Most conversations around heart attacks are focussed on men, probably because historical triggers like smoking and stress are more easily attributed to men than women. Also, heart attacks in women tend to be lesser than men in their reproductive years because of the naturally protective effect of female hormones like oestrogen. But after menopause, women catch up with men very fast and are just as much at risk, reporting high levels of cholesterol and triglycerides. Not only that, mortality from a heart event is higher in women than men. HOW ARE SYMPTOMS DIFFERENT? Heart disease among women continues to be under-recognised, underdiagnosed or simply diagnosed late. Part of that has to do with the fact that the symptoms of heart attack in women are different from those of men. Most men usually report sharp chest pain, particularly in the centre of the chest. Although this is the most identifiable marker, the pain could radiate to the left arm, right arm, upper part of the torso, sometimes going up to the jaw. But in women, symptoms are atypical and confusing and are more likely to be missed by doctors. They may report dull discomfort in the tummy, nausea, anxiety (this is mostly misread), a little pain in the jaw, some fatigue and dizziness. Sometimes women also tend to overlook heart attack symptoms as some minor issue. This delays the time in seeking diagnosis and even the treatment protocol. Also, once an intervention is done, like angioplasty or bypass surgery, the outcome is likely to be less favourable for women than men. There are no clear answers yet as to why this happens. Maybe it has something to do with the smaller size of arteries in women. The American Heart Association has highlighted many disparities of heart attacks between men and women. It found that within a year of a first heart attack, survival rates were lower in women than in men despite factoring in age. And within five years, it estimated that 47 per cent of women who had experienced a first heart attack would die, develop heart failure, or suffer from a stroke, compared to 36 per cent men. CHANGING AGE PROFILE Ten years ago, if a woman in the reproductive age complained of chest pain, we would seldom consider it as a heart attack at the word go. Now with younger women, as young as 35, reporting heart episodes, we do not take a chance and assess cardiac health on priority. So, what’s raising their risk of heart disease if their oestrogen is protecting them? Clearly, the rising incidence of diabetes and obesity in younger people and smoking are to be considered. This deadly combination makes younger women more prone to developing blockages in their arteries. Smoking among younger women, particularly in urban centres, has increased and has become habitual. Smoking tobacco sharply reduces HDL or good cholesterol in women. WHAT TESTS SHOULD WOMEN UNDERTAKE? Given their increased risk compared to men, women need to go for a battery of tests should they complain of what might look like heart attack symptoms. Let me clarify here that women have a higher chance of having a false positive TMT result, which means they could be subjected to more invasive tests and angiography. I would say a stress echo is more reliable for women than a simple TMT. A decision on medical protocol should not be based on TMT alone but after assessment of other factors. In the end, women should not take their heart health for granted but prioritise regular tests and most importantly, make lifestyle corrections early enough.
