AILSA CHANG, HOST:
Many people think the number one killer of women is cancer. It's not. It's heart disease. And as NPR's Patti Neighmond reports, only half of all women know this is their biggest health threat.
PATTI NEIGHMOND, BYLINE: Tracy Solomon Clark is outgoing and energetic, a former fundraiser for big companies and big causes. About six years ago, at just 44 years old, she had severe shortness of breath. She was dizzy. She went to the doctor and ended up in the hospital. She had no idea her symptoms had anything to do with heart disease.
TRACY SOLOMON CLARK: Not a clue. Heart? That was the farthest thing from my mind. There was no way it would be my heart. I'm young.
NEIGHMOND: But it was her heart. An angiogram showed a blockage. And a stint was inserted to open the artery. Even so, doctors did not diagnose heart disease. And Solomon Clark's symptoms persisted.
SOLOMON CLARK: It felt like a chest cold. And so they were treating me for a chest cold.
NEIGHMOND: Which clearly didn't help. Solomon Clark still felt out of breath and dizzy. Even when she went to the hospital, ER doctors, again, failed to diagnose heart disease.
SOLOMON CLARK: And they do an EKG and they were like, there's nothing wrong, you know? Or she's having anxiety attack.
NEIGHMOND: An anxiety attack for a woman with a clear history of heart problems. At Cedars-Sinai Medical Center in Los Angeles, cardiologist Noel Bairey Merz often sees situations like this. She directs the Barbra Streisand Women's Heart Center. And she recently surveyed about 1,000 women to find out what they knew about their risk for heart disease.
NOEL BAIREY MERZ: Only about half of women in the United States know that heart disease is the leading health care threat for women. A majority of those that didn't know it still thinks it's breast cancer.
NEIGHMOND: About 40,000 women die every year from breast cancer. Ten times as many die from heart disease. Bairey Merz says many of them could be saved. Once women are diagnosed with heart disease, treatments can be highly effective. But lots of women are misdiagnosed, often for years, in part because heart disease looks a lot different in women than it does in men.
Most research has focused on men who are prone to blockages in major arteries, which are easy to see on an angiogram. Women, on the other hand, are more likely to have problems with teeny tiny arteries embedded in the heart, which can be difficult to see and aren't likely to fill up with plaque. Bairey Merz.
BAIREY MERZ: They don't have enough of a wall to build up plaque. They're that tiny. But what they are is dysfunctional. They can fail to dilate when it's needed. Or they actually constrict.
NEIGHMOND: So if a woman suffers a heart attack and there's no obvious blockage, doctors often don't treat them for heart disease. Cardiologist Laxmi Mehta chaired a committee of the American Heart Association, which, just this year, wrote its first scientific statement on heart disease and women.
LAXMI MEHTA: They are less often prescribed the typical medications we give a heart attack patient such as aspirin, statins, beta blockers.
NEIGHMOND: And even after a heat attack, Mehta says, women are less likely than men to be referred to cardiac rehab programs, which dramatically prevent second heart attacks. When Dr. Bairey Merz surveyed women about heart disease, she also surveyed doctors.
BAIREY MERZ: Top concerns expressed by the physicians for their female patients - number one was weight management, number two was breast health, and number three was cardiovascular health.
NEIGHMOND: And she says it should be the opposite. Number one, heart health; two, breast health and three, weight. Dr. Laxmi Mehta says that with underdiagnosis and undertreatment of women with heart disease, she tries to get across a simple but important message to her female patients.
MEHTA: You need to pay attention to your body. If something seems out of the ordinary, best to seek medical attention, especially if something seems out of the ordinary and is occurring only with exertion or worsening with exertion. I'd rather be wrong and go to the emergency room than die at home is what I would tell my patients.
NEIGHMOND: Mehta says all primary care doctors should assess a woman's risk for heart disease on a routine basis. And if they don't, she says, women should take the lead and bring up the subject of heart disease. Patti Neighmond, NPR News.
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