MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- The No. 1 killer of all Americans -- cardiovascular disease, which includes stroke -- is American women's primary health threat. It causes one in three deaths each year. That's approximately one woman every minute.

This information from the American Heart Association may not be entirely new to some people, yet it remains shocking to many.

As Madigan Army Medical Center continues to observe American Heart Month in February, it is important to note information that is specific to women's heart health.

"The most important thing to recognize are the traditional standard risk factors for the development of coronary artery disease," said Lt. Col. (Dr.) Jeffrey Kunz, chief of Cardiology Services at Madigan. "I want the JBLM population of women to realize that the traditional cardiovascular risk factors are no different between men and women."

Uncontrollable risk factors:
• Age -- the older you are, the higher the risk of developing coronary disease
• Gender -- women have a higher risk
• Heredity -- history of premature coronary disease
• Race -- African Americans have increased risk, while Asian Pacific Islanders have lower risk
• History -- previous stroke or heart attack

Factors that can be managed:
• Hypertension -- high blood pressure
• Smoking
• Diabetes
• Hyperlipidemia -- elevated cholesterol
• Obesity
• Lack of regular activity

Kunz said he hones in on the last two factors.

The AHA agrees, noting on its website, "caring for your heart through a healthy diet and regular physical activity is the secret weapon to preventing heart disease. Even modest changes to your diet and lifestyle can improve your heart health and lower your risk by as much as 80 percent."

"There is nothing we can all do about our genetics," Kunz added. "But, where we do have control is our lifestyle and the diet that we choose to adopt."

Optimal diet:
• High in fiber
• High in fruits and vegetables
• Low in saturated fat

"If there is one particular diet out of the myriad of diets out there, the Mediterranean diet probably has the most evidence behind it in terms of a much, much, much lower risk of developing coronary artery disease," he offered.

Kunz offered another avenue for people to consider for fitting healthy food choices into the busy American day -- a meal preparation service. He and his family have been pleased with their experiences, and the food options offered.

Regular exercise:
Kunz advocates at least 30 minutes of aerobic exercise a day.

Activities that can be sustained at the target heart rate include:
• Treadmill
• Elliptical machine
• Rowing
• Swimming

Target heart rate:
"We look at target heart rate as 80 percent of their max predicted heart rate. Their max predicted heart being 220 minus their age. So, if you take that number, you take 80 percent of that, that's generally a good guide," noted Kunz. An example of this equation for someone aged 50 looks like this: 220 - 50 = 170 x .80 = 136 beats per minute

More research is required to fully understand the impacts of sleep and stress on the heart, but the AHA notes that the amount and quality of sleep can influence eating habits, mood, memory, internal organs and more. The AHA adds that stress may affect behaviors and factors that increase heart disease risk: high blood pressure and cholesterol levels, smoking, physical inactivity and overeating.

Additionally, the AHA recommends knowing some individual basic numbers.

Numbers to know and manage:
• Blood pressure
• Cholesterol
• Blood sugar
• BMI (body mass index)

"The last thing that I want my female patients to recognize are the hallmarks of myocardial infarction -- a heart attack," added Kunz.

"You always hear about women presenting atypically and not having those standard symptoms," he continued. While men may have chest pressure resulting from physical exertion, the chest pressure women feel may derive more from stress and emotional distress.

Regardless of whether symptoms seem typical or not, "I definitely would encourage female patients to self-advocate," said Kunz.

Standard symptoms of a heart attack or coronary disease:
• Substernal chest pressure -- elephant sitting on the chest
• Sweating
• Nausea
• Looking pale

Symptoms more common to women:
• Shortness of breath
• Nausea/vomiting
• Back or jaw pain
• Dizziness
• Feeling lightheaded or fainting
• Pain in the lower chest or upper abdomen
• Extreme fatigue

Cardiology experts agree that delaying consultation with a doctor when these symptoms present themselves is never a good choice.

If the symptoms are sudden and severe, that's likely a heart attack, and 9-1-1 should be called immediately. Symptoms can also present at a lower level of severity over time as well. That can indicate coronary disease. In that case, consult a physician for testing and a dialog about risk factors and heart health management.

Kunz advised that ignoring these symptoms, especially if a heart attack is likely, could mean a substantial risk of causing permanent damage and weakening of the heart.

"I don't want to speak to what patients feel, but I think it's like, 'oh, I'm going to be looked at like I'm silly.' But, that's the one thing I want people to understand that if it's your heart and you miss it, you can have serious complications down the road. There's no such thing as seeking healthcare, either emergently or more electively, where you are ever going to be found silly," said Kunz.