HEART OF THE MATTER CORONARY SYMPTOMS DIFFER FOR WOMEN, WHO ARE OFTEN MISDIAGNOSED AND UNDERTREATED.

Byline: Mariko Thompson Staff Writer

Much has been made in pop psychology about the planetary misalignment of men and women. When it comes to the heart, cardiologists say men and women really are different.

In the classic heart attack scenario, the stressed-out businessman clutches his chest and collapses. But heart specialists say this stereotype is misleading for women, who are more likely to complain of such vague symptoms as fatigue and back pain.

Now cardiologists and women's health advocates are setting out to dismantle the stereotype of the heart attack patient. Concerned that heart disease has been overlooked or misdiagnosed in women, they are warning female patients to become heart smart.

``I think men know their No. 1 killer is heart disease,'' said Dr. Afshine Ash Emrani, a cardiologist with the Encino-Tarzana Regional Medical Center's San Fernando Valley Heart Institute. ``Breast cancer has been pounded into women's minds from such an early age - and for the right reasons. But most women don't think about their hearts at all.''

The consequences can be dire, even fatal. Delay in recognizing symptoms and going to the hospital impact the ability to provide lifesaving treatments such as clot-busting drugs. The more time that elapses, the more damaged the heart can become.

Though polls have found most women cite breast cancer as their greatest health risk, statistics suggest they should be more worried about the state of their hearts. A half-million American women - one out of three - die of heart attack and stroke every year. Breast cancer claims the lives of 40,000 annually.

To get the word out, the National Heart, Blood and Lung Institute launched an awareness campaign called ``The Heart Truth'' with the help of first lady Laura Bush. The advocacy group, WomenHeart in Washington, D.C., surveyed and posted a list of heart centers specializing in women's health care on its Web site, www.womenheart.org. In recent years, books advising women on heart health have hit the shelves.

``The message is getting out,'' said Dr. Joseph Wen, an interventional cardiologist at Glendale Memorial Hospital. ``You don't want to scare women into overreacting, but you don't want them to be too quiet.''

Missing the symptoms

Eunice Percy-Campbell, 53, assumed the burning sensation in her chest was the result of indigestion or stress. She never suspected heart disease. The La Crescenta resident was fortunate to work as a case manager at Glendale Memorial Hospital, where vigilant co-workers urged her to visit the emergency room.

In December, the initial round of tests at the ER came back negative. But the burning sensation returned a month later. Percy-Campbell had a more invasive test done, and doctors discovered a blockage in one of her arteries.

``I've always been healthy,'' Percy-Campbell said. ``I eat well. It really never occurred to me that I could have a heart problem.''

During a heart attack, women often experience discomfort or pressure anywhere from the belly button to the jaw. Unusual fatigue, shortness of breath, nausea and dizziness also are warning signs. A recent study at the University of Texas in Houston found women were more likely to experience atypical stroke symptoms as well. These include headache, face pain and limb pain. Traditional stroke symptoms include poor balance and paralysis on one side of the body.

Though more women die of heart disease every year compared to men, women represent only 29 percent of bypass surgeries and 39 percent of angioplasties, according to WomenHeart. Women also are more likely to die within a year of having a heart attack and twice as likely to die after bypass surgery.

For African-American women, the problem is even worse. Studies have found that women in general are 40 percent less likely to receive clot- busting drugs. Broken down even further, African-American women are 60 percent less likely to receive clot-busting treatment than white men, said Dr. Karol Watson, co-director of UCLA's preventive cardiology program.

Out of the picture

Why the disparity in treatment? Dr. Nieca Goldberg, author of ``Women Are Not Small Men,'' suggests the problem starts in medical school, where the typical heart attack patient is described as a 165-pound middle-aged man. Until about 15 years ago, research and treatment revolved around men. Studies enrolled male patients. When angioplasty was first developed, the balloons used for the procedure only came in one size. Women didn't fare well.

``They missed the boat on half the population,'' said Goldberg, founder of Total Heart Care in New York.

Women also have been overlooked for another reason. Because natural estrogen is thought to confer protection on the heart, many doctors believed heart disease was highly unusual in women who had not reached menopause. Hormone replacement therapy was touted for menopausal women as a way of extending that protection. But a major study called the Women's Health Initiative poked holes in that theory, finding that HRT actually increased the risk of heart attack.

``Hormones are best used for menopausal symptoms,'' Goldberg said. ``They're not the answer to reducing risk for heart disease.''

Though women typically don't show signs until 10 years after menopause, heart disease can start much earlier. Today, experts recommend that women become concerned about their hearts at age 40. Risk factors include age, a family history of heart disease, smoking, high blood pressure, high cholesterol, diabetes and being overweight.

A cholesterol check, starting at age 20 to get a baseline, is recommended to assess heart disease risk. Doctors say a high amount of good cholesterol (HDL) may be just as important as low levels of bad cholesterol (LDL). Elevated triglycerides, a type of blood fat, also increase the risk of heart attack.

Lately, doctors have been advocating a C-reactive protein test. This measures inflammation in the body and is considered a better indicator of heart attack risk than cholesterol levels alone.

Patients with a strong family history of heart disease or who have heart disease but lack traditional risk factors also may have their levels checked for homocysteine, Lp(a) and fibrinogen. Homocysteine, an amino acid, can damage artery walls at high levels. Lp(a) and fibrinogen are proteins both associated with blood clotting.

``Women need to take action and get their numbers,'' said Nancy Loving, executive director of WomenHeart. ``Then they need to know what is optimal, where those numbers should be. Women have to demand better health-care screening and treatments.''

Plenty of work lies ahead. Research has not yet answered the underlying questions: Why are women's symptoms different? Why are women more likely to suffer from complications following procedures? And women still are not adequately represented in studies. Only 25 percent of participants are female, Loving said.

In the meantime, doctors say the best medicine is preventive. Quit smoking. Eat well. Increase daily activity and exercise.

Said UCLA's Watson: ``The first thing we need to do is take care of ourselves so we can take care of everybody else.''

Mariko Thompson, [phone]

mariko.thompson(at)dailynews.com

CAPTION(S):

3 photos, box

Photo:

(1 -- cover -- color) Heart of the Woman

Doctors, researchers paying more attention to the kind of prevention and treatment females need for coronary disease

Gregg Miller/Staff Artist

(2) Eunice Percy-Campbell, 53, was lucky to be working at Glendale Memorial Hospital when she first felt the burning sensation that signaled heart disease.

David Sprague/Staff Photographer

(3) Radiologist Christina St. John, left, and Dr. Joseph Wen perform an angioplasty on a female patient at Glendale Memorial. When the procedure was first developed, the balloons used for the procedure came in one size - to fit men.

Box:

COMMON HEART ATTACK SYMPTOMS

SOURCE: ``Women Are Not Small Men,'' by Dr. Nieca Goldberg

Gregg Miller/Staff Artist