As she saw it, the year 2004 was going well for Essence Harris Banks. She was enjoying her job in human resources for a corporation headquartered in downtown New Orleans, and she felt invigorated by her part-time work as a personal trainer, which allowed her to share her dedication to fitness and exercise with others. Most of all, Banks delighted in the 4-year-old son, who was the center and joy of her life.

But at some point during her 30th year, Banks began to sense there was trouble ahead. Though she was only 30 years old, she began experiencing shortness of breath during her workouts, and a few times even felt heart palpations.

At first she tried to shrug off the symptoms, chalking them up to a lack of sleep or missing a meal here and there. But one evening, after her son had fallen asleep in the car as they were driving home, Banks picked him up to carry him into the house and found that she could barely manage it. “I was totally winded when we got inside,” she recalled.

It took multiple medical visits and a barrage of tests before doctors pinpointed the source of Banks’ problems: Two of her coronary arteries were almost completely blocked.

How could this happen to a woman who outwardly appeared to be in the peak of health and physical fitness? Such questions echo throughout the ranks of millions of women who suffer from heart maladies, reflecting the many reasons that heart disease has become known as a silent killer.

The fact is, heart disease is the No. 1 killer of women. Conditions of the cardiovascular system cause one in three female deaths each year, outnumbering the total number of women who die from cancer annually.

Yet, despite the ominous numbers, few women are on alert for indicators that they may have heart disease.

“Women’s greatest health fear is breast cancer, we all seem to have that mindset,” said Pramilla Subramanium, a professor of medicine in the section of cardiology at LSU Health in New Orleans. She said that awareness of breast cancer has increased greatly through educational programs and women’s advocacy groups, with the result that most women today understand the importance of being screened through mammograms and understanding their risk factors for the disease.

But meanwhile, many women remain unaware of the far greater danger that they may have or will develop heart disease at some point in their lifetime.

“All cancers put together do not kill as many women as heart disease does,” Subramanium said.  

Many factors, from physiology to environment to cultural habits, combine to make the threat to women a serious one. Subramanium also points to some major risk factors. Hypertension and diabetes, for instance, not only increase women’s risk of developing heart disease but are more conditions that are more commonly found in women than men, Subramanium said. Then there’s the matter of cholesterol.

“Your cholesterol profile is related to your hormonal status, which changes after a woman experiences menopause” she said.

Premenopausal women have a good deal of the hormone estrogen, which helps protect them against heart issues. Women in that stage of life also tend to have high levels of “good” cholesterol, which increases their protection, she said. “But once you hit menopause, you lose the protective effect of the good cholesterol.”

Though men also may lose such protection over time, they don’t experience the same “dropoff effect” that hits women as they age, Subramanium said.

Another reason that women tend to overlook the dangers of heart disease is the lack of common symptoms. Many men have become alert to chest pain and tightness, and shortness of breath as potential signs of a looming heart attack, but the indicators in women often are more subtle and may vary widely.

“Women may feel fatigue or heartburn, or they may have arm or back pain, but not the classic symptoms that tell men they are about to have a heart attack,” Subramanium said.

Though risky lifestyle habits, such as smoking, greatly increase the danger of heart disease in both women and men, other factors seem to have a disproportionate impact on females. Diabetic women are at a higher risk than diabetic males, for instance, though doctors are not sure why.  

Also, physical differences in women, such as smaller coronary arteries, may contribute to a higher incidence of arterial blockages.
In addition, heart disease tends to strike women at a more advanced age than men. “Women typically are about 10 years older than men when they have the first symptoms of heart disease, and they are 20 years older than men when they have a first heart attack,” Subramanium said.

But, none of that explains why a young, physically fit Essence Banks, who had no history of hypertension, diabetes, cholesterol problems or smoking, fell victim to heart disease 15 years ago. One of her most troubling recollections of the events is that while she suspected she might have a heart problem, she could not get doctors to take the idea seriously.

At first her regular doctor suggested that she was having panic attacks and should take a few days off work. Even after she insisted on seeing a cardiologist, all her test results continued to come back negative for any problem at all.

“But finally they did a stress test,” Banks said, and that’s when the impact of her blocked arteries became clear. The doctor immediately scheduled an angiogram, which provides a view of blood moving through the coronary arteries, and in short order he inserted three stents in the blocked vessels to open them once again.

“I was lucky, my heart was really strong from all my working out, running and dancing, so I did not lose heart muscle,” Banks said.

If she could point to anything that may have contributed to her development of heart disease, Banks thinks it could be her early eating habits. She points out that she grew up in a modest household where her grandmother put Southern-style home-cooked meals on the table every day. “Back then, we didn’t question whether we should be eating things like fried chicken and smothered pork chops all the time,” she said with a laugh.

When Banks was growing up, as now, kids ate what was available to them. Today, that too often means children are eating fast food or “junk” foods that fill their stomachs but also deliver a boatload of unhealthy fats, sodium and calories that can lead to obesity and many other health risks.

Nutritionist Molly Kimball has been fighting that trend for the past 20 years. A registered dietician with Ochsner Fitness Center and current president of the local chapter of the American Heart Association, Kimball has made it her mission to help break the bad eating habits that have helped send millions of Americans to an early death via heart disease.

“One of the things I think is really under people’s radar, and women especially, is the risk of a high-sugar and its influence in heart disease,” Kimball said. She believes women are particularly vulnerable to the ill effects of sugar because women have a tendency to like sweet foods and desserts.

“A lot of women think they are eating healthy because they are not eating fried foods and other things they know will be bad for them. But if there is one thing we need to clear out of our diet it’s added sugar,” she said.

Kimball has taken her message about improving people’s eating habits into schools, restaurants, medical organizations and many other settings via the program she founded called EatFit Nola. She developed criteria that food providers must meet in order to label their products with the EatFit seal, and many area restaurants and grocery stores now carry and promote the EatFit foods.

Meanwhile, Essence Banks is working through other channels to help spread the message of healthier lifestyles to a population segment that does not often receive such information – children.

Banks founded a nonprofit organization called Heart n Hands to educate kids, particularly young girls, about the importance of protecting their hearts beginning at an early age. She has reached  scores of youngsters not only in school settings but through Girl Scouts, Girls on the Run and other groups focused on young women.

“If I can get to them while they’re young,” Banks said.” before they go off to college and have to make their own heart-health decisions that would be great.”