Heart attacks on television generally depict a man clutching his chest, leading to the common misconception that heart attacks are a ‘man’s problem’. The reality is that they are just as common in women, and just as serious. Every year, more women die of heart disease than men, yet heart disease and related risk factors are often overlooked in women.

Let’s examine the science

On average, women are up to 10 years older than men when they have a heart attack. Before menopause, the hormone estrogen helps protect the heart. It has a positive effect on the elasticity of the blood vessels, meaning they can stretch and contract to accommodate the normal flow of blood, offering some protection from heart disease. However, after menopause, estrogen levels decline, and a woman’s risk for heart attack increases, and eventually, surpasses that of a man with similar risk factors.

Most risk factors are similar for men and women. Standard risk factors include high cholesterol, diabetes, family history of heart disease, smoking or tobacco use, high blood pressure, and inadequate physical activity. A condition that is a strong indicator of heart disease in Indian women, known as metabolic syndrome, is particularly dangerous. Metabolic syndrome is a combination of conditions characterized by high lipids, abdominal obesity (fat around the waist), diabetes, and high blood pressure. The main reason why metabolic syndrome is on the rise is because of the dramatic lifestyle changes that India is witnessing in a much shorter span of time than other nations.

As a result of the age disparity in heart attacks between men and women, the symptoms are often different; blockages in arteries differ between the sexes. Men typically develop blockages in major blood vessels around the heart, while women may present with coronary microvascular disease, where the smaller blood vessels block the flow of blood.

Different symptoms can be deadly

The difference in symptoms means that sometimes, a woman experiencing a heart attack may not identify it correctly, and delay getting medical assistance. Women tend to wait longer before calling emergency medical services, putting them at greater risk. A study conducted in India found that while 40% of men got treatment late; that number doubled, with 83% of women getting delayed treatment. Moreover, education and occupation did not seem to have any influence on treatment-seeking behaviour. This alarming data is why it is doubly important to know the symptoms of a heart attack in women, and how they differ from men:

• Women and men have a similar amount of pain during a heart attack, but the location can be different. While women also experience chest pain, they may also have pain in the back, shoulder, or abdomen. There may be a sudden bout of indigestion or tiredness, caused by ‘silent heart attacks’. Women can also experience unusual pain in the neck or jaw.
• Women may go through bouts of unusual, extreme fatigue. Pay attention to your daily activities and exercise routine – if they leave you feeling far more exhausted or feeling ‘heavy’ in the chest, and if you experience sleep disturbances it could be a warning sign for your heart.
• Nausea, dizziness or sudden sweating are also documented symptoms. Pay attention to sudden shortness of breath.

Women often say they identified these symptoms a few weeks or a month before a heart attack occurred, which is why it is important to pay attention to these warning signs. If you experience any of the symptoms, trust your instincts and go to a hospital or call a doctor immediately. The sooner a problem is reported, the better the chances are of preventing a full-blown heart attack.

What can women do to reduce the risk of heart disease?

Women can make several lifestyle changes to reduce the risk of heart disease, such as:

• Maintain a healthy diet which includes whole grains, a variety of fruits and vegetables, low-fat or fat-free dairy products, and lean meats. Avoid saturated or trans-fat, added sugars, and high amounts of salt.
• Know your blood pressure. Having uncontrolled blood pressure can lead to heart disease. High blood pressure has no symptoms, so it’s important to have your blood pressure checked regularly.
• Consult your doctor about whether you should be tested for diabetes. Uncontrolled diabetes raises your risk of heart disease.
• Quit smoking, even regular exposure to smokers as a result of passive smoking can create a problem. Decrease regular alcohol consumption.
• Discuss checking your blood cholesterol and triglycerides with your doctor.
• Manage stress levels by finding healthy ways to cope with stress.
• Increase activity levels. Get at least 30 minutes per day of moderate-intensity exercise, such as brisk walking. Take the stairs rather than the elevator, do chores, park farther from your destination and walk/cycle to wherever possible.

Dr. Aashish Contractor, after working extensively in cardiac rehabilitation, said, “Women are so used to playing the role of caregiver that they almost feel guilty when it comes to taking care of themselves, this is also one of the reasons why they often receive less than adequate treatment even after being diagnosed with heart disease.” With the right lifestyle and timely medical check-ups, you can greatly reduce the risk of developing heart disease.

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