Most women readily admit they are more concerned about developing breast cancer than having a heart attack.

The reality is cardiovascular disease kills more women over age 65 than all cancers combined. It is responsible for 37 percent of deaths in American women of all ages, claiming almost 500,000 lives every year.

Yet many women still think of heart disease as "a male thing." While more men than women have heart attacks, women are almost twice as likely to die from them within the first year. Women also are almost twice as likely as men to die after bypass surgery.

Even the symptoms of heart disease exhibited by women may be more subtle than those experienced by men. Instead of the crushing chest pain usually reported by men, women with heart disease may experience fatigue, shortness of breath, nausea or vomiting, and back or jaw pain.

For both men and women, the biggest factors that contribute to heart disease are smoking, high blood pressure, high cholesterol, family history and age. While you can't change your genetic makeup or your age, you can reduce your risk of heart disease by adopting a healthy lifestyle.

Smoking — Smoking is a woman's single biggest risk factor for heart attack. Stop smoking, and you can lower your risk of heart attack by one-third within two years.

High blood pressure — This increases the heart's workload, causing the heart to enlarge and weaken over time. Lose weight, exercise regularly, reduce your salt intake and eat a healthy diet to lower your blood pressure. Your doctor also may prescribe medication.

High cholesterol — The risk of coronary disease rises as blood cholesterol levels increase. Your doctor can recommend dietary changes to lower your cholesterol, and, in some cases, may prescribe cholesterol-lowering medication.

Exercise — Lack of physical activity is a risk factor for heart disease. Regular physical activity plays a significant role in preventing heart and blood vessel disease. Exercising at least 30 to 60 minutes four to six times a week can help burn off calories, while working out your heart muscle. See your doctor before starting to exercise.

Obesity and excess weight — Extra weight puts strain on your heart and arteries and puts you at risk for many health problems. A low-fat diet — avoiding foods with saturated fat and keeping fat calories to 30 percent or less of your total calories for the day — can help you lose weight.

Diabetes — This seriously increases the risk of developing cardiovascular disease. If you have diabetes, it is critically important for you to monitor and control any other risk factors.

Take charge of your health by identifying your own risk factors and making any necessary lifestyle changes to reduce your risk of heart disease. Talk to your doctor about your family history, your personal risk factors and any symptoms you might have experienced.

Because heart disease is a killer — and it's not just for men anymore.

Dr. Donna Wagstaff, a family practitioner with a special interest in women's health, is a member of St. Anthony's Physician Organization. She practices at Telegraph Road Family Medicine, 4438 Telegraph Road, 314-543-5996. For a referral to any St. Anthony's physician, call 314-ANTHONY (268-4669) or 1-800-554-9550.