Comedian Rosie O'Donnell told her fans this week that she is "lucky to be here" after not recognizing signs of a heart attack. O'Donnell wrote on her blog August 20 about nausea, aches and other symptoms the week before. She said she did an online search for "women's heart attack symptoms" and was concerned enough to take aspirin. This can help to prevent blood clots that cause heart attacks. But O'Donnell did not go to the emergency room. She went to see a cardiologist the next day. O'Donnell said one of her arteries was 99% blocked. Doctors inserted a stent, a small tube, to open the artery. She urged her female fans to know the symptoms of heart attacks and not ignore them if they occur. The Associated Press wrote about O'Donnell's illness.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Rosie O’Donnell didn't have the crushing chest pain most people consider the cardinal symptom of a heart attack. Yes, her chest was sore and so were her arms. She thought it was likely muscle strain after helping lift a very large woman out of her car.

She took an aspirin in case it could be a heart problem. But even when she had other common heart attack symptoms -- sweating, nausea, vomiting and feeling lousy -- she didn't call 911.

O’Donnell's reaction to her symptoms is much too typical of an American woman. For too long, women have held the notion that heart attacks are a man's disease. And being a woman of just 50 years of age, O'Donnell probably thought she was too young to have a heart attack.

An American Heart Association survey done two years ago revealed some startling statistics about women and heart disease.

• Only 55% of women surveyed said they would call 911 if they thought they were having a heart attack.
• Half of women didn't know heart disease was the leading cause of death among women.
• Half said their family or caregiving responsibilities made it difficult or impossible to take steps against heart disease, such as exercise and healthful eating.
• About 32% said they didn't need to take preventive action since they weren't at risk for heart disease.
• About 58% said they were trying to prevent heart disease by taking vitamin A, C or E. None of these vitamins has been shown to work against heart disease.

What Changes Can I Make Now?

The symptoms of heart attack in women are often not as typical as the ones O'Donnell had. During an attack, women more commonly have:

• Shortness of breath
• Marked weakness
• Unusual fatigue
• Cold sweats
• Dizziness
• Nausea

Surveys of women who have had a heart attack found that up to 95% of them said they noticed something wasn't right in the month or so before their heart attacks. The two most common early warning signs, fatigue and disturbed sleep, were often severe. Some women, for example, said they were so tired they couldn't make a bed without resting.

Chest pain, a common early warning sign of heart trouble for men, is usually toward the bottom of the list of symptoms that women have. Those who do feel something in the chest leading up to a heart attack often don't use the term "pain." Instead they describe it as aching, tightness or pressure.

Get started now to avoid a heart attack. Modifying the major factors that increase the risk of coronary artery disease improves outcomes for women as well as men.

• Don't smoke. Quitting reduces your heart attack risk within weeks.
• Stick to a heart-healthy diet.
• Stay physically active and exercise regularly.
• Keep your blood pressure under control.
• Work to keep your LDL cholesterol and triglyceride levels down and HDL cholesterol up with diet, exercise and medicines if indicated.

What Can I Expect Looking to the Future?

While we know the basic ways to reduce risk of heart disease in women, we still have much to learn. For example, what role, if any, does estrogen play? Women at the beginning of menopause may actually keep blood vessels healthier by taking estrogen. In older women, any benefit is offset by the increased risk of blood clots.