How to foil the biggest killer ... heart disease

Q. My father died of heart attack when he was 49. I’m 45. Am I at risk, and what can I do about it?

A: Yes, you are at risk, but so are most of us.

It’s scary that so many women barely acknowledge that their hearts can physically “break.” But heart disease is the leading cause of death for American women, accounting for 30 percent of all deaths. (Cancer is second and stroke is third.)

We dismiss this disease because men have heart attacks 7 to 10 years earlier then women. They and their doctors know what to do, so they are more likely to get timely, lifesaving diagnosis and therapy.

HEALTH     MORE STORIES msnbc.com Adventures in Cancerland, Part 2: Lust for life In the second chapter of a journal chronicling his treatment for cancer, reporter and columnist Mike Celizic finds himself thinking not of the discomfort ahead, but “about how I’d let the weeds and creepers overtake my life” – and begins living in the moment again. Looking for love, 650-pound virgin loses 410   Your brain on shopping Keep it fresh! Dos and don’ts of storing food 8 ways the food industry tricks you to overeat

But more than 400,000 American women will have a heart attack this year, and a third of these will not even be recognized. (Many women write their symptoms off as indigestion or fatigue.) Of the women who are diagnosed, 42 percent will die within a year -- double the rate for men.

The younger we are when we get heart attacks, the worse the outcome. Women under age 65 are half again as likely to die of a heart attack as men in the same age group.

When a man has a heart attack, it often occurs after a slow formation of plaque, which closes off the arteries. When a woman does, it often occurs suddenly -- after a spasm of a coronary vessel, with the formation of a clot or the shearing-off of plaque. These bits travel through the blood stream and block a smaller vessel.

HEALTH LIBRARY Addictions Aging AIDS Allergies & Asthma Alternative Medicine Alzheimer's Disease Arthritis Cancer Heart Health Children's Health Cloning Cold & Flu Cosmetic Surgery Diabetes Diet & Fitness Digestive Diseases General Health Genetics Health Care Infectious Diseases Men's Health Mental Health Pets Sexual Health Stem Cell Research Women's Health

There are nearly 300 risk factors for heart disease, but an important one, as you suggest, is a family history of early heart attacks — before age 55 in men and 65 in women. This alone increases your risk two- to three-fold.

Other major factors that raise your risk:

• Smoking.
• Diabetes.
• Obesity.
• Untreated hypertension.
• A sedentary lifestyle.
• Abnormal lipids (a fatty substance in the blood), especially elevated triglycerides (body chemicals that transport fats) or high LDL cholesterol (the “bad” cholesterol).
• An elevation in the inflammatory factor C-reactive protein.

If you have both genetic risk and another factor, you should have a coronary assessment. This can include a stress electrocardiogram; however, this test is often falsely positive in women, so most cardiologists prefer a cardiac ultrasound during exercise.

Your doctor may also test your blood for C-reactive protein, homocysteine (an amino acid, too much of which is related to heart disease), fasting lipid levels and fasting blood-sugar levels.

Only on TODAY.MSNBc.com! Dr. Judith Reichman addresses your questions about women's health. LAST WEEK: Will removing my ovaries prevent cancer? GO TO ALL HEALTH TUESDAY COLUMNS

You should make efforts on your own to lower your risk. If your smoke, stop. Get at least 30 minutes of walking or other aerobic exercise daily.

If your lipid levels are high, talk to your doctor about taking statins to lower them. Your blood pressure should not be higher than 120/80. If it is, aggressive treatment with medication will make a big difference.

If you are more than 55, talk to your doctor about taking a low-dose (81 mg) aspirin daily.

Dr. Reichman’s Bottom Line: Although you may not want to admit you are at risk for heart disease, it’s to your advantage to know for sure. There is much you can do about it, including adopting a healthy lifestyle.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You willl find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of HarperCollins.

MORE FROM HEALTH

Health Section Front

Adventures in Cancerland, Part 2: Lust for life Looking for love, 650-pound virgin loses 410   Your brain on shopping Keep it fresh! Dos and don’ts of storing food 8 ways the food industry tricks you to overeat   Why women feel tired   Dr. Nancy answers your sleep questions   New questions about bottled water Swine flu shots could begin this fall Deadliest day for suicides: Wednesday Health Section Front   Add Health headlines to your news reader: