February is the official awareness month for heart disease. But women need to have heart health on their minds year round -- their lives depend on it.

For those who think cancer is the biggest threat to women’s health, consider this news from the American Heart Association: nearly twice as many women in the United States die of heart disease and stroke as from all forms of cancer, including breast cancer.

“Heart disease is a woman’s greatest health risk, and it is far underappreciated,” says Radha Kachhy, MD, a cardiologist at Duke Raleigh Hospital and the only full-time female cardiologist in Raleigh.

She speculates that many still consider heart disease to be something of a boy’s club, because women are usually older than men when their symptoms become noticeable. Though heart disease begins decades before its effects are felt, women of any age can take steps to reduce their risk and live longer, fuller lives.

Every woman has a unique genetic history, physiology, and risk profile for heart disease. But regardless of individual susceptibility, there are some classic, undisputed risk factors that every woman should monitor.

• Smoking. Many smokers believe that lung cancer will be the ultimate consequence of their habit, but a heart attack could cut their lives even shorter than they think. Smoking is the single greatest controllable risk factor for heart disease.
• Cholesterol. An increase in your level of bad cholesterol (LDL) is a warning sign, but so is a decrease in your level of good cholesterol (HDL). HDL goes down as women go through menopause, so it’s important to reassess your cholesterol count after you complete menopause.
• Blood pressure. Some women, particularly African- American women, develop hypertension as early as their 20s and never know it -- which puts them at risk for a heart attack in their 30s or 40s. It’s important to monitor blood pressure regularly.
• Diabetes. If you have type-2 diabetes, your risk of heart disease rises sharply. Luckily, the lifestyle modifications advised for treatment of type-2 diabetes -- exercise, weight loss, nutritional changes -- will help control your heart disease risk as well.
• Weight. “Nobody wakes up one morning 30 pounds heavier,” says Kachhy. “It’s a pound or two every year, which adds up over time.” But dropping your weight by even just 10 percent can have a tremendous heart health benefit.
• Syndrome X. Metabolic syndrome, or syndrome X, is a condition that’s still being explored. But it’s already clear that anyone who meets the criteria for metabolic syndrome is at great risk for heart attack.
• Exercise. Even a small amount of exercise, when done regularly, can yield health benefits. Pick an aerobic activity you enjoy, and start out at a pace you can maintain.
• Stress. Stress management techniques, exercises such as yoga or tai chi, and social or familial support networks may not seem like medical approaches, but they can mean the difference between health and heart attack.
• Menopause and HRT. A woman’s risk of heart disease rises steadily after menopause. Choosing whether or not to use hormone replacement therapy (HRT) should be influenced by other risk factors for heart disease. Consider menopause a milestone at which to reassess your health status and take the steps you need to give your heart a long, productive life.

Warning Signs for Women

Chest pain is the number-one sign of a heart attack for both men and women. But there are many other symptoms that are reported more commonly among women than among men, and any combination of the following could foreshadow a heart attack:

• Shortness of breath
• Severe sweating
• Abdominal pain
• Nausea, vomiting
• Pain in the jaw or arm
• Dizziness, fainting
• Difficulty when walking or during other physical exertion

In the absence of chest pain, how do you know when these symptoms are those of a life-threatening situation or those of, say, the flu? Kachhy says that heart attacks usually present a constellation of these symptoms -- in other words, nausea and sweating accompanied by shortness of breath; jaw or arm pain accompanied by dizziness and sweating; or another combination.

According to Kachhy, women have a tendency to “explain their symptoms away,” or put off addressing the warning signs of heart disease with the idea that they’ll ask about them at the next exam.

She advises always to err on the side of caution -- if you experience more than one of these symptoms, particularly if they are severe and especially if they are associated with difficulty in breathing or feeling faint, seek medical help immediately.

Syndrome X, a.k.a. Metabolic Syndrome

Research shows a clear association between metabolic syndrome and risk of heart disease. Often called Syndrome X, this unhappy checklist applies to more than 50 million Americans:

• Established obesity, particularly excess belly fat
• Insulin resistance, or glucose intolerance, in which the body is unable to properly use sugars in the bloodstream
• High blood pressure
• Blood fat disorders -- such as low HDL cholesterol and high triglycerides -- that encourage the buildup of plaque in the arteries
• High blood levels of substances that promote blood clotting, such as fibrinogen or plasminogen activator inhibitor-1
• Elevated levels of C-reactive protein in the blood, which indicate a pro-inflammatory state in the blood vessels

Although metabolic syndrome is frequently linked to type-2 diabetes, not all people with type-2 diabetes fit the criteria for metabolic syndrome. Those who have metabolic syndrome and type-2 diabetes, however, are at exceptionally high risk for heart disease.