If some skeptical lesbians dismiss the report, I guess it's understandable. We've gotten stern warnings about our health before that didn't amount to much. In the late '90s, researchers claimed we were at much higher risk for breast cancer than straight women, and our community shot into panic mode. Happily, no lesbian breast cancer epidemic has yet materialized.

But the issues raised by that scare - about lesbians' propensity to smoke, drink, and be overweight - continue to crop up. A recent San Francisco-based study about lesbian health, whose results were just released, hypothesizes that our body mass and waist measurements make us prime candidates for cardiovascular disease. In addition, a few months ago the University of Pittsburgh's Center for Research on Health and Sexual Orientation received funding from the National Institutes of Health to do a groundbreaking four-year study on the various risks of heart disease in lesbians.

A lot of us, I think, may end up ignoring such studies. First, for thin lesbians, the San Francisco report's highlighting of body size as a risk factor for heart disease may lead to the false assumption that a person has to be overweight to have a heart attack. In fact, high cholesterol, high blood pressure, and diabetes, which can lead to heart disease, can plague slim people, too.

Second, some lesbian feminists of size may assume that anyone who puts a negative spin on weight must be buying into male ideas about how women ought to look. Indeed, lesbians in general pride ourselves on being above the fray when it comes to body image; straight women have to worry about things like weight to please men, but not us. All sizes and shapes welcome! That's always been a very positive aspect of the lesbian community, but it could have negative health consequences, too. Besides that, it sometimes leads to an eerie silence in our community about weight concerns.

For example, the last time I wrote a column on weight and health, I got several sanctimonious e-mails from dykes of size who chastised me, a thin woman, for daring to voice an opinion about obesity and problems like heart disease. One reader offered her pity, surmising that I must have really deep-seated body-image problems. And didn't I know that most medical research is controlled by men?

Well, sure. In fact, that's the third and most serious reason why lesbians may fail to heed warnings about heart disease: because heart attacks have been gendered "male" by doctors, who fuel women's cancer fears instead. Even the Gay and Lesbian Medical Association's list of 10 health issues lesbians should discuss with their doctors puts breast cancer first and heart disease last (right after osteoporosis, which is a serious threat to women's health, but not a killer). The fact is, though, that more women die of heart disease than of all forms of cancer combined, including breast cancer.

Consider this personal anecdote: Since the age of 35 I've had more mammograms than I can even remember, based on doctors' recommendations. But I've had to specifically request cholesterol tests, whose purpose is to help identify the potential risk for heart disease and stroke.

Much of the medical establishment's de-emphasis of heart disease in women and overemphasis on cancer has its roots in sexism. Our society views breast cancer as particularly frightening, since a woman's loss of a breast to mastectomy is perceived as a diminishing of her femininity and attractiveness. But heart disease is "masculine" because it may be triggered by the stress of work or of worries about supporting a family. The assumption has been that woman don't have the same pressing concerns as men, even though we have jobs, too, and often take care of homes, children, or aging parents on top of that. Because of this gross misreading of heart disease, most women never learn until it's too late that our symptoms - nausea, fainting, shortness of breath - are very different from those that men experience.

When it comes to heart disease, then, lesbians have good reasons to keep a close watch on the study findings and ask a lot of questions of our health-care professionals. Among our concerns should be: How do weight and behavior affect our risk for heart disease? Can a thin nonsmoker be at risk? And how can we protect ourselves against this silent killer of women?

Paula Martinac is a Lambda Literary Award-winning author of seven books and editor in chief of Q Syndicate.