WHAT DO YOU think you are going to die from? If you had to guess, what would you guess will kill you?
If you are a woman, you almost certainly think you are going die from breast cancer. Sixty-six percent of you believe you will find a malignant lump and that it will kill you.
"Almost half of all women will die of heart disease or stroke," says Martha Hill, president of the American Heart Association and a professor of nursing at Johns Hopkins University.
"And few will be lucky enough to die in their sleep without symptoms."
Heart disease is the No. 1 cause of death among women, and no one is more surprised by this than the women who hear it from Hill, the first nonphysician to head the AHA.
"Women are blown away by this," she says at her Hopkins' office. "They want to know why no one told them."
Why? Because until scientists began to include women in their research, they did not realize how different heart disease is in women.
"Women get heart disease about 10 years later than men," says Hill. "It is very much associated with the post-menopausal loss of estrogen. When a man dies of a heart attack at 45 or 55, it receives a lot of attention. But when a woman has a heart attack at 65, it does not have the same impact. We just think she is old."
And a woman's heart attack doesn't feel the same as a man's -- a fact doctors are just beginning to try to explain. It is not the classic crushing chest pressure and shooting pain through the shoulder and arm.
"A women's symptoms are more subtle, more subjective, easier to miss," says Hill. She may feel tired, nauseous or dizzy.
"It may not occur to her family to say, 'Mom, you're having a heart attack.' Even her physician can miss it."
And that first heart attack is more likely to kill a woman than to kill a man. That may be because a woman will wait an average of 2 1/2 hours longer to seek medical attention than a man will.
But one fact of heart disease is the same for a woman as it is for a man: 54 percent of the factors that contribute to heart disease are related to lifestyle.
"Typically it is thought that heart disease, especially in women, is part of aging and there is nothing you can do about it," says Hill.
But there are a number of things you can do to prevent or delay heart disease and stroke: Don't smoke; know your blood pressure and cholesterol levels and whether they need to be controlled with medication; eat right, exercise and control your weight; and talk to your doctor about taking estrogen after menopause.
Hill makes another suggestion that is coincident with the holidays but has nothing to do with how much you eat and drink: When you are with relatives, talk about your family medical history. Your risk of heart disease, as well as other diseases, is hidden in the family tree.
"Most people don't know, or have misconceptions about, what their relatives died of. But heart disease -- and other medical conditions -- runs in families. You need to know your risks."
These are the kinds of lifestyle changes we would insist that our husbands make; the kinds of things we would investigate if our children's health was at stake. But women don't do it for themselves.
"That's how women define themselves -- taking care of others," says Hill. "But if you don't value yourself, you won't have the mental, physical and spiritual energy to take care of the people you love."
Pub Date: 12/21/97