It is common to think of heart disease as a ‘man’s problem,’ but you could be in for a surprise. The last two decades in India have seen a steady rise in incidences of heart attack among women, especially those in the reproductive age.
A recent study in the United Kingdom published in Heart , an international peer-reviewed cardiology journal, has shown that women who started menstruating at age 11 or earlier, or entered menopause before 47 had a higher risk of heart disease and stroke. The findings of the team, led by Sanne A.E. Peters a research fellow at the George Institute for Global Health, University of Oxford, suggest that women who have premature reproductive cycles or a history of adverse events should get themselves checked for heart problems.
While there are no studies of a similar kind in India, cardiologists say a low level of oestrogen — on account of changing lifestyle and other co-morbid conditions — is among the key reasons why younger women develop cardiovascular disease (CVD).
Indian survey
In 2013, a survey conducted by a team of senior doctors, titled “Visualising the Extent of Heart Disease in Indian Women” (VEDNA), mapped the trends of cardiovascular diseases among women based on interviews with 577 cardiologists from across the country. They found that 54% of doctors had observed a 16%-20% rise in CVDs among women since 2009. An estimated 65% of the doctors surveyed also showed that they had found insufficient oestrogen to be one of the main causes for younger women developing heart diseases.
Dr. C.N. Manjunath, Director, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, who was part of the survey, says, “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.”
This, along with risk factors such as a higher prevalence of diabetes, obesity and related ailments and physical inactivity, have worsened the problem, he adds.
Another study at the institute last November, which involved 750 patients below the age of 40 with premature coronary heart disease, found that 16% of them were women.
“At least three of the women patients (two were aged 25 and one was 26) did not have any conventional risk factors, indirectly indicating that low levels of oestrogen could be the cause,” says Dr. Manjunath.
Dr. K.K. Aggarwal, President of the Heart Care Foundation of India and immediate past national president of Indian Medical Association says what is worrying is that women exhibit atypical symptoms that delay diagnosis.
“The warning signs of this disease are different from those seen in men. For example, women do not have the characteristic chest pain but may have a jaw pain. This is one of the reasons why women do not get diagnosed in time, thus exacerbating the condition further,” he says.
Traditionally, heart disease has never been thought to be a woman’s disease. Thus, when a woman complains of symptoms such as breathlessness, it is very often mistaken to be some other problem, he adds.
“The classic pattern of angina with pain on the left side of the chest may be absent in women. They are more likely to have atypical angina, in which they could experience discomfort in the shoulders, back, and neck. Apart from this, shortness of breath is often the first and only presenting symptom. All of this can make the diagnosis tricky,” Dr. Aggarwal explains.
Risk factors
The risk factors for heart disease in women include the regular ones such as smoking, high cholesterol, high blood pressure, lack of physical activity, and an unhealthy diet. There are also some specific ones which include the use of birth control and other hormone pills.
Doctors say the need of the hour is to create awareness about the fact that heart diseases can affect anyone irrespective of age or gender. Only early and corrective lifestyle changes and preventive measures can help in combating the risk factors and avoiding heart diseases. Women in particular need to be aware of the signs and symptoms and take adequate care of their health.
yasmeen.afshan@thehindu.co.in
