Your Heart: An Action Guide

1 in 3 women in the U.S. die of heart disease and stroke. 42% of women who have heart attacks die within a year (compared to 24% of men)

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When it comes to women and heart disease, it's important to know the statistics, but you also need to hear the stories. Stories like KC Maurer's and Nicole Lawson's, which bring home the risks, and exactly how to protect yourself. Because there is so much you can do.

Let's begin with Maurer, who thought she was a relatively healthy 40-year-old when, out of the blue, she was struck with a sharp, stabbing pain in her chest. "It felt like someone had thrust their knuckles into my chest, a sudden, painful blow," she says.

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She thought, Well, that was weird, and continued scrubbing the floor at her house on the New Jersey Shore. After all, she had friends arriving the next day. Seconds later, a wave of nausea washed over her and she threw up. It must've been the fish I had for dinner, she thought. As the nausea passed, Maurer did what any Type A gal with guests coming would do: She hung new drapes and moved a couch.

"I felt incredibly tired—exhausted like I'd never been before—but I just chalked it up to the fact that it was 11 P.M. and I'd had a long, busy week," says Maurer, now 52. "I kept scrubbing and making beds until finally, around 11:30, I just felt totally wrung out and had to stop." She lay down on the couch, but when her head touched the pillow, she couldn't catch her breath. When she sat up, her breathing steadied. It happened again, so she called the local hospital and spoke to a nurse, who told her that the shortness of breath was odd, and that she should call 911 if it continued. Maurer thought the nurse was crazy, until the symptoms struck again 20 minutes later. "That's when I got nervous enough to call 911," she says. About two hours had passed since the first stab of pain.

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At the hospital, the doctor looked at her and said, "It's probably nothing." At 40, Maurer was young. She was very overweight (she stuck to a fairly healthy diet but says she ate too much) and didn't exercise, but she didn't smoke or have high cholesterol or blood pressure. Still, the doctor did blood tests to check her levels of heart enzymes and an electrocardiogram to look for abnormal heartbeats or blood-flow problems. The test results pointed to a clear diagnosis: "Young lady, you've had a heart attack," the doctor told Maurer, who was incredulous. The idea that she could be at risk of heart disease wasn't even on her radar.

Doctors in the Dark

Maurer found out about her heart issues over the course of just a few hours. Nicole Lawson's heart-health drama took decades to unfold.

A 53-year-old nurse in Los Angeles, Lawson exercises and has always had healthy eating habits. Still, she spent most of her 20s and 30s enduring bouts of severe chest pain. Every time she went to the ER, doctors told her it was just stress, acid reflux, or worse, all in her head—even when the pain was radiating down her arm, a classic sign of heart distress.

"One doctor handed me a prescription for Prozac and told me he thought I was depressed," she says. "Even when I turned 40 and doctors started taking the possibility of a heart condition more seriously, all the tests showed nothing—so the doctors just shrugged and sent me home." This happened more than 20 times. "As a nurse, I knew it wasn't just acid reflux even though a dozen doctors gave me that diagnosis. I'd ask, 'Then why is the pain and numbness only on my left side?'"

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At age 42, Lawson had pretty much resigned herself to the suffering. Then she got a call from Bairey Merz's office at the Barbra Streisand Women's Heart Center in Los Angeles. Bairey Merz was conducting a study of female patients with possible cardiac symptoms and normal test results. Lawson signed on immediately.

Bairey Merz did a specific test to gauge the blood flow through Lawson's coronary arteries, which showed that she had coronary microvascular dysfunction—a condition much more common in females than men that involves issues with blood flow in the smaller arteries around the heart. It had gone undetected in the standard testing she'd been given by every other cardiologist—standard testing that was devised for, and tested on, men's hearts, not women's.

Two stories, two sides of the problem. Women like KC Maurer often ignore symptoms of heart problems and put off getting help. And many doctors give women like Nicole Lawson the brush-off.

"Doctors were taught that heart disease is the major killer of men and that women die of other things. It takes a lot longer for us to unlearn something than it takes for us to learn something new," says Dr. Oz, who's been a cardiothoracic surgeon for 20 years. "I think women have this same bias, that heart disease is a bigger issue for men, and they tend to focus on issues like cancer. We watch out for what we fear most, not necessarily what threatens us most."

Women in Denial

KC Maurer's pure skepticism that she was even at risk of having a heart attack is common: Only one in six American women believe heart disease is their greatest health hazard. Too many speed toward disaster, oblivious. "For most women, everything and everyone comes before them—their kids, their spouse, work, home issues," says Dr. Oz.

