Slowly, women are awakening to the fact that six times more women die of heart disease than die of breast cancer. A recent national television ad campaign has helped raise awareness. It’s no wonder that many women think of heart disease as a man’s disease. Until recently, many health care providers held this belief as well.

Most medical research on heart disease – on risk factors, symptoms, diagnostic techniques and treatment options – has been conducted on white men, and the medical community has assumed that these research findings would apply to women and people of color.

Now, it has become clear that women are different from men when it comes to heart disease. The symptoms they experience are often quite different, so diagnosis and treatment may be delayed. Treatments that work well for men with heart disease may not be as effective for women.

African-American and Hispanic women have a significantly higher risk of death from heart disease and stroke as compared to white women.

Female hormones such as estrogen seem to protect younger women against heart disease, but after menopause, heart disease becomes more likely.

Taking oral contraceptives (birth control pills) increases a woman’s risk of hypertension, so these women should have their blood pressure monitored. Women who are over 35 years old and smoke should not take birth control pills due to the risk of cardiovascular problems, such as blood clots.

Risk factors for heart disease in women include: obesity (especially women who tend to accumulate fat in the abdominal area), smoking, a family history of heart disease, diabetes, high cholesterol and high blood pressure.

Recent studies have found that women who are admitted to the hospital after experiencing a heart attack are more likely to die than men. There are several reasons that help explain this finding.

Women may not realize they are having a heart attack because they do not experience the “classic” symptom of chest pain the way men often do. Women having a heart attack are more likely to have nausea, vomiting, indigestion, fatigue, shortness of breath, palpitations and pain in the upper back, neck or jaw. If these symptoms are not recognized, diagnosis and treatment take longer.

Most women who have had a heart attack report experiencing at least one of these symptoms in the months before their heart attack: shortness of breath, dizziness, unusual fatigue, difficulty sleeping, anxiety, indigestion or nausea, chest pain (including chest pressure or tightness) or pain in the upper back or shoulder blade area.

The average age of a woman having a first heart attack is 70 years; men tend to have heart attacks starting five to 10 years before this age. The older the patient, the more likely that she has other medical problems (such as diabetes, congestive heart failure or kidney disease).

However, women in their 30s and 40s (and rarely, even younger) can have heart attacks, too. Women who smoke tend to have heart attacks at an earlier age.

It is vital to recognize the symptoms of a heart attack. Many heart attack treatments work best if they are started within one hour after a heart attack begins; waiting longer increases the chance of death or permanent heart damage.

If you think you are having a heart attack, call 911 immediately; do not call your health care provider first as this may delay treatment. While you are waiting for the ambulance, take an aspirin (325 mg). If you have nitroglycerin tablets, put one under your tongue. Take a list of your medications and allergies – everyone on medications should keep a list in their purse or wallet at all times.

Kathryn B. Brown is a family nurse practitioner with a master’s degree in nursing from OHSU.