Heart disease and stroke kill more than 8.5 million women worldwide, which is more than HIV, tuberculosis and malaria deaths put together. In India, women account for half of the annual 3 million deaths from the two diseases.
Yet, the risk for women remains under-estimated, both by doctors and women themselves. On an average, women develop heart disease 10 years later in their life than men, but they rapidly catch up after menopause because of ovarian hormone deficiency that favours hypertension, diabetes, hyperlipidemia, central obesity and the metabolic syndrome.
Adding to risk is the fact that nine out of 10 women in India over 50 years have low levels of heart-protective good cholesterol (high density lipoprotein or HDL) and almost half have high blood levels of C-reactive protein (levels of this protein increase during systemic inflammation), both factors that heightens risk.
Obesity in women also plays havoc with their lipids (blood fats such as cholesterol and triglycerides, high levels of which cause heart attacks and stroke). According to the National Institute of Public Cooperation and Child Development, 37.5 per cent women in Punjab, 34 per cent of the women in Delhi and 30 per cent in Kerala are obese, with almost all reporting abdominal obesity (tendency to put on fat around the stomach), both independent risk factors for diabetes and heart disease.
Complicating matters further is the fact that women have atypical heart attack symptoms. Instead of the telltale symptom of angina (burning sensation, tightness or pain in the chest), women may just experience breathlessness, weakness, unusual fatigue, cold sweat, giddiness or neck and shoulder pain. With fatigue or weakness, many do not even realise they are experiencing a heart attack when they get one.
The good news is that the world is waking up to the gender bias in scientific research. Only 50 per cent of the clinical trials conducted in the last three years have enrolled both men and women. They showed an analysis of studies by gender at the Red Alert for Women’s Hearts Conference in France on November 5. Professor Stramba Badiale of the Istituto Auxologico Italiano reported that of the 62 randomised clinical trials published in Europe between 2006 and July 2009, only 33.5 per cent of the enrolled participants were women.
Till they get the balance right, women should start getting treated for heart disease even with two of these risk factors: smoking, family history of a parent or sibling having heart disease before 50 years, overweight, hypertension, low good cholesterol, high triglycerides or high blood sugar.