* Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts for more than a few minutes,  or goes away and comes back
 * Pain that spreads to the shoulders, neck or arms
 * Chest discomfort with light-headedness, fainting, sweating, nausea or shortness of breath

Women may experience other, less common warning signs of heart attack:

 * Atypical chest, stomach or abdominal pain
 * Nausea or dizziness
 * Shortness of breath and difficulty breathing
 * Unexplained anxiety, weakness or fatigue
 * Palpitations; cold, clammy, sweaty skin; or paleness

Objectives: To describe sex differences in symptom presentation after acute myocardial infarction (AMI) while controlling for differences in age and other potentially confounding factors. 

Compared with women, men were significantly more likely to report diaphoresis (profuse perspiration) and significantly less likely to complain of nausea as well as neck, back, or jaw pain.

Our observations are consistent with the results of a community investigation that showed that women are more likely than men to have neck and shoulder pain, nausea, vomiting, or dyspnea, in addition to chest pain, during AMI. A recent study, carried out in over 10,000 adults presenting to the emergency departments of 10 hospitals throughout the United States with symptoms suggestive of AMI, found that women were more likely to present with nausea or vomiting, shortness of breath, and clinical findings consistent with heart failure. Although chest pain was similarly reported in the majority of men and women, chest pain was reported as the chief complaint in a significantly greater proportion of men than women.

Traditional Risk Factors and Subclinical Disease Measures as Predictors of First Myocardial Infarction in Older Adults The Cardiovascular Health Study 
Bruce M. Psaty, MD, PhD; Curt D. Furberg, MD, PhD; Lewis H. Kuller, MD, DrPH; Diane E. Bild, MD, MPH; Pentti M. Rautaharju, MD, PhD; Joseph F. Polak, MD, MPH; Edwin Bovill, MD; John S. Gottdiener, MD 

Background: Risk factors for myocardial infarction (MI) have not been well characterized in older adults, and in estimating risk, we sought to assess the individual and joint contributions made by both
traditional risk factors and measures of subclinical disease. 

selected snippets follow:

Recruited 5888 adults aged 65 years and older 

At baseline, 1967 men and 2979 women had no history of an MI. 

After follow-up for an average of 4.8 years, there were 302 coronary events, 

The incidence was higher in men (20.7 per 1000 person-years) than women (7.9 per 1000 person-years).

7.8 per 1000 person-years in subjects aged 65 to 69 years to 25.6 per 1000 person-years in subjects aged 85 years and older

http://www.ravnskov.nu/cholesterol.htm is a fascinating well laid out site which has been developed by a much published (in peer reviewed journals) and well qualified Danish physician. He supplies references and cites for all his claims below. They might account for the "surprising" results of the HERS study. (Tishy)

The Cholesterol Myths by Uffe Ravnskov, M.D., Ph.D.

The idea that too much animal fat and a high cholesterol is dangerous to your heart and vessels is nothing but a myth. Here are some astonishing and scaring facts. Click on the figures (at the URL above) if you want the scientific evidence.

          1 Cholesterol is not a deadly poison, but a substance vital to the cells of all mammals. There are no such things as good or bad cholesterol,.......snip

          2 A high blood cholesterol is said to promote atherosclerosis (the scientific name for arteriosclerosis) and thus also coronary heart disease. But many studies have shown that people whose blood cholesterol is low become ....snip

          3 Your body produces three to four times more cholesterol than you eat. The production of cholesterol increases when you eat little cholesterol and decreases when you eat much. ......snip

          4 There is no evidence that too much animal fat and cholesterol in the diet promotes atherosclerosis or heart attacks. ......snip

         5 The only effective way to lower cholesterol is with drugs, but neither heart mortality or total mortality have been improved with drugs the effect of which is cholesterol-lowering only. ....snip

          6 The new cholesterol-lowering drugs, the statins, do prevent cardio-vascular disease, but this is due to .....snip

          7 Many of these facts have been presented in scientific journals and books for decades but .....snip

          8 The reason why laymen, doctors and even scientists have been misled is because ....snip

Abstract at http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10645114&form=6&db=m&Dopt=b

Int J Technol Assess Health Care 1999 Fall;15(4):729-37 
Women, the media, and heart disease. For better or for worse?
Savoie I, Kazanjian A, Brunger F

Extract:
OBJECTIVE: To analyze the nature and presentation of print media messages regarding cholesterol and heart disease in women. The hypothesis is that print media messages about cholesterol and heart disease may encourage and perpetuate the use of cholesterol-lowering drugs in women.
RESULTS: From the magazine articles, three main messages were identified. First, heart disease is the number one killer of women. Second, women must demand recognition of their high risk of heart disease and demand equal access to prevention and treatment services for heart disease. Third, lifestyles changes are not enough. Cholesterol-lowering drugs should be considered. Drug advertisements also emphasize that postmenopausal women are at high risk of heart disease and that lifestyle changes are inadequate or insufficient to lower this risk. In both cases, high blood cholesterol is considered not as a risk factor for heart disease but as the disease itself.
PMID: 10645114, UI: 20109463 

Background 

Observational studies have suggested that estrogen-replacement therapy may reduce a woman's risk of stroke and death...........

