cardiovascular disease in women is under-diagnosed and under-treated compared to cases in men, an expert said on Friday.

“Many women are unaware that Coronary heart disease is their main killer; their biggest fear is Breast cancer,” Ghada Mikhail, of North West London Hospitals and St. Mary’s Hospital Trust in London, wrote in an editorial in the British Medical Journal.

Although the disease kills more women in Europe than men and is a leading cause of death in both sexes worldwide, it is still often thought of as a male illness.

Women account for only 30 percent of participants in most studies and medical trials in cardiology, and healthcare professionals seem insufficiently aware of cardiovascular disease in women, according to Mikhail.

The problem is compounded because risk factors and symptoms for heart disease differ between men and women.

Women with Diabetes have 2.6 times the risk of dying of Coronary heart disease than women without Diabetes compared to a 1.8-fold rise in the risk among men.

Women also have more atypical symptoms such as back pain, burning in the chest, abdominal discomfort, nausea and fatigue than men. Often they need more urgent treatment.

“Better awareness and education, earlier and more aggressive control of risk factors, and appropriate access to diagnosis and treatment are desperately needed to tackle this potentially fatal disease,” Mikhail added.