I continue to be amazed at the answers I get from ladies when I ask them what the No. 1 killer of women is. The overwhelming majority respond, "breast cancer." While breast cancer is the number one cancer killer in women, and is estimated to have claimed about 39,500 women last year, it is not the biggest threat women face. It's estimated that 400,000 women died of heart disease in the same year.

Cardiovascular disease is arguably the most important women's health issue and is largely preventable. How can women be so unaware that they have a one in 31 chance of dying from breast cancer but a one in three chance of dying from heart disease? Could it be that breast cancer gets so much more coverage in the popular media? Is cancer generally more frightening? Is heart disease just plain boring to talk about?

Whatever the reason(s), women need to become educated about their risk of developing heart disease. The American Heart Association's "Go Red for Women" campaign (www.goredforwomen.org) is attempting to raise awareness.

It is well documented that in general, doctors give less attention to heart problems in women and inferior treatment when compared to men. Much of this has stemmed from scientific studies on heart disease that have not included women. More recent information is shedding light on the diagnosis and management of heart disease in women.

When surveyed, only one-third of women report discussing heart disease risk with their doctors. Women and their doctors continue to believe that they are generally at much lower risk for heart disease than men when, in fact, women account for 51 percent of cases. African American and Hispanic women are even less likely than white women to be aware that heart disease is a major threat.

Trends in risk factors for heart disease in women have been increasing over the last 30 years. These risk factors include diabetes, abdominal obesity and high blood pressure. A woman's risk for cardiovascular disease should generally be assessed in her twenties. Taking a personal history and doing some testing can place a woman into one of three risk groups: high risk, at risk, and optimal risk.

"High risk" women have one or more of the following: known heart disease, history of stroke, history of peripheral arterial disease, end-stage or chronic kidney disease, diabetes or a 10-year Framingham risk of cardiovascular disease greater than 20 percent. Framingham risk is a calculation that is done based on age, blood pressure, cholesterol values, blood sugar (diabetes) and smoking status. To calculate your risk, go to http://cvdrisk.nhlbi.nih.gov/calculator.asp.

"At risk" women exhibit one or more of the following: cigarette smoking, poor dietary habits, physical inactivity, obesity (especially abdominal), family history of premature heart disease (<55 years in a male or <65 years in a female), high blood pressure, elevated lipids (cholesterol), calcium deposits in blood vessels, or poor exercise capacity on a treadmill test.

Women at "optimal risk" have a Framingham risk of less than 10 percent, a healthy lifestyle, and none of the risk factors listed above.

Treatment recommendations can be made to reduce a woman's risk for heart disease after her risk factors have been identified. The most important things to work on in "at risk" and "high risk" women are smoking cessation, as well as treatment of elevated lipids, high blood pressure or diabetes. Diet, exercise and weight loss are important as well. Virtually all women at high risk should be taking aspirin, along with medications called beta blockers and ACE inhibitors that protect the heart.

Women should discuss their risk factors with their physician and develop a prevention plan. They should also avoid treatments that have not been shown scientifically to be of any benefit such as postmenopausal hormone therapy, and antioxidants like vitamins E, C, beta carotene and folic acid.