DEAR DOCTOR K:

For years I thought I was at lower risk for heart disease than men because I was a woman. Now I know better. I'd like to take steps to reduce my chances of developing it. What can I do?

DEAR READER:

Heart disease has carried a reputation as a "man's disease" for years. But it is not now -- nor was it ever -- a disease that mainly targets men. In fact, these days more women die each year of cardiovascular disease than men. (Cardiovascular disease refers to heart disease, stroke and related blood vessel conditions.)

Like you, a lot of my patients don't think of heart disease as a problem for women. Here's a pop quiz: Are women more likely to die of breast cancer or heart disease? The answer: More women die of heart disease each year in the United States than from all types of cancer combined. That includes breast, ovarian and cervical cancer, plus lung, stomach and colon cancer, plus leukemias, lymphomas and melanoma -- all types of cancer.

Why do I make such a point of heart disease being the No. 1 killer of women? Some disease has to be No. 1, you might say. The reason is that many deaths from heart disease in women are preventable.

The American Heart Association (AHA) offers advice for women like you who want to prevent heart disease. The guidelines aren't for women who already have heart disease or early warning signs of it. Although many of the recommendations would also apply to those women, they generally need more intense efforts to prevent a heart attack or stroke.

The AHA urges women to talk with their doctors about their risk for developing heart disease. The guidelines stress lifestyle changes over medications.

The updated prevention guidelines for women list strategies proven to work and those that probably work. Virtually all of these apply to men, too.

PROVEN STRATEGIES

-- Avoid tobacco.

-- Exercise for at least 30 minutes a day, more if trying to lose weight.

-- Adopt a healthy eating plan.

-- Maintain a healthy weight (a body mass index between 18.5 and 24.9).

-- Control blood pressure, with medication if needed.

-- Control cholesterol, with a statin if needed.

-- Control blood sugar with exercise, dietary changes and medications if needed.

PROBABLY EFFECTIVE

-- Screening for depression.

-- Raising protective HDL with medications such as niacin or a fibrate.

In the past, some practices were recommended for heart disease prevention that I don't think have stood the test of time: vitamin E, beta carotene, folic acid and aspirin (in women under age 65). There is still controversy about hormone therapy and heart disease (to be discussed in a future column).

You can also read more about heart disease prevention in women in our new book, "Smart at Heart: A Holistic 10-Step Approach to Preventing and Healing Heart Disease for Women." You can find out more about it at my website.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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