Surekha Pagare was on her way to work in Mumbai when she broke out into a sweat. She became breathless and her neck began to hurt. She dismissed this odd discomfort as tiredness caused by her stressful routine as a mammography technician. But she knew something was off. She decided to get tested, just to be sure.Pagare was 38 at the time and remembers feeling shocked when Dr Prafulla Kerkar of KEM Hospital informed her that the symptoms she was displaying were signs of an impending heart attack. She underwent an angioplasty and was able to avoid the worst because of timely intervention.But how did someone so young, especially a woman, develop an ailing heart?Pratik Chorge/HT PhotoSurekha Pagare (pictured here) was 38 when she experienced the onset of a heart attack.The prevailing belief is that pre-menopausal women are protected from a heart attack thanks to their high levels of oestrogen. The truth, however, is that heart attacks kill more women than cancers. The female hormone oestrogen offers some protection against heart disease, but after menopause, heart disease rates among men and women rapidly become similar.Your Heart and Your HormonesSo, what does oestrogen do?Heart attacks occur when there is blood flow to the heart is blocked, often by arteries clogged with cholesterol.“Cholesterol can clog an artery only after it has broken through the endothelium lining of the blood vessel,” says Dr Atul Mathur, director, of interventional cardiology at Fortis Escorts Heart Institute, Delhi. “Oestrogen is known to stabilise this lining, thus preventing cholesterol deposition. But hormonal protection from heart attacks is only one favourable factor. All the other lifestyle factors increase the risk of women getting heart attacks.”Dr Abhishek Wadkar, cardiologist at Mumbai’s Nanavati hospital has some sobering news for those who like to compare India and the West. “The average Indian is genetically predisposed to early heart disease and is likely to suffer a heart attack 10 years earlier than his or her Western counterparts,” he says.In India, 272 people per 100,000 people die of cardio-vascular diseases, including heart attacks, as compared to only 235 per 100,000 on average globally, according to the Global Burden of Disease study.The culprits are the usual suspects: Increased stress levels, poor eating habits, odd working hours and alcohol and tobacco addictions. Indian women are as susceptible to these as men, which means they suffer their effects as much too.The national ‘Report on Medical Certification of cause of Death – 2013’ shows that 26.8 % people in India died of heart attacks. Beat by beat: steer clear of myths about heart diseaseNot Just The West: The average Indian is likely to suffer from a heart attack 10 years earlier than his or her Western counterparts.Not Just The Men: The gender gap is closing. Women, even young women now suffer cardiac ailments.Not Just A Minority: In India, 272 people per 100,000 people die of cardio-vascular diseases, including heart attacks, as compared to only 235 per 100,000 on average globallyNot Just Working Women: An increasing number of housewives, with sedentary lifestyles report heart problems.Not Just Old People: Women in their 30s are now being diagnosed with cardiac blockages. Stress is a major driver of early onset cardiac ailments Not Just A Textbook Warning: Often, rather than chest pain, women report breathlessness, neck or stomach pain and symptoms that resemble indigestion, such as nausea.No Gender BiasAlthough, more men die of heart attacks, the gap between the sexes is closing fast.The rise in the number of pre-menopausal women having heart attacks and other lifestyle related heart diseases is “quite noticeable,” according to Dr Mathur. “Currently, anywhere between 5 and 10% of all my patients are younger women. A decade earlier, the number was just 1%,” he said.Among the young, stress is a major driver of early onset cardiac ailments. “Women, at least in the metro cities, have to deal with their household stress along with workplace stress – both physical and mental,” he points out. “Also, working women tend to eat at odd hours, trying to squeeze in the meal in between their busy schedules. The food is also whatever is available, which may not be a healthy option.”It’s not just working women either.“A lot of my patients are housewives,” says Dr Bhabha Das, senior cardiac surgeon at Delhi’s Indraprastha Apollo hospital. “Maybe it is the household stress, coupled with the fact that they do not get time to exercise. And not all the patients are regular smokers.”Shobha Rani Goel, 45, started having a weird pain on the left side of her body and the chest on Raksha Bandhan. She put it down to gastric problems brought on by festive food. However, two days later, the pain was back. This time it was unbearable. When over-the-counter solutions didn’t work, her husband took her to the nearest hospital.Burhaan Kinu / Hindustan TimesShobha Rani Goel is a heart patient whose condition was worsened due to early onset diabetes.“The doctors told me that I’d had a heart attack and that there was still a blockage in my heart for which I needed a surgery,” said Goel. She underwent an emergency to clear 100% block in one artery. Looking back she knows what went wrong. Her life was sedentary. She used to do her household chores in the morning and then spent the day attending to customers in her clothing shop downstairs.“We also found that she had been a diabetic,” says Dr Mathur. “Early onset of diabetes is a contributing factor.”Tick talk: Women, get your heart checked if youSmoke, are a passive smoker or drinkExperience stress at work or home or bothTend to eat at odd hours, and end up eating unhealthy foodAre diabetic or pre-diabetic. Early onset of diabetes contributes to heart diseaseTest positive for hypothyroismHave a family history of heart trouble, be it a male or female relativeHave a history of miscarriagesUse oral contraceptive pillsHave a sedentary lifestyle, regardless of your daily choresKeep it tickingHypothyroism – a condition in which the thyroid gland does not produce enough thyroid hormone – is another factor associated with heart disease. About 80 per cent of people with this condition are women. Other factors are family history, obesity and hypertension or a history of multiple miscarriages.Many studies also link women’s heart disease to the use of oral contraceptive pills. “They can form clots, which get stuck in the arteries,” says Dr Upendra Kaul, director of cardiology at Fortis Hospitals.And unlike men, the symptoms aren’t always textbook. Often, rather than chest pain, women report breathlessness, pain or discomfort in the neck or stomach and symptoms that resemble indigestion, such as nausea. As a result, underreporting and misdiagnosis are both a problem.So what steps can young women take to protect their hearts?Most specialists agree that a lifestyle change is of utmost importance. If you think this means adding exercise to your already full routine, you may want to think again. “Exercising at odd hours is almost as bad as none at all,” says Dr Wadkar. He suggests a healthy diet, concrete steps to reduce stress, no smoking and reduced alcohol intake.“Women need to realise that even they can get a heart attack and at a young age and make necessary lifestyle changes like eating healthy and exercising regularly,” says Dr Mathur.Surekha Pagare managed to keep her heart healthy for a decade in part because of a strict low-fat diet and an exercise regimen that includes yoga and jogging.Pratik Chorge/HT PhotoSurekha Pagare keeps stress at bay through yoga and meditation.“When I had the heart incident, I was physically fit – always on my toes and up and about with no trouble, but I was always stressed out,” she says. “Stress is inevitable, but I keep myself calm through regular yoga and meditation. I also make sure to go to my cardiologist for annual follow-ups.”The doctors also suggest that once women hit 30, they should get a fasting blood sugar level, blood pressure and cholesterol checked every three to four years, particularly if there is a family history of cardiac disease.