The No. 1 killer of men and women in the U.S. continues to be heart disease. But the most obvious expression of the disease—a heart attack—tends to strike women differently.

For one thing, these attacks tend to occur later in a woman’s life. On average, women have their first heart attack at age 72, compared with 65 for men.

Heart attacks in women are deadlier, too: 26 percent of women 45 and older die in the year after their first heart attack, compared with 19 percent of men, according to the American Heart Association (AHA).

To make matters worse, symptoms of the attacks are usually less obvious and more difficult to detect in women. That’s why it’s so important that everyone be aware of these key differences.

How Symptoms of Heart Attacks in Women Differ

Heart attacks in women often have more subtle signs, such as jaw or back pain, nausea, and shortness of breath, according to the AHA, rather than the classic symptoms of a feeling of pain or squeezing in the chest or pain radiating to one or both arms.

As a result, women may be less likely to seek medical help than men are and more likely to be misdiagnosed in the emergency room.

How Care Differs

When a heart attack is suspected, one of the first tests your doctor might want to perform is an angiogram, which checks for blocked or narrowed coronary arteries.

But that test may miss a type of heart disease more common in women, coronary microvascular disease—which damages smaller arteries in the heart—according to research from the National Institutes of Health.

In addition, plaque tends to be spread more evenly through women’s arteries, making it harder to see in a standard angiogram.

So when that test is normal in a woman suspected of having had a heart attack, the doctor should consider performing an intravascular ultrasound to look inside the arteries in more detail, says Suzanne Steinbaum, D.O., director of women’s heart health at Northwell Lenox Hill Hospital in New York City.

Anyone who has had a heart attack should be prescribed medications to protect the heart, such as low-dose aspirin as well as blood pressure and cholesterol-­lowering drugs, and be referred to an exercise and a cardiac rehabilitation program.

But research shows women are less likely than men to get referred to those programs, or to go when referred, Steinbaum says.

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Editor's Note: This article also appeared in the May 2017 issue of Consumer Reports magazine.