Ask a woman which health issues she is most concerned about and chances are breast cancer will be at or near the top of her list. But the truth, according to the American Heart Association, is that cardiovascular disease claims more women's lives in the U.S. than the next seven causes of death combined -- nearly 500,000 per year.

"Women need to realize that heart disease is their number one killer," says Chippy Nalluri, MD, a cardiologist at Manatee Memorial Hospital.

What's worse, she says, is that many women don't recognize the symptoms of a heart attack when it happens to them. While nearly everyone knows that serious chest pain is a sign to get help fast, many women don't experience this during a heart attack.

"Women tend to experience chest pain differently than men do, often mistaking it for indigestion," she says. "Women also tend to present with different symptoms when having a heart attack."

For example, women often complain of weakness, unusual fatigue, sleep disturbances, shortness of breath and mental stress or anxiety. They also may experience jaw, back or neck pain. Some report dizziness and heart palpitations.

Dr. Nalluri says biological differences between women and men could account for why women experience heart attacks differently. For example, she says, women generally have narrower veins, which might contribute to vasospastic angina, an attack that occurs predominantly while at rest.

"Also, because of the protective effect of estrogen, women, on the average, present five to 10 years older than their male counterparts," she says. "But once women are postmenopausal, they have the same -- if not a greater -- risk as men of having an acute myocardial infarction [heart attack]."

Chippy Nalluri, MD, Bradenton Cardiology 316 Manatee Ave. West Bradenton, FL 34205 941-748-2277

Dr. Nalluri points out that since women tend to have heart attacks later in life than men do, they often have other diseases such as hypertension, diabetes, arthritis or osteoporosis that make them more fragile and recovery more difficult. This helps explain women's greater mortality rate after heart attacks.

Dr. Nalluri believes women should make the necessary lifestyle modifications before they reach menopause to protect their heart health.

"Prevention is the key to reducing your likelihood of having heart disease," she says. Dr. Nalluri recommends that women eat a low-fat diet, not smoke, maintain a healthy weight, exercise regularly and have their blood glucose levels checked during annual physical exams.

To learn more about women's symptoms and risks of heart attack, visit the American Heart Association's Web site at www.americanheart.org.