Archana Mirgan played Under-19 cricket for Delhi in her teens and treks regularly with her husband and daughter. “People often remark on how active I am,” says Mirgan, 48.
She was diagnosed with heart disease two weeks after she returned to her Faridabad home after a trek to Amarnath with her family. Mirgan was just 40.
“It started with breathlessness and chest pain during the short walk from the car park to my office. I had to sit down for 15 minutes to get my breath back,” said Mirgan, who lives in Faridabad and works in Gurgaon. “When it happened two days in a row, I got screened for heart disease and was told I needed an emergency angioplasty to unblock two blood vessels in my heart.”
Mirgan was stunned by the diagnosis. “I felt cheated,” she says. “I’ve played active sports for half my life and had my annual health screening just a month before the angioplasty. My blood pressure, diabetes and cholesterol results all came back normal.”
Women at risk
Most people believe heart risk for women begins after menopause because of the protection offered by the female hormone oestrogen, which makes the blood vessels flexible to better accommodate fluctuations in blood flow. But other risk factors – smoking, obesity, diabetes, inactivity, using contraceptive pills and stress – counter oestrogen’s protective benefits and make disease rates nearly the same for both genders in India.
“Heart disease and stroke are the two biggest killers of women with diabetes,” says Dr Ravi R Kasliwal, chairman, clinical and preventive cardiology, Medanta. “In South Asians, obesity, diabetes and hypertension are stronger predictors of heart disease than in other ethnic groups, more so in women than men.”
What worked against Mirgan was her weight – she stood at 150 cm and weighed 72 kg – and undiagnosed insulin-resistance, a precursor to diabetes.
South Asians, both men and women, are also at higher risk because they have high abdominal fat – that spread around the stomach – which presses against vital organs and interferes with function. Fat distributed around the stomach puts South Asian women at risk of heart disease when their waist size crosses 32 inches, compared to 36 inches for Caucasians and other ethnic groups.
“Indians tend to have several metabolic anomalies. Most have higher levels of blood fats called triglycerides, low good cholesterol (HDL) and insulin resistance, but the strongest risk comes from high levels of lipoprotein (a), a type of bad cholesterol that leads that leads to atherosclerosis (thickening of the walls),” says Dr Ashok Seth, chairman of Fortis Escorts Heart Institute, New Delhi, and head of the Cardiology Council of the Fortis Group of Hospitals. More than one in three (35% to 40%) of Asian Indians worldwide have high levels of lipoprotein (a).
“Smoking and taking contraceptive pills raises heart attack risk for women by making the blood viscous and more prone to clotting, which can block blood flow,” said Dr Seth.
While the chances of a heart attack or stroke are very low for women under 35 years having low-dose hormonal contraceptives, the risk rises with age, found the world’s largest ever study of 1.6 million women in The New England Journal of Medicine.
Most South Asian women do not meet the 150 minutes of moderate-intensity activity a week recommended by the World Health Organization either.
While more men smoke, hypertension (persistent high blood pressure), diabetes, obesity and family history of heart disease are more common in women in India, showed data from 6,867 patients at an Ahmedabad hospital. Women also get sub-optimal treatment, irrespective of age or economic status, found the study, with invasive treatment options such as bypass surgery or stents being used less often to treat women. Instead, women were more often prescribed medicines to manage disease, irrespective of the risk factors or the extent of disease.
Traditional heart function tests such as the treadmill test is also not sensitive enough for women and may give false results, so an early angiography, cardiac CT scans and stress echocardiography are the tests of choice for early diagnosis.
The answer, doctors say, is also to start thinking about heart disease differently.
“Focus on prevention and early diagnosis,” says Dr Seth. “That done, heart disease can be easily managed with prescription medicines to control blood fats, sugar and blood pressure, along with a healthy diet.”
Diagnosis is missed in women because they often experience atypical symptoms. Instead of angina (burning sensation or pain in the chest), breathlessness, giddiness or neck and shoulder, neck and jaw pain are the only signs of heart trouble for many women.
Most put the symptoms down as signs of anxiety or general exhaustion and don’t seek treatment.
Renu Shivani, 45, had been feeling breathless and exhausted for a month before she finally made an appointment with her doctor. “I thought he would tell me to take it easy and eat better,” says the homemaker and mother of one from Mumbai.
Instead, she was told she had a heart condition and needed a bypass surgery, which she underwent two months ago.
“Even though I have a family history of cardiac disease, it came as a complete surprise — perhaps because both my parents developed their heart condition much later in life,” she says.
Her GP suggested she see a cardiac specialist and the diagnosis was angina — a tightness in the chest caused by an 80% blockage in a main artery.
“Angina doesn’t always show up as chest pain,” says Dr Tilak Suvarna, the senior interventional cardiologist at Asian Heart Institute who treated Shivani. “It can manifest as back pain, shoulder pain, jaw pain, arm pain or, as in Renu’s case, throat pain”.
Adds Dr Brian Pinto, a cardiologist at Mumbai’s Holy Family hospital: “Homemakers particularly fail to take symptoms seriously. With heart disease, this can be a fatal flaw.”
To lower the risk
• Blood pressure should be below 130/80 hg/mm
• Bad cholesterol (LDL) under 100 mg/dl
• Good cholesterol (HDL) above 45 mg/dl for men and 55 mg/dl for women
• Quit smoking and you halve heart attack risk
• Eat a high-fibre diet of vegetables and fruit, whole grains, fish, pulses, legumes, and unsaturated oils (mustard, olive, sunflower, rapeseed)
• Exercise briskly for 40 minutes a day
• Keep your weight in check
(With inputs from Shrishaila Bhandary)
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