Taking the Message to Heart

Not very well. The current gold standard for heart attack risk assessment is the Framingham risk calculator, which is based on data generated by a giant epidemiological study in Framingham, Mass., now more than 50 years old.

Drawing from data culled from more than 5,000 adults, the formula predicts an individual's risk of heart attack or death from heart disease in the next 10 years, based on the person's sex, age, cholesterol, blood pressure and smoking history. (To calculate your risk, see http://www.nhlbi.nih.gov/guidelines/cholesterol and click on "10-year risk calculator.")

The calculator identifies people as high-risk, intermediate-risk and low-risk. The problem, said Blumenthal, is that some recent studies have shown that unless a woman is a smoker, it's nearly impossible for her to get to the intermediate-risk zone using the Framingham Risk Score. He said plenty of women at low risk according to Framingham might be heading for a heart attack.

How does he know?

Together with colleagues at Johns Hopkins, Blumenthal ran a study of nearly 2,500 women over age 45 with no signs of heart disease. He found that when the researchers used Framingham, 90 percent of the women tested were ranked as low-risk, having a risk of less than 10 percent.

But when they used calcium scans -- high-tech imaging to detect arterial deposits of calcium and plaque -- 20 percent of the women were shown to have advanced hardening of the arteries, which Blumenthal said would put them at high or intermediate risk of heart attack.

Don't women tend to have their heart attacks when they're older? Does this mean I don't need to worry much until I hit retirement?

In order: Yes, and it depends.

Women are generally 10 years older than men when they have heart attacks -- 80 percent of them are 65 and older.

If you are a 55-year-old nonsmoking woman with normal cholesterol, weight and blood pressure, congratulations, you're in good shape. Start adding those risk factors -- especially smoking -- and risk goes up. And those birthdays really count against you.

Why are women over 65 more vulnerable?

"Age is a powerful risk factor," said Jacques Rossouw, project officer for the Women's Health Initiative at the National Heart, Lung, and Blood Institute (NHLBI). Starting as a teenager, your risk for heart attack doubles every 10 years, he said.