Delhi politician, 46, had 2 heart attacks in a day, now back at work: What her story reveals about rising cardiac risk in women under 50

Doctors moved quickly, inserting a stent or a device to widen the heart’s arteries and restore blood flow within an hour, thereby stabilising her condition. Sharma was out of the ICU in three days. “She had undergone a mild attack at first followed by a severe one. In the first, a piece of unstable plaque may have been partially blocking an artery. But then it probably ruptured, causing a clot to form and completely block the artery, leading to a severe heart attack,” says Dr Tarun Kumar, senior director, cardiology, Medanta-Moolchand Heart Centre.

Sharma’s case isn’t isolated. While heart attacks are common in younger men, even women under 50 are just as risk-prone, defying the long-standing belief that they are safe in their reproductive age because of the cardio-protective effect of the hormone estrogen. In fact, a study published in July 2020 showed that heart disease is rising faster in women than in men in India (‘Escalating ischemic heart disease burden among women in India’, published in the American Journal of Preventive Cardiology). The triggers range from excess weight, diabetes, smoking, high blood pressure, cholesterol and family history.

WHAT ARE TRIGGERS FOR YOUNGER WOMEN

Sharma had ignored the most important risk factor, that of family history. Her father, brother and three sisters had experienced some sort of cardiac issue. That was a cue for her to be vigilant and get herself tested early, which she didn’t. However, she believes that mental stress had pushed her body over the edge. According to Dr Kumar, “Women have a higher sensitivity to stress and depression, making awareness of these female-specific risks crucial for prevention. It also includes diabetes, lifestyle related risk factors like obesity, smoking and other treatments like steroids.”

Sudden acute stress, both emotional and physical, can rapidly weaken the heart muscle. “This stimulates production of adrenaline and cortisol, which result in inflammation and subsequent constriction of arteries. This also accelerates plaque formation and blood clots, leading to an unstable angina, heart attack, arrhythmia and sudden cardiac arrest,” says Dr Balbir Singh, chairman, Cardiac Sciences, Max Healthcare.

Most women in their 40s and 50s, if having high BP, blood sugar and cholesterol, tend to develop a tear in their heart vessels called spontaneous coronary artery dissection. “This could lead to blockages, disruption of blood flow, irregular heartbeats and subsequently cardiac arrest,” says Dr Singh. Sometimes dehydration, when body salts go down, especially potassium and magnesium, can trigger very fatal rhythm disturbances and cause a cardiac arrest.

He highlights how smoking and vaping can increase the risk of heart attacks in women by 34 per cent. “E-cigarettes contain nicotine which increases heart rate and BP. Then there are substance abuse and frequent popping of oral contraceptive pills, which elevate blood pressure and even change blood fats, lowering high-density lipoprotein (HDL) or good cholesterol and elevating low density lipoprotein (LDL) or bad cholesterol,” says Dr Singh.

Risk factors like diabetes and abnormal cholesterol impact women more than men. Studies have shown that diabetic men have a two to three-fold increased risk of heart disease, while diabetic women have a three to seven-fold increased risk. “That’s why I say that women’s markers on blood pressure, cholesterol and blood sugar must be on the lower side of the healthy range,” explains Dr Singh.

WHAT ABOUT PREVENTION

Dr Kumar says that most women patients, like Sharma, report their condition late as they do not experience typical chest pain. “Compared to men, they tend to ignore preventive heart-check-ups unless they are post-menopause. Often, the symptoms are subtle, easily mistaken for fatigue or acidity. And because women prioritise their families, work, or responsibilities, they tend to ignore early warning signs,” he says.

Sharma admits to punishing her already stressed-out body during campaigning. “Women put themselves last. Our eating schedules are bad, we skip meals and we normalise stress. My lunch hour was all over the place. I would go hours without eating. All of this disrupted my hormones, resulting in underlying conditions for heart attack that I had no clue about,” she says.

A woman’s waist circumference should not be more than 85 cm, triglycerides should not be more than 150 mg/dL, HDL or good cholesterol should not dip below 50 mg/dL, LDL or bad cholesterol should be below 100 mg/dL, blood pressure should not be more than 130/85 mmHg and fasting blood sugar should no way go higher than 110 mg/dL.

LIFE AFTER A HEART ATTACK

Now back at work, Sharma has overhauled her daily routine with a strict discipline she once lacked. “I start my day with a half-hour walk, followed by one hour of yoga. I do asanas, pranayama, even one-minute holds,” she says. She now eats on time and starts her day with a balanced breakfast to set her up for the day, something she rarely did earlier. A vegetarian, she avoids oil, preferring steaming over deep frying.

Her stress levels have not reduced as politics is a 24-hour job. “But I have learnt to offset and manage it with meditation and yoga. I can’t leave my work but I can take care of myself while doing it.” For a woman leader navigating the chaos of Delhi politics, that balance may be her strongest victory yet.