to overcome, however, is the false sense of security given by the premenopausal years, which to some degree help delay the start of heart disease about 10 years. Many men would love to have an extra 10 years in which to make positive changes in their lifestyles. Women who fail to take advantage of this gift do so at their heart's peril. --Reported by David Bjerklie, Alice Park and Sora Song/New York