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The heart of the gender divide

Most women believe they are immune to heart disease till they hit menopause. Wrong! Though the female hormone estrogen offers women some protection from heart problems until its levels drop after menopause, women have been losing the edge, writes Sanchita Sharma. See graph.

india Updated: Sep 28, 2008 14:43 IST
Sanchita Sharma

Most women believe they are immune to heart disease till they hit menopause. Wrong! Though the female hormone estrogen offers women some protection from heart problems until its levels drop after menopause, women have been losing the edge because of increasing incidence of hypertension (high blood pressure), diabetes and obesity in them.

Worse, 9 out of 10 women in India over 50 , 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 the factors put them at a very high risk of developing diabetes and heart disease, and the risk increases manifold after menopause.

“The study, published in the Journal Nutrition Metabolic and Cardiovascular Diseases, explains why cardiovascular diseases have suddenly become the leading cause of death for women once heart-protective estrogen levels fall after menopause,” says Dr Anoop Misra, lead author of the study.

High obesity levels in women also have a role, as does their poor lipid (blood fats such as cholesterol and triglycerides) profile. According to the National Institute of Public Cooperation and Child Development, 37.5 per cent women in Punjab, 34 per cent 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.

Not only is heart disease striking women at a younger age than they did a decade ago, but it is also creeping up insidiously. In most cases, women do not even know they have a problem until they end up in hospital with a heart attack.

Standard diagnostic tests such as a treadmill test, used to measure future heart attack risk, show a strong gender bias against women, and report more false negatives and false positives than for men. For women, cardiac CT scans and MRIs are more accurate. These, however, are also more expensive and are almost never part of a basic heart preventive check-up.

Complicating matters further is that fact that heart attack symptoms tend to be atypical in women. Instead of the tell-tale symptoms of angina (burning sensation, tightness or pain in the chest), women may have breathlessness, weakness, unusual fatigue, cold sweat, giddiness or neck and shoulder pain. With the patient only reporting fatigue or weakness, her family and sometimes even the physician do not realise she is experiencing a heart attack.

That’s why experts insist women with even two of the conditions that include overweight, hypertension, low good cholesterol, high triglycerides and high blood sugar, should start aggressive drug treatment even if there are no symptoms.