Many women are unaware of the warning signs

At age 30 and seemingly in great health, Cindy DeMarco was jolted awake early one Saturday three years ago with nausea, upper back pain, shortness of breath and a strange pressure in her chest. She thought the pain had to be related to her distance running or the racquetball game she had played the previous evening.

She took some ibuprofen. When the pain hadn't relented 12 hours later, she went to the hospital, where she was given muscle relaxers and advised to go home. Instead, DeMarco demanded an electrocardiogram. Even after the nurses reluctantly hooked it up, they thought the machine had to be malfunctioning when it indicated she was having a heart attack.

"Because I was young and female, they weren't even thinking of that," DeMarco said.

Like most women, the Alexandria, Va., attorney feared that she'd get breast or some other type of cancer one day. But in reality, 10 times as many women die of heart disease and stroke as they do of breast cancer -- about half a million each year in the United States. A woman's risk of heart disease rises substantially after menopause, but not all victims of heart disease have reached that milestone. About 10,000 women under age 50 died of heart disease in 1998, far greater than the 6,286 who died of breast cancer that year, the last year for which such figures were readily available.

Moreover, women under 50 are more than twice as likely to die of heart attacks as are men in the same age group. One reason: Women are more likely to be misdiagnosed in the emergency room.

Women under age 55 were the prime candidates for misdiagnosis: They were 6.7 times more likely to be misdiagnosed and sent home.

Emergency room staffers have a stereotype that "a person having a heart attack looks like Dick Cheney -- in his 50s or 60s and white," says Nancy Loving, executive director of the National Coalition for Women With Heart Disease, who had a heart attack at age 48.

Many middle-aged women, such as Toni Miller of West Los Angeles, never know they are at risk until they have a heart attack. Miller's occurred in October 2001 at age 50.

She didn't smoke or drink, she wasn't obese and she was energetic -- skating over to her mother's house, running a busy oral surgeon's office and being what she calls the "go-to gal" when friends and family needed things done.

"I wasn't sitting on the couch eating butter for the past 10 years, I was active," Miller says with a raucous laugh.

Miller had kept up with her Pap smears and mammograms. But like many other women, she relied on her gynecologist for primary medical care, she hadn't had any cholesterol tests and she hadn't paid much attention to her family history (both of her parents had heart disease).

It took several months to recuperate from the initial heart attack, a second attack suffered while she was doing a stress test on a treadmill, and triple-bypass surgery for three blocked arteries. Miller still tires easily. In addition, she was diagnosed with breast cancer about a year ago and has been undergoing chemotherapy.

These days, Miller is taking drugs called statins, which have reduced her cholesterol levels. Now, she says, she wants to do whatever it takes so she can meet her future grandchildren. "It's so cliche, but I so appreciate just the green trees, or just being able to walk the dogs," says Miller.

DON'T IGNORE WARNING SIGNS

Women often don't recognize that they're having a heart attack and may ignore the warning signs. Experts say to call 911 if you have one or more of these symptoms:

Chest pain or discomfort. Most heart attacks start slowly, with mild pain or discomfort, usually in the center of the chest. It can feel like uncomfortable pressure, squeezing, fullness or pain.

Discomfort in the stomach, jaw, neck or back. Women frequently feel this type of pain, either in addition to or without the chest pain.

Shortness of breath

Cold sweat

Nausea or a feeling of indigestion

Lightheadedness accompanying these symptoms.

-- Los Angeles Times