We are all too familiar with the image of a stressed-out executive clutching his heart in agony. What we are not so aware of is the fact that heart disease is the number one killer of women worldwide. And in South Africa, according to the latest figures released by the Medical Research Council (MRC), heart disease kills five times as many women as breast cancer. Shocking statistics. So why do most of us believe cancer is a bigger problem for women than heart disease? One reason is that cancer can hit at any age, but heart attacks in women have tended to occur only post-menopause.

Heart experts believe that the higher levels of oestrogen women have before menopause play a protective role. So, while men succumb to heart disease from their mid-forties, women have a buffer period of 10 or 15 years. But all this is changing. Certain trends – increased smoking in teenage girls, binge-drinking and our stressful, calorie-dense, sedentary lifestyles – suggest that women are storing up serious problems for the future.

'In my personal, anecdotal experience, I have seen an increase in pre-menopausal women with heart attacks from lifestyle factors, not familial history,' confirms cardiologist Dr Robin Tager. 'Women feel their hormones offer them protection from heart disease relative to men, but they are not immune. Women must not be lulled into a false sense of security.' Shouniez Haffagee, mother of two boys, is a case in point. 'I was only 40 when I had my heart attack. It really hit me for a six,' she says. 'I used to have these pains in my chest. The pain used to come and go, but I never took notice. I thought it was wind. I was taking Gaviscon and popping Rennies. As a woman, and still so young, I really did not realise it could be my heart. I believed that it was only 60-plus people who could get heart disease. Now I realise those pains were warning signs.'

When the pain became so bad that it felt like an elephant sitting on her chest, Shouniez headed for her local hospital, which did not have a cardio unit. Only one doctor realised it could be a heart attack, and made decisions that saved her life.

Shouniez was a lucky woman, because, as Tager points out, 'There is a gender bias in the diagnosis of heart disease in women.'

He refers to studies that show that women presenting with heart disease are less likely to undergo necessary diagnostic tests than men. Because of the false sense of security in the general public and the medical fraternity about the risk of heart disease to women, women have actually been denied tests on the basis of their gender.

The ECG, the first line diagnostic test for heart disease, is also not as sensitive for women as it is for men. 'A woman might have a normal ECG but still have heart disease,' says Tager. Two additional tests that might give the cardiologist a clearer picture for women are the Nuclear Perfusion Scan or the Non-invasive Coronary Angiogram (the latter is not covered by some medical aids). Tager urges women who have a normal ECG but who are still experiencing symptoms to go back to the doctor, or get a second opinion.

According to the Heart and Stroke Foundation of South Africa, women also tend to experience less specific symptoms than men, and their symptoms are often dismissed as indigestion.