Is it possible that heart disease is the leading cause of death among women because they're underrepresented in medical research?

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The Miami Herald on Tuesday tried to answer that very question: "Heart disease is the leading cause of death in women. So where's the research?"

The answer is troubling.

"Heart disease death rates in the United States have declined steadily for men over the last quarter century," the Herald reported. "Not so much for women."

Heart disease killed 289,758 women in 2013, according to the Centers for Disease Control and Prevention. That's about one in every four deaths among U.S. women.

Are women suffering because they're not being included in studies on heart disease research as much as men?

There definitely needs to be more research about women and heart disease, Helga Van Herle, an associate professor of clinical medicine at USC's Keck Medicine Division of Cardiovascular Medicine, told ATTN:

"I think women are being included more and more, and I think in order to get federal funding for a lot of these studies from the government you have to — or least attempt to — include women," Van Herle said. "But there's other factors involved. Not only [is there a] lack of outcome studies [involving women], but women present [symptoms] a lot later in life, about 10 years later than men. So that's one thing."

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Van Herle added that there needs to be more awareness about the differences between men and women when it comes to heart disease and its symptoms. "The awareness, although it's increased since the Go Red campaign [from the American Heart Association], is still a lot lower I think than with men," she said.

The symptoms of heart attacks differ between men and women.

"Most women don't present with chest pain when they are having a heart attack," Van Herle said. "But there's a lack of awareness that could be associated with something significant that needs attention."

Heart attack symptoms that are more common in women than in men include nausea, vomiting, profound fatigue, and shortness of breath. Heart attacks in women may occur "without any other symptoms [of what a heart attack is traditionally associated with]," Van Herle added.

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A lack of studies about women and heart disease can be dangerous for women, cardiologist David Ancona told the Herald. "Textbooks have been filled with how men present, but we have unfortunately been burned too many times, and females have suffered because of the dismissal of benign-appearing symptoms," he said.

Women aren't doomed to die of heart disease.

"There's a lot of lifestyle things we can do to effect our risk factors," Van Herle said. "Smoking portends a higher risk for developing heart disease in women than in men. Most of the heart attacks in women under the age of 40 are associated with a smoking history. That's something you can do something about in terms of your lifestyle, like quitting smoking or getting your cholesterol checked. Knowing your family history. Exercise. Heart-healthy diet. All those things. There are things we can do."

[H/T Miami Herald]