Dr. Rama Garimella, an experienced cardiologist at Cary Cardiology, knows the secret of living a long and more fulfilling life: taking good care of your heart.  So when the North Carolina Division of Public Health revealed that, at least in our state, heart disease had dropped to the number two cause of fatalities (behind cancer), for Garimella, it was a victory.

But for one group of patients, it is still a little more difficult to convince to make time to take better care of their hearts: women.

Studies have shown that women do not have the textbook symptoms that are often associated with a heart attack, Garimella says.

"They don't have typical chest pain, typical radiation to the left arm.  A lot of times, they can have symptoms like indigestion, shortness of breath, fatigue or jaw pain," she says.  And because these symptoms are so nebulous, women may be reluctant to go to the emergency room or to their primary care physician for treatment.  

"Lots of women think they're crazy because of the multiple symptoms," Garimella says. And if the women do decide to get their symptoms checked out, Garimella adds, some doctors may misdiagnose these atypical signs.

In addition, women are sometimes reluctant to take the time out to care for themselves.  "I tell them—you need to go to the hospital right now," Garimella says.  "And they'll go: 'Oh, I need to take care of my husband.'"

Your husband can live, Garimella reminds them.  You need to take care of yourself, she advises them.

Some risk factors for heart disease, such as age, race and family history are simply unavoidable. But others are.  Here's how:

• Quit Smoking - Immediately after quitting smoking, heart rate and blood pressure become lower.  Soon, circulation and lung function improve.  The American Cancer Society reports that after quitting long-term, the risk of dying from smoke-related diseases decreases significantly, even for a life-long smoker.  If you're not a smoker, stay away from those who do.  A Center for Disease Control report indicated that exposure to second hand smoke can increase the chance of developing coronary heart disease 25 – 30%.

• Exercise – The American Heart Association recommends that healthy people exercise at least 30 minutes a day, most days, at a rate of 50 -85% of maximum heart rate.  (To find that maximum heart rate, use the formula of 206 minus 88% of your age. Take 50% of that maximum heart rate to find the lower end of your target heart rate range, and 85% to find the upper end.)

• Watch Your Diet – By eating foods low in saturated fats and cholesterol, you can help prevent the buildup of excess fat in the bloodstream.  On the other hand, foods that are high in fiber, and low in fats can help lower levels of LDL, or bad cholesterol.

• Make Adjustments as You Age – Know that your risks increase as you age, so a cholesterol number that may not have been a red flag at the age of 20 may be more concerning when you are 50.  Talk with your doctor about how to best take care of your heart, as you get older.

• Talk with Your Doctor – About any concerns you have about your health.  If you feel dismissed or ignored, consider visiting another physician who can fully address your concerns.

• Learn More – February is American Heart Month, a period initiated by the American Heart Association to education people on heart health, and to raise funds for research. More specifically, the American Heart Association's Go Red For Women campaign (www.goredforwomen.org) specifically encourages awareness of heart disease among women.

To help prevent heart disease, as Dr. Garimella tells her patients: take the time you need to take care of your health before you can take care of someone else.   Or, in the doctor's own words, "an ounce of prevention is more than worth a pound of treatment."