An unhealthy diet, lack of exercise and a generous waistline put me at risk for heart disease. At least that's what a test — the Women's Heart Disease Risk Quiz — at the Women's Heart Foundation Web site www.womensheart.org has determined.

More startling news from the site:

"Over 60 percent of women believe their biggest health threat is breast cancer, but heart disease kills six times as many women as breast cancer."

"Some risk factors are different for women than for men."

"Heart attacks often strike without warning. If a woman does not realize heart disease is a health threat, she will not make heart-healthy changes or respond to symptoms once they occur."

It's one thing to read statistics, but it's another when you sit face-to-face with a woman who had a heart attack at age 48.

I "met" Joanie Constable of Visalia, Calif., via e-mail almost a year ago. Constable, an artist, was promoting Arts Visalia's annual Sofa Art show. We recently met face to face in Kingsburg, Calif., just a few miles from the Del Monte plant, where she works as an accounting clerk. The Fresno, Calif., native, now 54, told me about the day of her heart attack on Dec. 19, 2001.

"I never had chest pains, but I had pain in my back and fleeting tightness in my jaw," she says. "I just felt weird. At work, someone told me I looked pale."

She went home after her shift and took aspirin. While relaxing on her recliner with her two cats, she talked to two friends over the phone. She joked with one friend, saying, "I'm probably having a heart attack."

Still not feeling well, Joanie was in bed by 9 p.m.

"I wasn't in any pain, but it hurt to lie on either side," she says. "I thought I had pulled a muscle in my back."

She felt better the next day but decided to see her primary-care doctor. Since Christmas was a few days away, she stopped at a store to buy wrapping paper before going to her appointment.

After an afternoon EKG, her doctor referred her to a cardiologist for further examination. By 7 p.m., she was admitted to Kaweah Delta Hospital and had two heart stents placed inside one of her small arteries.

"It all happened so fast," she said. "After the surgery, I felt better immediately, even in the ICU."

Within two weeks, Joanie was back to work.

"Having a heart attack does wake you up a bit for a while," she says. "Then, it's back to real life."

Joanie's story is important because it illustrates the importance of women being able detect a heart attack. The July issue of Fitness magazine reports some sobering news: "Not every woman who has heart disease will undergo an attack, which occurs when the heart is deprived of blood and oxygen, usually from a blockage in the artery.

"But women who do suffer one are more likely than men to die of it, in part because women don't always have easily recognizable, chest-grabbing, arm-clutching symptoms. Female heart attack victims describe generalized discomfort in the chest, breast, back, shoulders, neck or throat."

The article cites research by Jean McSweeney, RN, Ph.D, of the University of Arkansas for Medical Sciences, who says the most common heart attack warning among her subjects is fatigue. "Shortness of breath, anxiety and nausea were other common symptoms in subjects," according to the article. "Other women report sleep disturbances and severe indigestion."

Yale University research says jaw pain also afflicts many women.

Joanie has been told by doctors to "pay attention" if she experiences these symptoms again. Her reaction to being told the obvious wasn't G-rated: "No — —," she says.