U.S. women still do not fully understand their high risk of heart disease and are confused by reports that suggest being overweight and inactive are not really that dangerous, the American Heart Association said on Tuesday.

Statistics released on Tuesday show 483,800 American women died from heart disease and stroke in 2003, the latest year for which detailed statistics are available.

Six million women had coronary heart disease and 3.1 million had strokes, the association said in a special issue of its journal Circulation.

“That’s more lives than were claimed by the next five leading causes of death combined: cancer, chronic obstructive pulmonary disease, Alzheimer’s, diabetes and accidents,” the Heart Association said.

But only 55 percent of 1,008 women surveyed knew that heart disease is the No. 1 killer of U.S. women over the age of 25 - although that is up from 30 percent in 1997.

Just 38 percent of blacks and 34 percent of Hispanic women knew heart disease was their biggest disease risk, the Heart Association said.

Women also fail to realize the importance of exercise and weight loss, said Dr. Frank Hu, an associate professor of nutrition and epidemiology at the Harvard School of Public Health in Boston.

Hu studied 88,393 women between the ages of 34 and 59 who were taking part in the larger Nurses’ Health Study. He found that those who were obese and who did not exercise were 3.4 times more likely to have heart disease over the 20 years of the study.

Those who were active but obese were 2.48 times more likely to have heart disease. Those who were at a normal weight but who did not exercise were 1-1/2 times as likely to have heart disease as the very few women who were both lean and who exercised regularly.

FIT AND FAT

“A high level of physical activity did not eliminate the risk of coronary heart disease associated with obesity and leanness did not counteract the increased coronary heart disease risk associated with inactivity,” Hu told reporters in a telephone briefing.

“Obese, sedentary smoking women had 9.4 times the risk of coronary heart disease compared to lean, active women.”

Hu said the findings countered some recent studies that suggested people could get away with being fat if they exercised.

“Both fitness and weight are independent and serious predictors of heart risk,” Hu said.

Dr. Lori Mosca of New York-Presbyterian Hospital in New York said doctors and patients alike often are misled by news reports of individual studies. “I think what women find confusing is the mixed messages about diet and lifestyle and drug therapy,” Mosca told the briefing.

“What happens is when studies get reported one week and then the next week there is a study showing a completely different finding, that confuses the public and doctors alike,” she said. “In science and medicine there is rarely a single report that is definitive and changes medical practice.”

Another study in Circulation showed that women in Europe do not get the same treatment for heart disease as men do - echoing recent U.S. findings. “Women are under-investigated and under-treated,” said Caroline Daly, a cardiologist in training at the Royal Brompton and Harefield National Health Service Trust in London.

Her study of more than 3,700 patients with chest pain at 197 centers across Europe showed women were less likely to get a standard electrocardiogram or to get drugs to treat heart disease.