Heart Attacks in Young Women

A common sight in Indian households these days is a woman in her 30s or 40s trying to juggle a full time career, managing errands and kitchen at home, children's schedules, taking care of her family but having no time to look after herself.

Studies show that heart attacks in Indian women are frequently overlooked, misdiagnosed and treated less aggressively than heart attacks in men. 35% heart attacks in women are estimated to go unnoticed. If any woman develops a symptom such as acidity, indigestion, breathlessness, uneasiness- it is usually dismissed and shrugged off very easily both by the woman herself and depending on circumstances sometimes by her family. But these symptoms might indicate a fatal heart attack.
Heart attacks used to be previously considered a disease predominantly affecting men. Women historically had heart attacks much later in life, mainly after 55 years. This age is now reducing and it is now a relatively common scenario to routinely see pre-menopausal women in their 30s and 40s present with life threatening heart attacks.

This uprising trend of increased heart attacks and its complications in women is disproportionately under-diagnosed and shockingly, sub-optimally treated.

Why are heart attacks in women under-diagnosed?

1. Atypical symptoms- Women commonly have a different set of symptoms from heart attacks compared to men. A heart attack might not always present with chest discomfort in women- sometimes it can present as uneasiness, breathlessness, anxiety, arm or jaw pain, indigestion like symptoms.
2. Self neglect- women commonly ignore, dismiss or downplay their symptoms.
3. Neglect by the system- even some healthcare professionals may easily dismiss atypical symptoms of heart attack in women. In fact many large studies in emergency departments have shown than women are less likely to undergo cardiac testing including ECGs, angiograms etc whenever they present with symptoms suggestive of heart attacks.

Hence, a diagnosis of heart attack is often late in women as compared to men which might lead to worse outcomes.

Why is there an increasing trend of heart attacks in women even in the pre-menopausal age group?
Estrogen hormone which is produced by ovaries in women offers natural protection against heart attacks in pre-menopausal women. This effect gets neutralized after menopause. However, now a days, there are multiple risk factors which are neutralizing the protective effects estrogens which causes early heart diseases in women-

1. Genetics and modern lifestyle- Since we Indians have the notorious "South Asian" metabolism where our genes are evolutionarily programmed to store maximum energy in form of fat with minimum food, this effect is even more pronounced in women. Women have even more tendency to store visceral fat ie fat which encases visceral organs as compared to men mainly due to lesser lean muscle mass. Men in general have more muscle mass due to testosterone, which given them faster and better metabolism compared to women. Hence women have a greater tendency to gain fat- especially the dangerous visceral fat. When this is combined with modern sedentary lifestyle, high stress which is a part of daily lives for many women, multi-tasking, stress of juggling career and parenting, it literally spells out a recipe for disaster.
2. Unique culprits in women- in addition to the usual culprits of heart attacks like high blood pressure, high cholesterol etc, women have a few unique risk factors for a heart attack namely PCOS (Polycystic ovarian syndrome) which has been newly renamed PMOS. This unique disorder is closely linked to insulin resistance and can start in teenage years and drastically increases risk for future heart attacks.
3. Pregnancy, post-partum and it's complications- women naturally gain weight in pregnancy and post-partum period but on many occasions, this weight gain can be excessive and unnecessary, even harmful. This can be due to excessive calorie intake due to practicing wrong traditions surrounding pregnancy and post-partum period. Hence, a pregnancy might be the stepping stone for future overweight or obesity in a woman which in the long run can increase risk of heart attacks. Pregnancy related complications like high blood pressure and diabetes during pregnancy are again risk factors for future heart attacks.
4. Smoking and other addictions- all addictions are bad in all humans but smoking same amounts of cigarettes is disproportionately more harmful to a woman compared to a man, with much more rapid blockage of arteries (atherosclerosis) in women.
5. Other risk factors- The heart's arteries (coronary arteries) are also on average smaller in diameter in women compared with men, therefore at risk of more severe blockage from smaller plaques. Chronic stress, untreated depression, hypothyroidism, uncorrected hypertension (raised blood pressure), pre-diabetes and diabetes, family history, central obesity, air pollution are all universal risk factors for heart attacks.

My advice to every young Indian woman reading this: self-care is survival, not selfishness.

To protect your heart, it is essential to:

1. Know Your Numbers: Do not wait for menopause to check your health. Get a baseline lipid profile, HbA1c (blood sugar), and blood pressure check by age 25 and every 2-5 years after this as suggested by your physician.
2. Manage lifestyle: Ditch smoking and alcohol. Chronic stress and sleep deprivation also kill. Try to prioritize 7 hours of sleep, and carve out 30 minutes daily for exercise including weekly weight training and cardio.
3. Listen to Your Body: If something feels deeply wrong in your chest, upper body, or breathing, do not wait overnight. Visit an emergency room immediately.