Doctors now know that heart disease is so deadly for women that their chances of dying from it are one in two. That means basically that either you or your best girlfriend is likely to die of a heart attack, stroke , or related heart problem. Doctors have traditionally used a one-size-fits-all approach to identifying and diagnosing heart disease. In this view, women often lack the "classic" signs of reduced blood flow to part of the heart, a condition known as ischemia. Doctors and patients often attribute chest pains in women to noncardiac causes, leading to misinterpretation of their condition. Men usually experience crushing chest pain during a heart attack.

Cardiovascular disease encompasses the diseases of the heart and the blood vessels. These develop and progress slowly over our lifetime and often without symptoms. Cardiovascular disease (CVD) accounts for more deaths than the next seven causes of death in women combined, including all forms of cancer. Since 1984, men have experienced a decline in deaths due to CVD; women have not. Cardiovascular disease (CVD) is the number one killer of women in the United States. Long thought of as primarily affecting men, we now know that CVD-including heart disease, hypertension, and stroke-also affects a substantial number of women.

Estrogen provides a beneficial effect on the arteries. When estrogen production slows down, women lose that protective effect," Even so, Kusler adds, women in their 30s and 40s still experience heart attacks. Estrogen serves as protection against heart disease in women, therefore once a woman has gone through menopause her risk increases dramatically.

Risk of coronary events begins to decline within months of stopping smoking and reaches the level of persons who have never smoked within 3 to 5 years. Sadly, though, smoking cessation rates have declined more slowly among women than men. Risk was not associated with dose or duration of use of estrogen and did not persist after oral contraceptives were discontinued.

African Americans are at substantially higher risk for death from CVD than are whites. This difference is attributable in part to a greater risk for strokes and a higher prevalence of high blood pressure among African Americans. African American and Hispanic women, who are at higher risk of heart disease than white women, continue to have lower rates of awareness.

Aspirin therapy is recommended for women over age 65 to prevent heart attack and stroke as long as blood pressure is controlled and the benefit is likely to outweigh the risk of gastrointestinal side effects. Regular use of aspirin is not recommended for healthy women under age 65 to prevent heart attacks. Aspirin treatment reduced risk of subsequent cardiovascular events by about 25%. Lipid-lowering therapy also appears to provide substantial benefit in secondary prevention in women. Aspirin has also been shown to be of preventive benefit in women to reduce the incidence of coronary artery disease and strokes. In women with multiple risk factors for coronary artery disease, a dose of 325 mg per day is recommended, while in lower-risk women, 81 mg is probably sufficient.