.......................The women who were randomly assigned to receive estrogen therapy had a higher risk of fatal stroke (relative risk, 2.9; 95 percent confidence interval, 0.9 to 9.0), and their nonfatal strokes were associated with slightly worse neurologic and functional deficits.

Estradiol does not reduce mortality or the recurrence of stroke in postmenopausal women with cerebrovascular disease.  This therapy should not be prescribed for the secondary prevention of cerebrovascular disease.

FINDINGS: After adjustment for confounding variables and correction for the trend in sales of HRT preparations, no significant associations were detected between current use of unopposed oestrogen replacement therapy and non-fatal subarachnoid haemorrhage (odds ratio 0.52 [95% CI 0.23-1.22]), intracerebral haemorrhage (0.15 [0.02-1.09]), or thromboembolic infarction (1.16 [0.86-1.58]), respectively, compared with never use. Current use of combined oestrogen-progestagen replacement therapy had no significant influence on the risk of subarachnoid haemorrhage (1.22 [0.79-1.89]), intracerebral haemorrhage (1.17 [0.64-2.13]), or thromboembolic infarction (1.17 [0.92-1.47]). A significantly increased incidence of transient ischaemic attacks among former users of HRT and among current users of unopposed oestrogen may to some extent be explained by selection--HRT users being more aware of symptoms than non-users. 
INTERPRETATION: Unopposed oestrogen and combined oestrogen-progestagen replacement therapy have no influence on the risk of non-fatal thromboembolic or haemorrhagic stroke in women aged 45-64 years. 

PMID: 9357407, UI: 98020277

http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9783485&form=6&db=m&Dopt=b
J Hum Hypertens 1998 Sep;12(9):587-92 

The epidemiology of the association between hypertension and menopause.
Staessen JA, Celis H, Fagard R Department of Cardiovascular and Molecular Research, University of Leuven, Belgium. 

Menopause is a normal aging phenomenon in women and consists of the gradual transition from the reproductive to the non-reproductive phase of life. The median age at the menopause is currently around 50 years. As a result of the increasing life expectancy in the first and second worlds, many women will be postmenopausal for over one-third of their lives. The influence of menopause per se on blood pressure remains uncertain. Recent experimental and epidemiological evidence supports the hypothesis that oestrogen deficiency may induce endothelial and vascular dysfunction and potentiate the age-related increase in systolic pressure, possibly as a consequence of a reduced compliance of the large arteries. However, the latter hypothesis requires further investigation. 
PMID: 9783485, UI: 98454806 

Which tells us what? Not much ;-) Tishy

Background: Early natural menopause has been postulated to increase the risk of cardiovascular disease. 
Methods: Analysis was restricted to 35,616 naturally postmenopausal women who never used estrogen replacement therapy and with no diagnosed cardiovascular disease at baseline, followed up from 1976 to 1994.
Conclusions: We observed an overall significant association between younger age at menopause and higher risk of CHD among women who experienced natural menopause and never used hormone therapy. This increased risk was observed among current smokers but not among never smokers. The apparent elevated risk of CHD with decreased age at natural menopause among smokers might reflect residual confounding by smoking. 
Arch Intern Med. 1999;159:1061-1066 

Fiber is really good, for both women and men in preventing heart disease mortality, antioxidants are not quite as good and only helped men.

Another gender difference or something else? Hard to tell in an epidemiology study. [Kathryn]

Am J Epidemiol 1999 Nov 15;150(10):1073-80 
Dietary antioxidant vitamins and fiber in the etiology of cardiovascular disease and all-causes mortality: results from the Scottish Heart Health Study. Todd S, Woodward M, Tunstall-Pedoe H, Bolton-Smith C

Vitamin E and Coronary Artery Disease
Anne P. Spencer, PharmD; Deborah Stier Carson, PharmD; Michael A. Crouch, PharmD 

Various studies have evaluated the antioxidant effects of vitamin E in the prevention or treatment of coronary artery disease (CAD). 

<snip of description of good , bad and indifferent results of vit E supplementation of doses ranging from 50 to 800 units daily. Food rather than supplements "should be emphasized at this point".
Reference is made to "possible adverse effects"

 If vitamin E supplementation is initiated, the literature suggests dosages of 100 to 400 IU/d, with the higher dosage considered in patients with documented CAD. Additional investigation is warranted to
further define the role of vitamin E supplementation in CAD and to critically evaluate the optimal dosage, duration of use, and method of consumption (dietary vs supplemental). 

Arch Intern Med. 1999;159:1313-1320