“While one in 31 American women dies from breast cancer each year, heart disease is the cause of one out of every three deaths,” states the American Heart Association on its “Common Myths About Heart Disease” page. “That’s roughly one death each minute.”

Quick quiz: What is the leading cause of death for women in America?

A. Diabetes.

B. Cancer.

C. Chronic lower respiratory diseases.

D. Heart disease.

E. Stroke.

If you did not select D., heart disease, the correct answer, you are not alone. Misunderstandings and myths endure about the number-one killer for women, the same as it is for men, according to the Centers for Disease Control and Prevention.

Start with the less-than-universally known fact that because of physiological differences between the genders, a woman’s symptoms of a heart attack may be different than a man’s. A heart attack is caused when blood flow to a part of the organ is blocked, typically by a clot. Deprived of oxygen and nutrients, muscle tissue will die. Death can result.

“The classic symptoms of a heart attack are severe chest pain — the ‘elephant sitting on your chest,’ ” says cardiologist Dr. Katharine French, director of the Women’s Cardiac Center at Lifespan and assistant professor at The Warren Alpert Medical School of Brown University. "The pain can radiate down your arm, up to your jaw, you can have perfuse sweating, you can have nausea, shortness of breath.”

But studies have demonstrated that fewer than half of women suffering heart attacks “actually present with chest pain,” the cardiologist says. “Some women are much more likely to present with vague, nondescript symptoms, like severe fatigue. They have more shortness of breath. If they do have chest pain, it might be 'atypical' chest pain – it’s more likely to radiate to their jaw or to their back. Sleep disturbances. The symptoms are a lot less classic.”

French’s advice?

“Be aware of those differences and understand that if you just don’t feel right, then you should go see your physician,” she says. And, needless to say, call 911 in an emergency.

Differing symptoms, French says, are but one aspect of the longstanding misunderstandings surrounding women and cardiovascular disease. History and culture have combined to create the impression still held by some that heart disease is more an issue for men than women. Hardly. “While one in 31 American women dies from breast cancer each year, heart disease is the cause of one out of every three deaths,” states the American Heart Association on its “Common Myths About Heart Disease” page. “That’s roughly one death each minute.”

The medical profession itself shares some blame for poor outcomes.

According to French, “there’s a lot of data” that shows that women presenting with their first heart attack “tend to do worse than men who present with their first heart attacks.” Some treating physicians, she says, fail to recognize the symptoms, just as some women themselves do not. “Even when they are recognized, there’s data to suggest that women presenting with the same condition that men do are less likely to be referred for lifesaving treatment,” French says.

And while the cardiologist says “the hypothesized reasons are manifold,” gender inequity at the MD level surely plays a role. Historically, male physicians have always outnumbered their female counterparts and while the gap is closing, men still greatly outnumber women. According to data compiled by the Kaiser Family Foundation, as of March, 633,817 men practiced medicine in America, compared to 333,833 women. The disparity in Rhode Island is 2,858 to 1,946.

“Biases exist throughout our medical system,” French says. The best medical training today, however, does work toward eliminating them, with new generations of doctors more likely to reflect true knowledge in their practices.

French emphasizes another aspect of women’s heart health: recognition of risk. Just as with men, women who smoke or have high blood pressure, poor cholesterol, diabetes or a family history of heart disease, among other factors, are more likely to experience cardiovascular disease. The good news is that risk can be reduced, even after a cardiac incident or disease diagnosis.

For those people, so-called secondary prevention, says French, involves “the importance of compliance with cardiac medications prescribed to decrease the risk of disease progression.”

Such people also should practice primary prevention — as should everyone, with or without known disease, French advises.

“Primary prevention-efforts aim to decrease the risk of developing cardiovascular disease,” she says. “The two most important elements in primary — and actually secondary prevention, as well — are maintain an active lifestyle with regular physical activity and don't smoke. Other important elements include a healthy diet — much debate about what that is, I recommend the Mediterranean diet — and making sure other risk factors are well controlled,” such as high blood pressure, cholesterol and diabetes.