(Jun Cen for The Washington Post)

Every year about 610,000 American men and women die from heart disease; that’s 1 in every 4 deaths, according to the Centers for Disease Control and Prevention. It’s a leading cause of death for both genders.

Where men and women differ is how they respond to heart disease and how they manifest symptoms. Roughly two-thirds of women who suddenly die of coronary heart disease never show any advance signs. And that grab-your-chest, crushing, fall-over kind of pain is not what most feel when they have a heart attack.

“Women will describe a discomfort, or they will have pain in their jaws or necks,” said Annabelle Santos Volgman, a professor of medicine at Chicago’s Rush College of Medicine and medical director of the Rush Heart Center for Women. “They’ll have nausea or just not feel well. They have more vague symptoms than men.”

As a result, doctors often misdiagnose women, Volgman said. Volgman is a co-author of a recently released study done for the American Heart Association about sex-specific differences in heart disease. She recently talked with The Post about this issue.

How are men’s and women’s hearts different?

Anatomically, men and women have similar hearts. But physiologically, men and women have different hormones, and blood vessels respond to those hormones. Women have cyclical hormones because of menstruation, pregnancy and menopause.

As women get older, especially after menopause, they have more incidents of high blood pressure. They tend to not want to get treated. They tend to want to try lifestyle changes. If, after three months, lifestyle changes don’t lower cholesterol and blood pressure, women should not be in denial. They need medication. They need to understand they are at risk of having a heart attack and dying.

Men describe an elephant sitting on their chest during a heart attack. What about women?

For women, it’s very subtle. They usually have some sensation in their chests. They describe it as heaviness or discomfort. I’ll say, “We need to do some testing because of the chest pain.” Women get upset, saying they don’t have chest pain. They have different perception of pain. They don’t like to use the word “pain.”

What can be done about that?

We haven’t educated women, especially African American and Hispanic women, well enough. So many women are unaware heart disease is the number-one killer. They worry about breast cancer because they hear a lot about that. That’s why we want to put it out there that heart disease is their number-one threat.

If you are worried or have any symptoms in your chest, shortness of breath, pressure in chest, nausea, unexplained fatigue, go to your doctor and get tested for heart disease.

We have a simple blood test now that is sex-specific that is really helpful for women. It’s called the Corus CAD test and incorporates age, sex and gene-expression measurements into a single score that indicates any likelihood of obstructive coronary artery disease.

Should women start asking for this test during their yearly checkup?

When you go to the doctor, he or she should assess your symptoms and check risk factors. If you are complaining of symptoms that could trigger thoughts of heart disease, the doctor will get an EKG [electrocardiogram]. Also, specifically ask for the Corus CAD test if you are worried or have symptoms in your chest.

What lifestyle changes should women with high blood pressure follow?

Try to get 30 minutes of aerobic exercise a day, five or six days a week. Get a Fitbit or use your phone to see how many steps you are getting in a day. If you are getting 10,000 steps in a day, that’s pretty good.

Eating healthy foods, such as fresh fruits and vegetables, is so important. Vitamins, which are so healthy and important, come from fruits and vegetables, not from supplements. A lot of the supplements are processed, so a lot of the vitamins are changed once they are put in supplements. Decrease your saturated fat intake. Decrease sugar and refined carbs.

When you talk about family risk factors, what should women look for?

Learn about your family history. Learn how your father or mother died, or your grandparents. Officially, when we talk about family history, we are talking about men who had heart attacks at less than 55 years of age and women at less than 65 years of age. If the heart attack occurred after that, we don’t consider that a family-history risk factor.

We can get risk factors from genetic testing, and the cost of genetic testing has markedly decreased so that it’s not that expensive to know what your risk factors are. I do this especially with patients with a family history. A patient will say, “My father had a heart attack in his 50s, but he smoked. He was heavy and didn’t exercise.” These tests help me distinguish patients with family history [who] truly have the risk.

Any patients with a family history should have advanced lipid testing [to measure the “bad cholesterol” lipoproteins associated with an increased occurrence of heart attacks and strokes.] Women, especially those of South Asian and African American heritage, have a higher risk for lipoprotein (a).

Should everyone get genetic testing to find out any hidden risk factors?

Every woman should have her risks assessed. There are free screenings. The national organization WomenHeart [is] pairing with Burlington Coat Factory to do free screenings. They check blood pressure, cholesterol and glucose to make sure someone isn’t diabetic. These are the basic tests when we do heart-healthy screenings.

And those specific symptoms for heart disease for women?

There is a great website, gospreadtheword.com. If people go to that website, it talks about symptoms of heart disease. Go to know your testing options or know your symptoms. It actually asks you what your symptoms are and will give you an idea of what you should do after you answer a few questions.