It’s the familiar story. A woman just into her middle age rushes to a doctor’s clinic with complaints of a racing or thumping sensation in her heart, and breathlessness. The 45-year-old housewife is put through the usual gamut of cardiac tests. She clears the treadmill test, also her coronary arteries do appear normal in an angiogram. The woman goes away, rightly imagining that all is well. Six months later, she suffers a massive heart attack and dies.
This scenario only highlights how deceptive and misleading symptoms lead to a delayed diagnosis and treatment of heart disease in women—one of the biggest health challenges today. Heart disease is the leading cause of death in women worldwide, including India. “Heart disease among Indian women is the biggest cause of death, six times more than breast cancer,” emphasises Dr Ashok Seth, chairman of Fortis Escorts Heart Institute, Delhi. Despite the statistics, all the attention claimed by ‘bikini-zone diseases’ such as cancers of the breast and reproductive system detracts from the threat.
Women manifest heart disease differently from men, due to their unique biology and physiology. Unlike in the case with men, they may not have chest pain. “Fatigue, breathlessness, a sense of anxiety and sometimes even flu-like symptoms are more common in females,” says Dr Seth.
Diagnosis is a tricky business for other reasons too. Blood vessels are smaller and organised differently in women, so non-obstructive heart disease is more common than the obstructive variety. That’s why arteries may appear normal in an angiogram. “But this doesn’t rule out heart disease,” emphasises Roopa Salwan, director of Myocardial Infarction Programme (dealing with heart attacks) and senior consultant (interventional cardiology), Max Super Specialty Hospital, Delhi.
Sometimes, symptoms may be due to ‘cardiac syndrome X’, a poorly understood condition that isn’t life-threatening. “Cardiac syndrome X is a microvascular angina, which is usually tackled through medication,” says Siddharth Dagli, consultant interventional cardiologist at Breach Candy hospital, Mumbai.
Well, that’s not the only source of confusion. False positive and negative results for diagnostic tests such as stress exercise test and thallium scan are more common in females too. “CT scans (that makes use of computer-processed combinations of many X-Ray measurements) are sometimes required to confirm a diagnosis,” says Dr Salwan.
Still Man’s Problem
Culturally and socially ingrained notions that heart disease doesn’t affect women perpetuates the dangerous cycle of ignorance. Heart disease is traditionally seen as a male disease. So when a woman complains of symptoms such as breathlessness and/or fatigue, everyone around her—including doctors—rarely attribute the blame to a heart problem.
The problem is that women perpetuate this belief by refusing to confront the diagnosis. “They still refuse to accept that it’s the Number 1 killer among them,” asserts Dr Salwan, citing a 2016 study that confirms that heart disease is “an equal-opportunity killer”.
Coronary artery disease is the commonest ailment in females, and if left undiagnosed, frequently leads to heart attacks, angina, arrhythmias and heart failure. Currently, there is no nationally representative surveillance data on the prevalence of CVD either. Recent reports suggest that 30-42 per cent mortality among both sexes is attributable to this. “The incidence is 5-6 per cent among women, and 10-11 per cent among men,” says Dr Seth. “This is double the figure 20 years ago.” Despite the escalating number of women with heart disease, however, the cardiac wards of hospitals don’t reflect the upsurge.
One out of two women risks developing heart disease today. A 2016 study by the National Heart Institute shows the number of women patients admitted to its state-of-the-art hospital in Delhi having risen by 10 per cent in the five-year span of the study. Younger, pre-menopausal women constitute at least half of the female patients.
This doesn’t surprise experts, who say the profile of the heart disease victim has changed dramatically over the past decade. “At one time, heart disease typically hit women after menopause,” says Dr Salwan. Today, women of a reproductive age have joined the high-risk category. Cardiac disease is just one of a package of non-communicable diseases that have become public health challenges. Spiralling rates of obesity, diabetes and hypertension fuel the epidemic of heart disease. Risk factors such as smoking and family history are the same for men and women too.
But here’s the twist. An underlying disorder like type-2 diabetes makes women five times more vulnerable to dying from heart disease than men. The gender bias doesn’t end here. Female smokers are 25 per cent more likely to develop heart disease than men. Other specifically female problems such as polycystic ovarian disorder and menstrual irregularities make women prone to metabolic syndrome, another condition implicated in heart disease.
Finally, female vulnerability to heart disease is heightened by emotional factors, such as depression and unresolved stress in both home and work settings. New-age lifestyles are a significant risk factor for heart disease. “Women’s lifestyles today involve juggling high-powered careers alongside roles as mothers, wives and daughters, placing them under high stress,” says Dr Dagli.
At least 80 per cent of heart disease is preventable. Be it for men or women, “healthy living practices that include mindful eating, regular exercise and effective stress control pave the way for a healthy heart,” advises Dr Seth. Both groups, points out Dr Dagli, need to make measures to reduce the risk of narrowing of the main arteries with age.
Early detection of cardiac diseases has the best possible outcomes. “Regular check-ups are advisable for the middle-aged, to screen for risk factors such as hypertension, high cholesterol, high level of C-reactive protein, smoking, obesity and diabetes,” says Dr Seth.
A family history of heart disease shouldn’t be ignored, especially if there are signs of discomfort during exertion. Staying alert to the possibility of cardiac ailments can make the difference between life and death. “Doctors must not ignore prodromal symptoms—those which are new and intermittent before a cardiac episode, but resolve afterwards,” says Dr Salwan.
Effective stress management is also vital for a healthy heart. “Women’s cardiac health depends upon their mental health and emotional well-being,” says Kamna Chhibber of Fortis Healthcare. A clinical psychologist who heads the department of mental health & behavioural sciences at the hospital, she advocates maintaining enriching relationships and regular social interactions, to improve well-being and reduce women’s vulnerability to heart problems. “Ensure that you find joy, take regular breaks, and talk about troubling issues with someone you trust.”
Tips To Reduce The Risk
- Quit smoking or at least cut it down
- Weigh yourself often. Walk, run or do yoga to reduce excess weight
- Keep a check on blood-sugar and cholesterol levels
- Choose monounsaturated fats, such as olive oil or canola oil for cooking. Replace some calories with a portion of almonds and walnuts.
- Eat 5 servings of anti-oxidant rich fruit and vegetables. Cut back on the sugar and salt. Stick to home cooked food.
- Socialise regularly and maintain supportive relationships. Include some fun-filled activities in your week.
- Get an annual flu vaccine. Don’t ignore any signs of discomfort, regardless of how innocuous they seem.
(The writer is a microbiologist who writes on health and medical issues.)