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When women reach menopause, their risk of heart attack increases dramatically. With this in mind, cardiologists stress the important for women to know their family history of heart disease and to control other risk factors, particularly smoking.

Heart disease has traditionally been considered more of a risk for men than for women. But studies show that women, especially those over age 50, face just as great a risk of having a heart attack as their male counterparts, and are actually more likely to die if they do suffer a heart attack. Gary DeWeese, M.D., staff cardiologist at Durham Regional Hospital, part of the Duke University Health System, says once women reach menopause, their risk of heart disease escalates.

"That's exactly the time that their risk of heart disease catches up with men. Estrogen before that time is relatively protective, both in the lipid profile and the overall risk of having a heart attack, but it rapidly catches up, especially in smokers," DeWeese says.

In fact, adds DeWeese, virtually all the women he has seen who have suffered heart attacks have been post-menopausal.

"The ones that present early, in their 30s or 40s, are almost always women who smoke. In my experience as a practicing cardiologist, I can't remember a case of someone in their 30s who's female who had a heart attack without also smoking."

DeWeese says it is sometimes more difficult to diagnose women who are experiencing heart problems, because they do not always exhibit the classic textbook symptoms that most men do.

"With men, it's usually a pressure-like pain that spreads across the chest, sometimes to the inner aspect of the arm, to the neck, between the shoulder blades, sometimes associated with vomiting, profound sweating and shortness of breath"

However, women's symptoms are often not so clear-cut. And even though women are typically more sensitive than men to changes in their bodies, they may not suspect a heart problem.

"Women can sometimes present with fatigue, vague discomforts that they disregard for whatever reason. I once had a patient whose only symptom was pain in the ear canal, but who required bypass surgery," DeWeese said. "In many cases, by the time they actually present, it's quite late in the clinical course. There are many patients who had symptoms days or weeks before, and it would have been much easier to take care of them at that point than at the point when they're in extreme distress and losing a lot of heart muscle."

DeWeese believes the most important thing women can do to prevent heart disease is to control their risk factors. While the biggest factor is heredity, other primary risk factors are controllable, including smoking, high cholesterol, obesity and high blood pressure.

"The key for women is to know your risk factors and know your family history," says Deweese.