Why heart attacks among Indian women are on the rise and what they need to do about it

While we are supporters of equality of women with men, certain parameters – on which women are fast catching up with men – are certainly emanating disturbing signals. One such parameter is the rising incidence of heart attacks among women. A disturbing trend that has been observed in the last few years is that women are getting prone to heart attacks – something that had been more of an exception than a rule until recently. 

A number of recent studies have revealed that more women are falling prey to heart diseases, breaking the myth about men being at a greater risk.

A survey last year found that low levels of oestrogen, due to changing lifestyle and other co-morbid conditions, is among the top five reasons for younger women developing cardiovascular diseases (CVDs). 

The survey, “Visualising the Extent of Heart Disease in Indian Women”, by Heal Foundation was conducted by 577 cardiologists from across the country and mapped the trends of cardiovascular diseases among women. It revealed that 54% of the doctors observed a 16 to 20% rise in CVDs among women in the last five years. 

There have been a number of instances of women with no exposure to smoking or drinking and no family history of heart attacks having suffered heart attacks. 

While stress is one of the major causes for rising instances of heart diseases among young women, an estimated 65% of the doctors surveyed also revealed that they had found low level of oestrogen to be one of the main causes for younger women developing heart diseases. 

A number of national and international studies have indicated that women with diabetes have more than three times the risk of developing heart disease than women without diabetes. Even younger women with diabetes have an increased risk of heart disease. 

Why do women with diabetes face an increased risk of heart disease? 

When women develop diabetes, there are more adverse changes in their physiology that add to heart disease risk. Their blood pressure rises, HDL (good) cholesterol levels fall, and abdominal fat increases. Diabetes Mellitus increasing to an epidemic level has significantly contributed to heart disease.

Patients with acute coronary syndrome (ACS) frequently show typical chest pain; however a considerable proportion may also show atypical symptoms. 

A recent study by the Journal of Cardiology (Atypical presentation of acute coronary syndrome) representing one of the largest observational studies comparing the impact of symptoms at the manifestation of ACS on patient outcomes, indicated that women were more likely to show atypical symptoms in comparison to men and this gender gap had negative impact on the survival rate.

Cardiac conditions are largely the functions of lifestyles and there has been a significant change in the lifestyles of Indian woman in the last couple of decades. While Indian women are becoming equally participative at the workplace, there is no major respite for them from domestic duties.  Due to demands of children and limited family support (on account of nuclear families), the level of stress in their lifestyles is continously increasing. Other factors such as unhealthy food intake (due to their lifestyles) and lack of exercise  also contribute significantly to the plight of Indian women. 

The most worrying factor is that it is affecting more women in the reproductive age group now, unlike in the past when women got it mostly after menopause. The main reason for this is extreme stress caused by juggling home and the workplace. This, coupled with risk factors such as higher prevalence of diabetes, obesity and related ailments and physical inactivity, has only added to the problem. 

Cardiovascular illnesses have been long neglected in their role as the primary cause of mortality in women, both by patients and physicians. Another problem with cardiac conditions in women is that most times, women do not know they are having a heart attack. 

What are the symptoms of a possible heart attack? 

The classic symptoms like chest pain are a possible sign of warning, but as women grow older or if they are diabetics, there will be a feeling of fatigue, shortness of breath, indigestion, upper abdominal pain or nausea, jaw or throat pain and a shooting pain in the arm, chest pain in left, right or even in the middle. Believing a heart attack can never happen to them, women mostly ignore the symptoms and pains that indicate a possible heart attack. Women, who feel tiredness and breathlessness, have a perception that these pains are a part of their daily routine and which cannot lead to heart attacks. However, we urge women not to ignore these symptoms and consult a physician at the first experience of unusual pain

When it comes to a routine health checkup I find most women only worried about breast and genital cancers. They rarely undergo comprehensive cardiac evaluation.
Women who smoke have a higher incidence of vascular complication as compared to men. Women who are passive smokers too can experience similar effects .

Dr Zakia Khan is the Interventional Cardiologist at Fortis hospital Kalyan and faculty member of the Paediatric Cardiology team at Fortis Hospital Mulund