What is the number one killer of women in the United States? The answer may not be what you think it is. Despite the focus on cancer prevention and treatment in the media, cancer is not the number one killer. Rather, heart disease and stroke are responsible for more deaths among women than all forms of cancer combined. So why haven’t we heard about it?

A lack of physician and patient awareness is one major factor that has contributed to the problem. While heart attack symptoms are widely recognized in men, the symptoms are much more subtle in women. These symptoms are often mistaken for other conditions like indigestion and doctors may be reluctant to point out the risk for some women. In addition, they may be hesitant to proactively treat the issue and provide helpful recommendations about prevention. While much research has been done on men’s heart health, knowledge and prevention strategies in the field of women’s cardiovascular health is sorely lagging behind.

Incidence of heart disease death rates across the U.S.

While most people realize that both genders suffer from heart attacks and strokes, they often don’t realize that these cardiovascular problems affect men and women differently. A crushing pain in the chest that radiates down one arm is a classic heart attack symptom in men. However, women suffering from a heart attack may not experience this symptom. Rather, a heart attack manifests itself in these easily missed signs: fatigue, sweating, shortness of breath, nausea, stomach pain, and pain in the arms, neck, back, or jaw. Some women may feel pain or discomfort anywhere in their chest that can be described as a “squeezing or fullness”.

Women often miss these vague symptoms but even if they recognize them, they may be hesitant to report them; a recent heart association national survey reported that even if women believe they are having a heart attack, 36 percent do not call 911. This startling statistic raises concern about what steps we are currently taking to combat a deadly disease, long thought of as solely a men’s health problem. In a time of rising rates of obesity and hypertension, cardiovascular health demands more attention and a careful consideration of the multitude of factors that are putting American women at risk.

Contributing factors to cardiovascular disease can be categorized as genetic, environmental, and lifestyle. While genetic and environmental factors can significantly influence an individual’s heart health, lifestyle factors such as diet, exercise, and smoking have been linked very closely to heart attack and stroke risk. A diet rich in saturated fat and poor exercise habits can lead to abnormal cholesterol and triglyceride levels, resulting in high blood pressure. Hypertension has consistently been shown to be the number one risk factor for stroke. Poor exercise habits may also lead to obesity and a predisposition to Type 2 diabetes. An individual with Type 2 diabetes is twice as likely to develop cardiovascular disease as an individual without the condition.

Not surprisingly, tobacco and marijuana use significantly increases the risk of cardiovascular disease as well. Research has revealed that women on birth control pills who regularly use tobacco are especially at risk of cardiac problems. Stress is another lifestyle factor that many women and even physicians may overlook when considering heart disease. Stress can stem from a whole host of sources, including marital and work problems, loss of a loved one, social isolation, and depression.

Fortunately, the factors listed above fall under the category of “modifiable” risk factors. Unlike the risks tied to family history, ethnicity, and age that cannot be modified, lifestyles can be changed. Major lifestyle changes can offer huge benefits, foremost among them being a significantly lower risk of cardiovascular trouble in the future. In order to combat the prevalence of cardiovascular disease in the United States, physicians and other organizations must promote healthy lifestyle options from the start, thereby preventing problems in the future.

When considering prevention strategies, diet and exercise are the first place we should start. These two lifestyle factors play a major role in not only cardiovascular health, but also in mental and overall health. A recent New York Times article titled “One Twin Exercises, the Other Doesn’t” discussed a study that offers insight into the effects of exercise. In a study involving ten identical male twins, researchers uncovered a variety of significant differences between the active and sedentary twins. The active twins possessed lower BMIs, lower body fat percentages, more grey matter in the brain, and no signs of insulin resistance or metabolic problems. Clearly, aerobic exercise contributes to a healthy heart and an overall healthy body.

Diet may exert an even more profound influence on cardiovascular health. Eating a diet rich in fruits and vegetables, which contain important antioxidants, can make a substantial impact on heart health by keeping LDL (or “bad”) cholesterol levels low and preventing the onset of Type 2 diabetes. Along with diet and exercise, sleep and taking the time to relax play an important role in heart health. Getting the recommended amount of sleep as well as having a positive outlook on life significantly lowers heart attack and stroke risk.

Heart healthy foods; diet is an essential component of cardiovascular risk.

Like infectious disease, cardiovascular disease can be characterized as being silent and deadly, impacting those who least suspect that they are at risk. However, the two classes differ in this important fact: cardiovascular disease largely depends upon lifestyle choices. This is good news for the current problem in the United States. However, physicians and other organizations like the American Heart Association must take action to stave off the future cardiovascular crisis.   Starting in medical school, future physicians must learn more about how to recognize heart attacks in women and how to better prevent them from even occurring. Current physicians must strive to take these risks seriously and convey the message to their female patients. Diet, exercise, and abstention from smoking should be emphasized especially. Other organizations like the AHA can bring the issue to national attention by promoting heart health awareness, through programs designed to educate and inform American women on cardiovascular wellness. By redefining cardiovascular issues as a problem that affects both genders, we can lower the incidence of heart attacks and strokes among women.