AILSA CHANG, HOST:

Here's something you may not know. What do you think is the number one killer of women in the U.S.? Cancer? No. It's heart disease. In fact, every year, more women die from heart attacks than men do. But it seems when it comes to talking about the risk, the focus has always been on men, including the focus of most clinical research.

Dr. Marianne Legato is trying to fix that. She's a cardiologist who started the Foundation for Gender-Specific Medicine. And she joins us now from New York. Welcome.

MARIANNE LEGATO: How are you?

CHANG: Very good. Thanks for being with us. So why the disparity? Why does there seem to be more of a concern when it comes to men at risk of heart disease than women?

LEGATO: Well, in the first place, women get a pass, if you will, from coronary disease in general until after their menopause. And the disease attacks men with the first symptoms apparent, in general, even at the age of 35. So the early onset and the severity of heart disease in men is really 20 years sooner. And so that may have tipped the scales.

The other interesting response is the fact that women concentrated on breast health and pelvic health, often only going to the gynecologist. The other misconception is that heart, coronary disease attacks only older post-menopausal women. And that's not correct. It is now apparent that young women do have heart attacks. It can happen in their 30s and 40s. And in fact, when it does strike this much younger population, the disease is quickly fatal, as opposed to the older women.

CHANG: So how do women typically show signs of a heart attack?

LEGATO: Fifteen percent of women do not have the classic chest pain that men experience. They have shortness of breath, perhaps back pain. They think they may have indigestion. They sweat profusely and are nauseated.

CHANG: So tell me a little bit about what was happening to female patients with heart conditions who later came to see you. What was happening to them before they got to you?

LEGATO: Well, historically, when we began our work, women were told that they were hysterical, emotionally disturbed, they were having panic attacks.

And I will never forget going to a meeting of women in the Midwest. And a woman stood up at the microphone and said that she was the wife of a physician who had been sent to see a cardiologist because of recurrent attacks of chest pain and shortness of breath. And she was told, literally, her husband should take her away and give her what she was most in need of, and her chest pain would go away. She had a heart attack one month after that pronouncement by a presumably well-educated cardiologist.

CHANG: Wow. How does the lack of clinical research about women and heart disease play a role in all of this?

LEGATO: In general, women were excluded from clinical investigation because they were perceived as more unstable than men from an endocrine point of view and that their estrogen and progesterone fluctuated during the month. The second concern was that their reproductive ability would be harmed by any clinical intervention. And the third is that a fetus conceived during the course of a clinical trial would be born malformed. For all of those reasons, we began to study women in meaningful numbers only - I would say - relatively recently in biomedical investigation.

CHANG: So what advice do you have for women? I mean, in my own life, I don't think I have any women friends who regularly see a cardiologist. Do you think that...

LEGATO: I do have...

CHANG: ...There are steps we should take?

LEGATO: Yes. Every woman should not restrict her medical care only to the gynecologist, but should seek out a primary care doctor or internist who will evaluate her as a whole person and regularly check her health. The second thing to remember is that women deny their illnesses and soldier on. And the average wait before they come to an emergency room or call their physician when they are having symptoms they think might be a heart attack is four hours longer than men wait. So I think the index of suspicion should be high that women do suffer from heart disease, that it is their chief cause of death and not always at an older age.

CHANG: Dr. Marianne Legato is director of the Foundation for Gender-Specific Medicine. Thank you for joining us.

LEGATO: It's been a pleasure. Thank you for having me. Transcript provided by NPR, Copyright NPR.