For Diane Gessel, 69, of Williamstown, breakfast used to be a cigarette and a cup of coffee.
A former glass decorator and trainer at Fenton Art Glass, she recalls going home from work one night and "feeling kind of low."
"I just felt like I had hit rock bottom," Gessel said. "I didn't know at the time that was one possible sign of a heart attack, and thought I was just stressed out from work."
Later that night she woke up with pain in her upper chest.
"I never thought of calling 911. I was feeling some confusion and couldn't recall my daughter's phone number," Gessel said. "When I finally reached her I said 'Honey come quick, I can't breathe.' She was still in her pajamas when she arrived."
Gessel survived her heart attack that night but heart disease remains the top killer of women in the U.S., where 435,000 women have heart attacks every year, according to The Heart Foundation.
Many women still believe heart disease is mainly a problem for men, but the foundation reports that women account for just more than half of the nation's total heart disease-related deaths each year.
As a hospital liaison for Heartland of Marietta, Pamela Roff, 42, of Marietta, tries to help people avoid heart issues and hospital time by teaching them how to stay well through exercise, diet and monitoring for high cholesterol and blood pressure.
But it was while taking a cardiovascular class in college that Roff learned she had a heart-related problem herself.
"I discovered I have a bicuspid aortic valve," she said. "The valve is supposed to be shaped something like a Mercedes Benz symbol, with three sections or leaflets."
The aortic valve regulates blood flow from the heart into the aorta, which is the main artery carrying blood to the rest of the body. A normal three-leaflet valve prevents blood from flowing back into the heart when the heart muscle relaxes.
Roff's aortic valve only has two leaflets, which can allow blood to leak from the aorta back into the heart when the muscle is at rest.
"This means I'll face heart valve replacement surgery somewhere down the road," she said. "The danger is that the valve may rupture at some point."
A ruptured bicuspid valve can be deadly, especially if a patient can't reach a hospital in time.
A mother of two, Roff said she keeps a close eye on her health.
"I'm keeping my cholesterol in check and my blood pressure down," she said.
Roff added that her condition can be hereditary, so she's had her children checked as a precaution.
"My son does have a leaky heart valve, but it's not bicuspid," she said. "Anytime there's a family history of heart problems it's a good idea not to ignore it and seek treatment. You can keep yourself from becoming a statistic."
Women should pay more attention to their heart health, agreed Dr. Martha Gulati, director of preventive cardiology and women's cardiovascular health at The Ohio State University's Wexner Medical Center.
"We hear a lot about breast cancer in women, but heart disease is the No. 1 killer," she said. "And the next seven cancers down the list put together don't add up to the number of deaths from heart disease."
Gulati said breast cancer can be a legitimate concern, but heart disease is the most common killer of both men and women.
"An estimated 42.9 million women are living with heart disease in this country right now," she said. "And the odds of a woman getting heart disease in her lifetime are one in two-it's really just a toss of the coin."
Comparatively, the chances of a woman contracting breast cancer are about one in eight, Gulati added.
"Heart disease is very common, and women need empower themselves by knowing they're at risk and what to look for," she said.
Risk factors include smoking, diabetes, poor diet, high blood pressure, high cholesterol, inactivity, being overweight and having a family history of heart disease problems.
It's a lesson many like Gessel learn the scariest way.
The night of her attack, she was transported by ambulance to Camden Clark Medical Center in Parkersburg.
"I was hurting so bad. It was like someone had stabbed me with a knife and it was coming out through my back," she said.
Tests later showed the attack had inflicted damage on about 3 percent of the back side of Gessel's heart.
"They couldn't believe there had been so little damage," she said. "It didn't require any invasive surgery. I still have a leaky heart valve, but I just live with it."
Gessel said she tries to eat right to keep fats and cholesterol down, and she exercises daily.
"I stay positive. You can't keep worrying about it," she said. "But you still want to do whatever you can to prevent another attack."
Gessel said she now takes daily medications to reduce her cholesterol and help regulate her blood pressure.
Gulati said women need to do a better job of educating themselves about heart disease.
"The heart is hidden inside the cage of our bodies, so we can't see it, but we depend on it for every breath of our lives," she said. "Learn about it and do something good for your heart every day."