Heart disease ? it?s the number one killer of women across the globe and, yet, it has been known largely as a man?s disease.

This was so much the case that awareness campaigns and research studies about heart disease have often focused on men even though the symptoms and risk factors for men and women can be quite different.

Heart disease is a broad category which encompasses coronary artery disease, abnormal heart rhythms or arrythmias, heart failure, congenital heart disease, heart muscle disease (cardiomyopathy), pericardial disease, aorta disease and Marfan syndrome (blood vessel disease).

Today, two American health professionals, Dr. Barbara H. Roberts (above right) and nurse and sailor Maureen (Moe) Roddy (above left) are trying to close the gender gap by educating women around the world about heart disease.

They were recently in Bermuda during heart disease awareness month to help the Bermuda Heart Foundation to spread the word about the disease.

Dr. Roberts is the director of the Women?s Cardiac Centre at the Miriam Hospital in Providence, Rhode Island, one of the few hospitals in New England to have a heart centre set up specifically for women.

She is also the author of How to keep from Breaking your Heart: What every Woman needs to know about Cardiovascular Disease.

?Heart attacks are often misdiagnosed in women,? said Dr. Roberts. ?Therefore, that is one of the reasons that a woman under the age of 50 is twice as likely to die of a heart attack as a man of the same age.?

Dr. Roberts said ever since heart disease was really studied by doctors, the focus has been on men rather than women.

?Even when I was in medical school in the 1960s this was the case,? she said. ?The hypothetical patient was always male. The symptoms that were described were always male.

?People just assumed that women would have the same symptoms, and the same risk factors and the same response to treatment. But in fact, women don?t. Women often have different or ?atypical? symptoms.?

For men the classic symptoms of a heart attack are crushing, substernal (under the breast bone) chest pain associated with sweating, shortness of breath and a feeling of impending doom.

In women, the most common symptom of an acute heart attack is: shortness of breath and sometimes overwhelming fatigue and pain in other locations such as the jaw or the back.

?In a study published a few years ago in ?Circulation?, the journal of the American Heart Association, fewer than 30 percent of women were found to have classic substernal chest pain with their heart attack,? said Dr. Roberts.

When Ms Roddy started working with Dr. Roberts in cardiac surgery at Miriam Hospital, a few years ago, she was also unaware of the difference in symptoms for men and women.

?I am a cardiothoracic nurse,? said Ms Roddy. ?When I started doing cardiac surgery I didn?t realise what the statistics were for cardiac deaths in women. If I was a nurse and a professional and I didn?t know this information then the average lay person isn?t going to know it either??

Ms Roddy lost her mother to breast cancer when she was just a child. Seeing the even larger numbers of women dying from heart disease made her think of all the children who were left without their grandmothers, aunts and mothers.

?This is something that is killing 500,000 women each year,? she said.

As she pondered what a single nurse in Rhode Island could do to fight a global pandemic like heart disease, she was preparing to enter the 2005 Bermuda 1 - 2 Yacht Race. Her first act against heart disease was to name her new J35 sailboat ?Red Dress?.

She also had painted a red dress with a white heart on the sail. The red dress is the symbol of the Heart Truth campaign organised by The National Heart, Lung and Blood Institute (NHLB).

?I thought if I could do something with my boat,? said Ms Roddy. ?I named the boat the Red Dress and then it snowballed.?

When she sails and races she also gives lectures about heart disease to the people she meets in different ports.

Ms Roddy and Dr. Roberts felt that simply by educating women about heart disease prevention, risk factors and symptoms, they could stop the heart disease pandemic.

?Approximately 18 percent of the disease is hereditary,? said Ms Roddy. ?The other 82 percent can be affected by lifestyle changes such as diet and exercise. That is huge. We could impact 400,000 lives. They don?t have to die.?

Dr. Roberts said women often don?t realise that they are even at risk for heart disease.

?They don?t know what their own risk factor profile is, for example,? said Dr. Roberts. ?They may take chest pain in their fathers or husbands and ignore it themselves if they have chest pain or they may go to doctors with symptoms that aren?t typical and just be reassured and patted on the back and told that nothing is wrong.?

She said that patients are often referred to her with very little understanding of what their diagnosis means.

?The patient will say that their doctor sent them to me because they have angina,? said Dr. Roberts. ?I will say: ?What does angina mean to you?? and they won?t have a clue. They have no idea.

?There is a tremendous amount of lack of information and therefore educating that needs to be done.?

She said educated patients are more likely to comply with the radical lifestyle changes that are often needed to get heart disease under control or to prevent it.

?I tell my patients ?yes we all have to die, but the trick is to stay healthy until the moment you go?,? said Dr. Roberts.

She became interested in heart disease as a student in medical school.

?I had the opportunity when I was a resident to do a rotation in a heart catheterisation laboratory,? said Dr. Roberts. ?I found it fascinating to be able to correlate what I saw on the film with what I heard when I listened to the patient?s heart.

?For example, correlating the murmurs with what we found was wrong with their valves. It was intellectually very challenging to me.?

Dr. Roberts has now been a cardiologist for 31 years, and has been lucky enough to have a family blessed with healthy cholesterol. Still, she works hard to take care of her own heart health.

?I have never smoked and I try to avoid second hand smoke,? Dr. Roberts said. ?I eat a heart healthy diet, basically a plant-based diet. I try to eat lots of colourful fruit and vegetables.?

One of her secret weapons is olive oil, which she tries to eat everyday because studies have found it to raise good cholesterol (HDL) levels.

HDL and LDL are lipoproteins, substances found in the bloodstream, that transport cholesterol and triglycerides in the body.

?For a woman the only important risk factor is a low level of HDLcholesterol,? she said. ?It is different from men in that respect. What is most important for men is the level of the bad or LDL cholesterol.

?If your HDL is low, you have a higher risk of developing atherosclerosis or hardening of the arteries.?

Good cholesterol is found in foods high in mono-unsaturated fats such as olive oil, canola oil and in certain nuts.

Dr. Roberts also eats very little red meat and tries to eat seafood several times a week. She also power walks for 12 miles each week, helping to keep her weight down.

While in Bermuda, Dr. Roberts and Ms Roddy participated in a heart health walk to raise awareness of the disease in Bermuda, where heart disease is the number one cause of death for women and men.

?In the entire world there is only one place where cardiovascular disease is not the number one killer of women and men and that is Sub-Saharan Africa,? said Ms Roddy. ?Everywhere else it is the number one killer.?

?In many parts of the developing world it is killing men and women in the prime of life, during their most economically-productive years,? said Dr. Roberts. ?In the United States and most of the west, cardiovascular disease has been shifted to the older age group.

?We are getting better at preventing it and treating it in middle age. In the developing world, where the true scale of this epidemic is unrecognised, cardiovascular disease is killing people in the prime of life and impacting very adversely on the economics of the country.?

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For more information about heart disease check out Ms Roddy?s website at www.reddressracing.com .