The big mythFirst let’s blow up the biggest myth—you know, the one that says that women don’t get heart attacks.Women do get heart attacks!Heart disease is the leading cause of death among women of all ages. In fact, in every year since 1984, more American women than men have died from coronary heart disease (blockages that can cause heart attacks).Heart attacks in womenOn average, women who suffer heart attacks are five to 10 years older than their male cardiac counterparts. This means that the average age of a female heart attack victim is 70. But don’t be fooled into thinking that younger women are immune. Each year, heart attacks strike 35,000 American women who are 55 or younger. This means that all women need to safeguard their heart health at every age.MORE: Manage Stress to Fight Heart DiseaseMenopauseIt is particularly important to reassess risk factors around the time of menopause, as heart attack risk in women really begins to take off at that time.Menopause causes a variety of changes that can spell trouble for the heart. In the year that menopause begins, total and LDL cholesterol levels increase, and many women also experience a decrease in HDL cholesterol (the “good” cholesterol). In addition, clusters of risk factors, including obesity, diabetes and hypertension, tend to appear around the time of menopause, putting women on a collision course with cardiovascular disease. Meanwhile, the cardiac protective effects of estrogen largely disappear, with a women’s estrogen level dropping by 90 percent as menopause sets in.These changes in risk factors explain the dramatic increase in heart attack risk that occurs after menopause. But this sequence of events is not inevitable. You can prevent it.MORE: Does Estrogen Really Protect Women’s Hearts?Take charge of your heart healthThe average age at menopause is 51, and the average life expectancy of women in developed countries is 82 years. This means that women live more than one-third of their lives after menopause. Take the right steps to ensure that you remain healthy and functional during this third of life.The onset of menopause is a time to check your risk factors for heart disease and to work with your doctor to develop a heart-healthy plan, including exercise, a calorie-appropriate Mediterranean diet, and annual checks of blood lipids (cholesterol) and blood pressure.Do you need other heart tests?In general, the answer is no. For a woman with no symptoms of heart disease (no chest pain, shortness of breath, ankle swelling), further testing is generally unnecessary. Although some doctors recommend an annual stress test, few people really need such serial exams. And definitely avoid a “screening” CT scan of the heart. These heart scans are of no proven benefit in people without symptoms; but they do expose you to a hefty dose of radiation.What about hormone replacement therapy?We have large studies demonstrating that hormone replacement therapy does not protect women’s hearts. In fact, it can be dangerous, and in some women actually increases the risk of heart problems.But it does have a use. In the younger woman who is troubled by symptoms of menopause (hot flashes, night sweats), hormone replacement therapy provides relief. Most physicians agree that it is safe to employ short-term hormone replacement therapy in the woman within 10 years of menopause.MORE: Six Products to Manage MenopauseA time of changeMenopause is a time of change. Many of the changes are beyond your control. But you can secure your heart health. Check your risk factors. Stick to a heart-healthy lifestyle. Take a few simple steps, and your heart will keep on ticking for decades to come!