Dr. Matanoski's column will appear every Tuesday in the health section.
Many people are shocked when they learn that heart disease kills 250,000 women annually. In fact, cardiovascular disease kills twice as many women as all cancers combined. Women today have a one-in-nine chance of contracting breast cancer but a six-in-nine chance of developing heart disease.
Q: What are the symptoms of heart disease?
A: Chest pains, tightness in the chest, shortness of breath, breathing difficulty when lying down and fluid retention could point to heart disease.
Q: Which women are at greatest risk?
A: They include those with a mother, father, brother or sister who have the disease. Also at risk are women who smoke, have diabetes or are hypertensive. Post-menopausal women, those who are overweight or women who do not exercise regularly also are at increased risk.
Q: Is a woman at risk even if she doesn't have most of those conditions?
A: Yes. Women have more chest pain than men and die suddenly at greater rates than men. Women also have more "silent heart attacks," which occur with no pain. After 50, women should have an electrocardiogram (EKG) every two or three years and more often if risk factors are present.
Q: What precautions should be taken?
A: Women must follow the same advice given to men:
* Stop smoking
* Exercise regularly
* Lose weight if you're 20 percent overweight
* Reduce fats and sugars in your diet
* Control blood pressure
Q: Is there anything else a woman can do?
A: The use of hormones afer menopause reduces risk of heart disease by 50 percent.
Q: But aren't there other risks associated with hormone therapy?
A: Yes, as with all drugs there are risks and benefits. Hormone therapy has been in use for 50 years. It has proven effective in controlling the side effects of menopause, reducing the risks of heart disease and preventing osteoporosis. Women using estrogen also report more comfortable sexual activity as they age, improved cognition and reduced incontinence.
There are some increases in uterine cancer and gallstones in women receiving hormone therapy and the jury is still out on whether or not breast cancer risk increases.
It is unusual for women to experience heart disease before menopause. As they enter that stage in life, they and their physicians should discuss their risk of heart disease, the risks and benefits of hormone therapy and other prevention techniques.
Remember: Do not pass off chest pain as anxiety or too much stress. Heart disease is an equal opportunity killer.
Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.