Heart disease has been the leading cause of death in women since 1912, but today doctors still underestimate women's heart risk, according to a study published in the February 2005 issue of Circulation: Journal of the American Heart Association. In fact, the study found that less than one in five physicians recognized that more women die of heart disease each year than men. As a result of doctors' misperception that a woman's risk is lower than a man's, women are less likely to receive recommendations from their physicians for preventive therapies such as cholesterol-lowering drugs, aspirin therapy and cardiac rehabilitation to protect them against heart attacks and death. This is a mindset that must change, said Anu V. Rao, MD, FACC, Director of the Women's Cardiovascular Center for CardioVascular Associates, P.C. at Brookwood Medical Center in Birmingham. "Heart disease kills almost twice as many women each year than all cancers combined," Rao pointed out. "Women still need to be concerned about breast cancer, but they also need to be aware of their total body." Rao said what women do early in life can prevent problems later, and doctors need to treat cholesterol and hypertension more aggressively in their female patients. "The good cholesterol norm for women is higher than for men, but doctors need to manage the bad cholesterol as well. You can't ignore the bad just because the good is okay," Rao said. Doctors and their female patients need to be aware that heart attack symptoms present differently in women. "Men often experience severe chest pain during a heart attack, but that's not always the case in women," said Rao. "Women can hurt in their shoulders, back, neck, behind their ear, anywhere in the upper body. They may also have tingling in their arms." Other typical symptoms in women include shortness of breath on exertion and fatigue. "Unusual and profound fatigue for a period of time can be a warning sign before a heart attack," Rao added. Testing for heart disease with traditional stress tests can be more difficult in women because the breast tissue can cause false positive readings, said Elizabeth Branscomb, MD, FACC, a noninvasive cardiologist with CardioVascular Associates at Brookwood. Branscomb, who specializes in nuclear imaging diagnostics of the heart, said a new PET/CT (positron emission tomography/computed tomography) stress test is changing the way cardiologists diagnose heart disease. This advanced stress test combines two of the most advanced imaging technologies available to check the health of the coronary arteries. "Studies show that PET scans have a higher diagnostic accuracy than similar tests," Branscomb said. "We are the first people in Birmingham to do PET stress testing, and we've done more PET stress testing than anyone in the world. We've found it to have twice the diagnostic accuracy and it also gives us half the false positive readings and less than half the false negatives of other tests." Branscomb added that besides being noninvasive and significantly more accurate than arteriography, PET/CT can provide physicians with prognosis of whether the patient will suffer a heart attack or cardiac death in the near future. She said the PET/CT is faster. It uses less radiation than other scans and no dye, making it a safer diagnostic tool and one that should decrease the number of unnecessary cardiac catheterizations. "Caths carry some risk," she said "Our goal is to do an arteriogram only on people who need it for stents or bypass, and PET/CT can help us make that determination."