Way to a woman’s heart: 5 uncommon heart truths

Commonly considered a ‘man’s problem’, surprised faces fill consultation rooms when women are diagnosed with cardiovascular diseases (CVDs). The lack of awareness and discussion has resulted in CVDs being the leading cause of death among women in India; precisely 18% of all female deaths, according to the Global Burden of Disease Study. This could also be attributed to the ‘uncommon’, subtler symptoms in women with underlying heart diseases.
It is also not unusual for women with CVDs to be asymptomatic.In many cases, women diagnosed with CVDs showcase no symptoms. With fewer studies conducted on women than men, it is important to know and spread awareness around women’s heart, heart diseases and heart attacks. Here are five uncommon heart truths you should know:
Heart Truth 1: Women’s hearts’ physiology could delay heart disease diagnosis and treatment
The heart of a man and a woman may look the same. However, women’s hearts are smaller with thinner muscular walls and narrow blood vessels making their arteries more prone to blood clots or plaque blockages. According to the National Heart Blood and Lung Institute’s (NHBLI) research, women are more prone to heart diseases in the smaller arteries of the heart, called coronary microvascular disease (CMD). Diagnosing this with standard tests is a challenge because micro-vessels are too small to assess. Delayed diagnosis and treatment increase the risk of heart attack. Regular health checks with heart check-ups are the only way to diagnose the underlying heart conditions in such cases.
Heart Truth 2: Drop in Estrogen, Progesterone and Androgen levels in menopausal phase could increase heart attack risk
During the reproductive phase of their lives, women are naturally protected from CVDs due to the production of high levels of sex hormones (National Library of Medicine research article). However, as they near the menopause age, there is a decline in these hormones' production – drop in estrogen, progesterone and androgen levels - leading to lower impact on vascular function and lipid profiles. At this juncture, a woman’s body is equally at risk with a man’s body in getting CVDs. This is why many women in the age group of 40+ years suffer from heart issues. Women with poorly managed diabetes, cholesterol levels and blood pressure are more prone to CVDs after menopause.
Women also go through bodily changes post menopause that result in visceral obesity, atherogenic dyslipidemia, dysregulation in glucose homeostasis, non-alcoholic fatty liver disease and arterial hypertension that could lead to CVDs. Even if a woman has no serious heart condition prior to entering the menopausal phase, it is important that they get a heart check-up done, especially, in the cases of early or late menopause.
Heart Truth 3: Other non-communicable diseases increase the risk of heart issues in women
Non-communicable diseases (NCDs) account for about 74% of deaths globally. While heart diseases and strokes are among the top NCDs, there are other NCDs in women like cholesterol, diabetes and visceral obesity, that contribute to cardiovascular diseases and heart attacks.
High LDL cholesterol leads to heart issues because it builds up in the walls of blood vessels of the heart, creating plaque. This is more common among women in the menopause age group because of the reduction in production of the estrogen hormone that helps the liver regulate cholesterol levels.
Gestational diabetes (high blood sugar during pregnancy) is another NCD in women that causes heart issues. According to studies, about 30 million women are diabetic in India, the diabetes capital of the world. Unfortunately, with time, the blood sugar levels from diabetes can damage blood vessels in the heart and impede the flow of oxygen in blood leading to heart attacks and strokes. In several women, gestational diabetes turns into Type 2 diabetes over the time.
Here’s another NCD fact – 40% women in India have abdominal/visceral obesity with the condition being stronger in women in their 30s or 40s, according to a global study. Visceral obesity is a true predictor of CVDs because visceral adiposity promotes systemic and vascular inflammation. These are fundamental to the development of atherosclerosis – a condition where arteries become narrow and hardened.

Heart Truth 4: Women with endometriosis stands a higher risk of heart attack
Endometriosis is a painful condition in which the tissue that is similar to the lining of the uterus grows outside the uterus often affecting ovaries, fallopian tubes and the tissue lining the pelvis. In India, ~42 million women (about twice the population of New York, USA) have endometriosis, a condition for which we have no permanent cure.
According to recent research published by the European Society of Cardiology (ESC), women with endometriosis are at a 20% greater risk of heart attack or ischemic stroke (blockage in an artery that supplies blood to the brain) compared to women without endometriosis. The painful condition, affecting millions of women across the world, is associated with heightened oxidative stress, systemic chronic inflammation and atherogenic lipid profile that may increase their risk for heart diseases.
Heart Truth 5: Pregnancy increases the risk of heart diseases in women
Pregnancy adds to the cardiovascular stress in women. During pregnancy, the blood volume goes up 40-50% and the heart rate increases to pump more blood. At this point, the female body is working harder to grow the fetus. But the extra stress experienced during pregnancy could result in heart conditions and to the worsening of existing conditions.
It is essential to closely monitor the blood pressure of pregnant women. Normally, blood pressure gradually lowers until the middle of the pregnancy period. Later, it slowly increases and reaches the normal level by the end of the pregnancy. In case of any abnormalities in blood pressure, it is advised to get heart health checks done to rule out any possibility of pregnancy-related heart problems.
Among Indian women, mortality rate due to heart diseases is higher than any other disease. As mentioned above, certain health conditions add to the existing heart problems or are causes of new heart problems. It is suggested to begin the monitoring of heart health, much before the pre-menopause phase and consistently, so that healthcare professionals can foresee any upcoming heart conditions. Health conditions are better diagnosed sooner than later. With the latest developments in the cardiology space, healthcare professionals across the world can predict an individual’s heart health into decades. The only advice would be – don't wait, act now.
(Dr Sarita Rao, Sr. Interventional Cardiologist, Apollo Hospitals)