Written by: Dr Nishith Chandra
6 min readJul 11, 2023 05:26 PM IST
First published on: Jul 11, 2023 at 09:00 AM IST
We tend to be surprised as younger women are having more heart attacks than before but the trends were caught in the Atherosclerosis Risk in Communities study a couple of years ago. Researchers reviewed more than 28,000 hospitalisations for heart attacks in four cities and were surprised to find out that while the heart attack rate had decreased among older adults, it had risen in women aged between 35 and 54 years old, basically, those in their reproductive cycle. Traditionally, the menstrual phase of women, with active estrogen, was believed to have protected them from early heart attacks. But as cardiologists, neither do we disregard the possibility of early onset symptoms of a heart attack, nor do we ignore chest pain or discomfort of any kind among women.
Clearly, there is an increased prevalence of risk factors accompanying current lifestyle behaviour among younger women. Topping the threat threshold is the fact that more women are turning smokers at an earlier age, elevating their risk.
Smoking: Smoking tobacco is known to sharply reduce high-density lipoprotein (HDL) or good cholesterol. Besides, it causes inflammation, increases coagulation or thickening of the blood and damages the lining of the arteries. Smoking is reported to have increased the risk of heart disease and stroke by two to four times in both men and women. Also, women smokers have a 25 per cent higher risk of developing heart disease as compared to men smokers. Carbon monoxide and tobacco deprive your heart, brain and arteries of oxygen.
Then there’s vaping that has been flagged by the American Heart Association too. Did you know that vaping can increase the risk of heart attacks by 34 per cent? There is irrefutable evidence on the negative attributes of Electronic Nicotine Delivery Systems (ENDS) on human health. E-cigarettes may be banned but are accessed clandestinely.
They may not contain tobacco per se but they contain nicotine, which is a toxic chemical and the principal ingredient of tobacco, unregulated levels of which cause addiction among users. The flavours are intended to target adolescents and young adults, who end up not having control on the nicotine they take in. Vaping has been shown to increase the risk of the subsequent addiction to cigarette smoking. Also, nicotine dependence levels in young e-cigarette users have been reported to be over two times higher compared to traditional tobacco smokers. Nicotine causes dysfunction in the lining of blood vessels, restricting the development of new blood vessels and stoking inflammation. Daily use of e-cigarettes has been found to be independently associated with an increased risk of heart attacks. We cannot ignore substance abuse among young women too, which increases the risk of heart-related deaths due to decreased blood supply to the heart or arrhythmias.
High stress levels: Young women are exposed to higher stress levels at the workspace than say even a generation ago. While competitive work schedules mean that they are just as achieving as men, we forget they are also picking up additional role responsibilities expected of their familial role, where they have no help or task-sharing. Accelerated stress levels stimulate production of adrenaline and cortisol, which result in inflammation of arteries and formation of atherosclerotic plaque and thrombus or blood clots. These can lead to an unstable angina, heart attack and sudden cardiac arrest. Sometimes in younger women, smoking is often stress-induced.
Unregulated use of birth control pills: More and more younger women are becoming sexually active earlier in their life cycle and consuming oral hormonal pills to prevent pregnancy, which impact the heart. Studies have shown how hormones in birth control pills can raise your blood pressure if you are hypertensive. Most women do not get their BP checked before they start popping the pills. Neither do they rely on medical advice as they buy them over the counter. Contraceptive pills are thrombogenic or cause blood to clot. These also change the composition of blood fats, reducing HDL and increasing low-density lipoprotein (LDL) and triglycerides.
Traditional lifestyle risk factors: Obesity, sedentary lifestyle, poor diet and lack of exercise are just as common among young women as men. Then there’s diabetes, which in itself increases one’s risk of heart attacks by two to four times. Generally diabetes is also associated with obesity, hypertension and deranged lipid levels which together increase the risk of heart attacks significantly. According to a recent study, the prevalence of hypertension in Indians less than 30 years of age is said to be 11.2 per cent. Hypertension leads to thickening of your arteries.
Know and control your risk factors: Monitor your blood pressure, blood sugar and cholesterol levels regularly. If any of these factors seems to be outside the healthy range, work with your healthcare provider to manage them effectively. Understand your family’s medical history, particularly regarding heart disease, and share this information with your healthcare provider. It can help determine if you have an increased risk and need appropriate preventive measures.
Seek regular medical check-ups: Visit your healthcare provider for routine check-ups, even if you feel healthy. Regular screenings and assessments can identify any underlying health concerns and allow for early intervention if needed.
It is time to shed traditional ideas about heart attack as a matter of concern for men. Heart disease is the leading cause of death for both men and women. So it’s just as important for women of every age to be alert about symptoms, some of which are not too pronounced, and seek immediate medical attention. Leave no room for doubt.
More and more younger women are becoming sexually active earlier in their life cycle (Source: Getty Images/Thinkstock) 
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