Heart disease is typically depicted -- like in the image above -- as a disease that mostly afflicts men. The statistics show otherwise.

"We’ve all seen commercials for aspirin, with men on the tennis court having a 'Hollywood' heart attack," said Theresa Beckie, a cardiovascular expert and professor at the University of South Florida. "People are still surprised, including women themselves, that heart disease is the number one killer of women."

In fact, heart attacks strike more women than men in this country, and death rates from cardiovascular disease remain higher among women than men. Women who suffer heart attacks also tend to have longer hospital stays and more complications than the average male patient.

But because the causes and symptoms of heart attacks can be strikingly different between the sexes, women are more vulnerable to slower diagnosis and inadequate treatment, according to a new scientific statement published Monday in the American Heart Association's journal Circulation.

"Despite stunning improvements in cardiovascular mortality for women in the past two decades, heart diseases remains understudied, underdiagnosed and undertreated in women," Beckie and a group of co-authors write in their paper. Cardiovascular disease "is an equal-opportunity killer, and since 1984 the mortality burden has been higher in women than men."

The paper highlights how the differences go beyond just gender. For example, compared to white women, black women have higher overall rates of heart attacks. Black and Hispanic women tend to have more risk factors for heart trouble, such as high blood pressure, diabetes and obesity. Young black women have higher in-hospital death rates than their white counterparts.

In addition, for reasons researchers don't fully understand, the notable decline in heart attack mortality in recent years doesn't apply to women under 55. "Troubling trends of worse risk factor profiles and higher mortality among younger women compared with older women persist," the authors write.

Yet why the lingering disparity between the sexes?

While blockages in arteries occur in both men and women, the way they form a life-threatening blood clot can differ, researchers say. Women often have less severe blockages that don't require a stent, but they still can suffer from damaged blood vessels that hinder blood flow to the heart -- and may lead to a heart attack. And while chest pain and discomfort are the most common signs of heart attack for both sexes, women are more prone to display symptoms such as nausea or vomiting, shortness of breath and back or jaw pain.

Beckie and her colleagues argue that if doctors don't accurately diagnose the underlying cause of a woman's cardiovascular disease, she is less likely to receive adequate care. Too often, they write, doctors don't prescribe women statins and other medications typically used to treat heart disease. They also are less likely to send women to cardiac rehabilitation therapy, and women themselves are less likely to complete it.

"Women fear breast cancer more than they fear heart disease. But the numbers show that far more women die of heart disease," said co-author Laxmi Mehta,  director of the Women's Cardiovascular Health Program at The Ohio State University Medical Center.

They should be proactive in talking with their doctors about ways to spot, prevent and treat coronary heart disease, which affects roughly 6.6 million U.S. women, Mehta said.

"Knowledge is power," she said. "Women and minority groups really need to understand these symptomatic differences. Adequate treatment improves outcomes."

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