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After that bombshell, doctors and their female patients had a lot of questions. If hormones don't prevent heart disease, what does? Is the ailment fundamentally different in men and women? If not, why do their symptoms seem to differ? And why do treatments such as bypass surgery and angioplasty, which work so well for men, often fail for women? In some ways, says Dr. Sharonne Hayes of the Mayo Clinic in Rochester, Minn., "the findings have allowed us appropriately, and perhaps belatedly, to refocus our efforts."
It's not as if doctors were starting from scratch. Cholesterol-lowering drugs like statins and antihypertensive medications like beta-blockers clearly help both men and women, as do a healthy diet and plenty of exercise. "The vast majority of heart attacks in women could be prevented with a combination of lifestyle modifications and medication," says Dr. JoAnn Manson at the Brigham and Women's Hospital in Boston. "Just making use of existing information could nearly eradicate the disease."
At the top of the list of risk factors that men and women share is smoking, the most dangerous killer for both sexes, followed by diabetes, high blood pressure, high cholesterol levels, excess weight and physical inactivity. Some factors, however, seem to affect women more severely than men. In fact, smoking and diabetes completely counteract whatever protective benefits a woman normally enjoys before menopause. Also, women are more likely to be overweight, less likely to exercise and appear to be affected more adversely by stress.
Of course, neither men nor women can do anything about their age or the genes they were born with. (If your father had a heart attack before 55 or your mother had a heart attack before 65, you should pay special attention to your heart health.) And it's still unclear why heart disease seems to strike men and women so differently. Structurally, their hearts and arteries are basically the same; women's hearts are smaller, but in proportion to their bodies. So doctors are pretty sure that any differences are matters of degree rather than kind.
Cardiologists are confident that they understand how heart attacks occur in men. The trouble usually begins when a fatty deposit or plaque, which has taken decades to build up on the inside of a coronary artery, becomes unstable and bursts, triggering a clot that blocks a blood vessel. Doctors can see these plaques during a fairly invasive procedure called an angiogram, in which a catheter is threaded through an artery in the groin or leg up to the arteries of the heart and a dye is then released to make any blockages easier to spot.