Most of my patients think that breast cancer is the number one cause of death among women.
They worry about it all the time, ask me what they can do to prevent it, and talk about it with their friends.
They are all surprised when I tell them that the biggest killer of women above the age of 50 is actually heart disease, not any type of cancer.
They think that heart attacks and strokes only happen to men.
This is partly because many of the stories that we hear related to heart attack cases are about men, whether it's from family, friends or the news.
But this does not mean that heart disease does not exist in men.
Perhaps stories about breast cancer are simply given more prominence compared to stories about heart attacks in women, because of the symbolism of breast cancer and the fearsome role that it occupies in our minds.
As many women are still belabouring under this misconception, I decided to write about heart disease in women to make readers more aware of their heart disease risk and how they can protect themselves.
There are many different types of heart disease, but the most common type in women is coronary heart disease (CHD), also called coronary artery disease (CAD).
This form of heart disease affects the coronary arteries, where plaque builds up on the inner walls of the arteries.
The build-up of plaque can cause the arteries to become narrow, or can form blood clots. Both these instances reduce or block blood flow to the heart.
This is how a heart attack happens.
CHD can also lead to heart failure, irregular heartbeat (arrhythmia) and sudden cardiac arrest.
It's a woman's disease, too
The myths and misconceptions that heart disease is "a man's disease" are exceptionally dangerous.
Not only is heart disease also a woman's disease, but it also kills more women than men.
Women are more likely to die from a heart attack because they usually develop heart disease at an older age (about 10 years later than men) and also tend to have other significant health problems when the heart attack occurs.
There is another reason for the higher number of deaths among women: women are less likely than men to receive appropriate treatment after a heart attack.
This may be because their symptoms were not recognised (I will discuss more about symptoms later), or because they respond differently to some cardiovascular medications.
Our symptoms are different
We automatically assume that heart attacks are characterised by chest pain.
But women do not always have symptoms related to chest pain or discomfort, and are more likely than men to have other types of symptoms or more subtle symptoms.
Some symptoms that occur in women include pain or discomfort in the neck, shoulder blade or upper back; profound fatigue; difficulty breathing; dizziness; nausea and vomiting; profuse sweating; burning abdominal pain; or even an impending feeling of doom.
As you can see, some of these symptoms could easily be mistaken for exhaustion or some other type of illness or discomfort.
Many women may also minimise the significance of their symptoms, telling themselves or those around them that it's "just indigestion or fatigue".
It is also believed that women have higher tolerance for pain, compared to men (although this does not mean that the disease is less severe in women).
All this means is that women may wait too long before seeking help.
Lastly, CHD is often missed or misdiagnosed in women because normal testing procedures, such as the treadmill, stress test and angiography, are not as effective in diagnosing women's heart disease.
For instance, an angiogram may give false-negative results in women when the plaque lining has not yet entered the blood vessel and shows up as "clear" on the angiogram.
The right treatment
So far, we have seen that the symptoms of heart disease in women are different, and the testing methods are not as effective in women.
To add a triple whammy to that, even the treatment of heart disease in women differs from that in men.
Procedures like angioplasty and stenting are designed to treat CHD by flattening bulky, irregular plaques, which are more common in men's arteries.
However, plaque in women's arteries tend to build up as an even layer along the vessel walls. Therefore, angioplasty and stenting are not as effective in women.
Treatment with medications also tend to vary in efficacy.
Certain heart medications, like clot-busting drugs, are known to be more effective in women than in men.
Aspirin therapy works better in reducing the risk of stroke in women, as opposed to heart attacks.
These differences in how women and men respond to therapy are important, so that women are not poorly treated, with fatal outcomes.
Reducing your risk
Women of all ages, particularly those with a family history of heart disease, should make a serious effort to reduce their risk of heart disease.
We all know about the general risk factors, such as overweight or obesity, high cholesterol and high blood pressure.
However, there are certain risk factors that are more of an issue for women, compared to men. Even though we may not read or hear much about them, we should be equally vigilant about these factors.
First, there's the deadly quintet of conditions called the metabolic syndrome, which has a greater impact on women than on men.
This syndrome is a combination of abdominal fat, high blood pressure, high blood sugar levels, high triglycerides, and low HDL levels, that increases your risk of developing heart disease and diabetes.
Women's hearts are also more severely affected by psychological stress and depression.
We still do not know enough about how mental health affects cardiac health, but we know for sure that stress and depression can impair a woman's ability to maintain a healthy lifestyle and manage her condition.
It is crucial that mental health problems in women are professionally treated.
Smoking is even more detrimental in women than in men, as it causes an even higher risk of heart disease.
It is an ugly habit that you should endeavour to stop immediately.
Finally, menopause, and the decrease in the production of oestrogen, is one of the main risk factors for developing heart disease, especially in the smaller blood vessels.
This is why women "catch up" with men very rapidly from age 50 onwards, and by the age of 65, have the same risk of having a heart attack, stroke or any other coronary disease as men do.
Reducing the risk factors above will require a lot of effort and a change of lifestyle habits, for most women.
The medical guidelines also recommend that women at high risk of heart disease should take aspirin for prevention.
However, this is something that you need to discuss carefully with your doctor or specialist, as there are other side effects involved.
Regardless of your health status now, you should be aware that heart disease is a major killer of women.
The risk factors could creep up on you, but it is never too late to make changes in your life to prevent that deadly heart attack or stroke.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit www.primanora.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care.