"Every day female patients tell me things like, 'I had excruciating pain in my chest one night and just curled up in the fetal position until it passed.' Or, 'I had radiating pain in my jaw and couldn't catch my breath, but I waited two hours to come in,' " says Holly Andersen, M.D., director of education and outreach at the Ronald O. Perelman Heart Institute of New York-Presbyterian Hospital/Weill Cornell Medical Center (which has partnered with the Barbra Streisand Women's Heart Center to form the Women's Heart Alliance). "There's this pervasive problem of refusing to act during a cardiac event, which I think is due in part to many women not recognizing their risk."

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Denial is common in many people having heart symptoms—but while men tend to seek help right away, fewer than one in four women actually call 911 when they are having a heart attack. Says Andersen: "As women, we're not as scared as we should be."

We're plenty worried about breast cancer, despite the fact that one in 30 women die of that disease per year compared to one in three women who die of heart disease and stroke. "I think that's because a lot of young and middle-aged women can't name another woman their age who's had a heart attack, whereas everyone knows someone who's dealt with breast cancer," says Andersen. "There isn't the same conversation about heart disease. Women need to realize it's crucial to take responsibility for their heart health—because it's more likely that a doctor is going to attribute their symptoms to non-heart-related issues, such as acid reflux."

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Is Your Doctor Heart-Smart?

Research backs up Andersen's concern: In one national study in the journal Circulation, fewer than one in five physicians knew that more women than men die each year from the disease. Another survey, by the Women's Heart Alliance, just found that among primary care physicians—often the first doctors that women will see—only 39% say they're extremely concerned about heart disease, when given a list of top health issues for women. These stats could explain why, when Maurer talked to doctors to find out how to prevent another heart attack, she didn't feel like she was getting all the help she needed.

"After about six months of asking what steps I could take, it became clear that the doctors didn't know exactly what to do with me," says Maurer. Then she had a second heart attack, again with nausea, vomiting, and shortness of breath—and the doctor in the ER looked straight at her medical history and told her it was probably just a pinched nerve. Maurer had to demand that he do blood work and an electrocardiogram.

When she started seeing Holly Andersen, though, she got specific guidance. "She gave me a nice but stern lecture about how I needed to exercise and improve my diet," says Maurer, who started walking in 5K and 10K races and lost 110 pounds over the course of three years. The day Maurer walked her first marathon, Andersen was at the finish line.

It's not just Maurer: We need all doctors to get smarter. In the Women's Heart Alliance survey, only 49% of primary care doctors and 52% of cardiologists agreed that a woman's heart is different from a man's. But they aren't the same. "Every cell in a woman's body is completely different from every cell in a man's body," says Stacey E. Rosen, M.D., a vice president at the Katz Institute for Women's Health at North Shore-LIJ Health System. "That means their organs don't necessarily function the same way." And, she points out, "Many heart procedures that are used on women haven't been sufficiently tested on them."

This is one reason why almost twice as many women as men who have had heart attacks die within a year, says Andersen. "Women are coming to us with more extensive heart disease, in part because our diagnostic tests—all developed on men—aren't catching the problems at an earlier stage, when they're more treatable," she says. A more female-centric approach certainly would have helped Nicole Lawson. For the past decade, Bairey Merz has worked with her on managing her condition and her pain. Now it's under control. "I spent years wondering if the pain really was all in my head," says Lawson. "My heart condition dominated my life until I finally got a diagnosis."

Pissed Off? You Should Be

Here's the crucial thing that Dr. Oz and the other heart specialists we spoke to want you to know: You need to take your heart health into your own hands. Don't wait for a doctor to bring it up. If your concerns aren't taken seriously—or, more critically, if symptoms are brushed off—you need a new doctor.

Another next step: Get pissed off. If this story has made you angry and frustrated, then join Barbra Streisand in making some noise. Talk to your doctor; urge your friends to do the same; clamor for more research. The louder women get, the more lives will be saved—including, quite possibly, your own.

Dr. Oz Says: Get 3 Tests

Your Blood Pressure —Ideal: under 120/80 (over 140/90 is high). "This is the most important test," says Dr. Oz. High blood pressure can cause wear and tear on your blood vessels, making it easier for plaque to build up and create blockages. The potential result: a heart attack or stroke.

Your Cholesterol — HDL (the good kind) should be 60 and above Total cholesterol should be below 200. But HDL is key: Ideal is 60 and above. LDL (bad kind): below 100. Triglycerides: below 150. High cholesterol doesn't always cause havoc, says Dr. Oz—but when paired with high blood pressure, you see problems. Get checked for diabetes as well.

Your Waist Size — It shouldn't be above 35 inches.A large waist circumference is a risk factor for high blood pressure and high cholesterol, says Dr. Oz. "While your blood pressure may be the most important, your waist measurement is the easiest thing to change."

This story originally appeared in the December 2014 issue of Dr. Oz The Good Life.

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