Q: I heard that women, once diagnosed with a heart attack, have a worse prognosis than men even after treatment. Is this true, and if so, what accounts for this difference?

A: Heart disease is the No. 1 cause of death for both men and women accounting for 1.2 million deaths in the U.S. annually. However, women before age 60 are less likely than men to develop heart problems, but once the disease occurs, women often fare worse than men.

Just some of the observations that may account for these gender differences include:

- Women often underestimate the severity of cardiovascular disease and fail to take preventive measures, acknowledge warning signs, or seek treatment for symptoms.

- Women with blocked coronary arteries tend to be older than men with similar blockages and to have worse symptoms and more advanced disease.

- Women are also more likely to have other problems like high blood pressure, high cholesterol and diabetes, which may make surgery riskier.

- Women’s symptoms tend to be more subtle and less predictable, leading to potentially detrimental outcomes.

- Women are more likely than men to develop heart failure, a weakening of the heart muscle that causes varying degrees of shortness of breath and can be fatal.

- Women have more complications after bypass surgery, angioplasties or stents, all treatments for blocked coronary arteries. These differences have been attributed to smaller blood vessels.

- Women are more likely than men to have problems with inflamation and anemia,which have been suggested as possible factors contributing to worse outcomes.

Dr. John Kennedy is an invasive cardiologist who practices in Southern CaliforniaMarina Del Rey Hospital in Marina Del Rey, Calif. He is and works primarily as the Director of Preventative Cardiology and Wellness at the co-author of the book "Breathe: Heal Your Heart in Just 15 Minutes a Day," which will be released by John Wiley & Sons in  February 2009. Learn more  at www.johnmkennedymd.com. Send your questions to John@smartnow.com.