At Heart Failure 2023, a scientific congress of the European Society of Cardiology (ESC), a startling revelation was made: women are more than twice as likely to die after a heart attack than men.
“Women of all ages who experience a myocardial infarction are at particularly high risk of a poor prognosis,” said study author Dr Mariana Martinho of Hospital Garcia de Orta, Almada, Portugal, in the press release. “These women need regular monitoring after their heart event, with strict control of blood pressure, cholesterol levels and diabetes, and referral to cardiac rehabilitation. Smoking levels are rising in young women, and this should be tackled, along with promoting physical activity and healthy living.”
Heart disease and women of India
According to the Global Burden of Disease Study, heart disease is the leading cause of death for women in India, accounting for more than 18% of all female fatalities. Remarkably, heart disease kills Indian women more frequently than breast cancer combined with all other cancers combined.
According to Dr Vinoth, Consultant Cardiologist at CARE Hospitals Hitech City, Hyderabad, there has been an increasing awareness and subsequent rise in the number of women being diagnosed with heart conditions. “Increased stress, poor diet, lack of exercise, and higher smoking rates in some populations have contributed to a rise in heart disease. Also, as the overall population ages, more women are entering the age group where heart disease risk is higher,” he says.
During the premenopausal years, estrogen protects the heart by relaxing the arteries and encouraging healthy cholesterol, but post-menopause women lose this shield and become prone to heart conditions.
How it pans out
In 2011, a 60-year-old Shobha Chaturvedi, then a lecturer in a women’s degree college in Kanpur, didn’t pay heed to her symptoms, which seemed like cough, until a fellow morning-walker pointed it out. She would also experience occasional pain in her chest but busy with her professional life and personal responsibilities of managing the household, Chaturvedi ignored her health. She had an early menopause.
Soon, post the angiography, which reveals blockages in three arteries, her sons advised her to come to Bangalore. In 2012, Chaturvedi had her bypass surgery in Fortis Bannerghatta.
If it were not for the fellow morning-walker, Chaturvedi would have continued ignoring her symptoms like most of the women. It’s fairly common among women to delay their health check-ups and visit a doctor.
Delay in proper heart care
“Delayed health check-ups and doctor visits can lead to delayed diagnosis and treatment of heart conditions in women. Factors contributing to this delay include – symptom misinterpretation, in which women might experience atypical symptoms and not recognise them as related to heart disease. Women often prioritize family responsibilities over their own health, leading to delays in seeking medical care. Socio-economic factors and lack of access to healthcare can also contribute to delays,” notes Dr Vinoth.
Clinical trial gaps remain
He adds another pertinent point that historically, women due to underrepresentation in clinical trials for heart disease, lead to gaps in understanding gender-specific symptoms and treatment responses. It’s interesting to note that while women are equally at risk, when it comes to heart diseases, the heart health narrative seems to revolve around men.
“While women are equally or more susceptible to heart issues, they don’t get as much attention from brands. Probably because they are not the primary demographic with the same purchasing power as their male counterparts. It’s also because women prioritize their needs after those of everyone else. For instance, a homemaker will buy an oil that promises to take care of their family’s health or that of their spouse. But if the same brand promotes the oil as being good for a woman’s health, they’ll likely neglect it,” states Vinita Bhatia, a media professional.
Atypical symptoms among women
Women also experience atypical symptoms, which makes it difficult for patients to understand how serious the issue is. Dr Pavan Rasalkar, Consultant-Interventional Cardiology, Fortis Hospital, Nagarbhavi, says, “Unlike men, who are more likely to exhibit classic symptoms like chest pain, women may experience atypical symptoms like fatigue, nausea, or jaw pain during a heart attack. This, coupled with the invisibility of heart disease in women, leads to underdiagnosis and potentially worse outcomes.”
Dr Rashmi Dharaskar, senior consultant, obstetrics and gynecology, Surya Mother and Child Super Speciality Hospital, Pune, agrees with Dr Rasalkar. “Several women who come to us complain of nausea, angina (which is a full or heavy chest ache/discomfort), neck pain, jaw pain, back pain, and excessive tiredness – which are all silent signs of heart diseases.”
Shifting the focus from men’s heart health in public discourse, raising awareness among women about cardiovascular health and factors disrupting it and healthcare providers to recognise unique symptoms are keys to bringing as many women as men under the radar. Experts in public health also emphasise how important it is to include more women in cardiovascular clinical trials and integrate gender-specific findings into clinical guidelines.
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