Heart diseases (Heart Attack) in women: How to understand symptoms and risk factors?

According to physician and epidemiologist Prof. K. Srinath Reddy, smoking significantly lowers HDL cholesterol and significantly raises the risk of heart attack in women, even more than it does in males.

It was a common misperception fifty years ago that men were more likely to suffer from heart disease. The reason for this is that males were more likely to adopt behaviours that raised their chance of developing heart and blood vessel disease. Hormonal impacts on women were protective before menopause. A male-dominated medical research organisation created and tested diagnostic tools only on males before applying them improperly to women, frequently ignoring the indications and symptoms of heart disease in female patients. Men only were the focus of health education messaging and risk reduction programmes. Even drug clinical studies had only male participants. Fewer women sought treatment for symptoms because the threshold for diagnosing cardiac disease was excessively high in this population. Doctors who did not anticipate this frequently misdiagnosed those who did. women to have heart disease.

Cardiovascular disease is the leading killer in the world. It affects your heart and blood veins throughout the body, including those that feed blood to the heart and brain. Women who smoke during the third trimester of pregnancy may be at an increased risk of heart disease.


Internal valves which separate the chambers of the heart are also vulnerable to disease. Rheumatic heart disease was till recently a widely prevalent cause of autoimmune valve damage in young persons, with some forms more common in women.

This is related to an inability to produce nitric oxide which reduces blood flow to the heart muscle. The condition caused a bacterial infection of the heart muscle with streptococcus bacteria. It ultimately resulted in a heart attack. This often occurs in people with heart disease. With widespread use (and misuse) of antibiotics and improved living conditions, this threat has receded. Age-related degeneration of some valves may occur in older decades of life.

The covering of the heart can also become inflamed (pericarditis) due to viral or tubercular infection. The arteries supplying blood to the brain, lungs or limbs can manifest disease in many ways. High blood pressure can arise during pregnancy, threatening both mother and child. The veins are not exempt  — the deep veins of the legs and pelvis can develop clots that may travel to the lungs and threaten life (pulmonary embolism).


Women can develop cardiovascular illness in a variety of ways, but the two main causes globally are coronary heart disease and cerebrovascular disease. Heart attacks or angina are the former’s symptoms. The latter results in brain attacks (temporary or permanent paralysis of some body parts). Both of these rise in frequency with some regional differences where these two disorders are more predominate when cultures go through developmental transitions. These occur more frequently as life expectancy rises, though they can also happen earlier in life as lifestyles change. to develop health system capacity for effective management of these illnesses, identify risk factors and early warning signs, and promote long-term self-care in order to avoid these disorders through public health programmes.

Dispelling the notion that heart and blood vessel disorders are infrequent in women is crucial for these to take place. The greatest cause of death for women is cardiovascular disease in many nations. The risk factors for heart disease and stroke are many and largely controllable. Blood vessels throughout the body are toxic due to high blood pressure, smoking, diabetes, obesity, bad eating habits that lead to aberrant blood fat patterns, and physical inactivity, with the blood arteries supplying the heart and brain being particularly vulnerable.


Female sex hormones typically preserve the blood arteries before menopause. Women of reproductive age had higher levels of protective HDL blood cholesterol than men. Even more so than in men, smoking significantly lowers HDL cholesterol and raises the risk of heart attacks in women. Thus, the slogan “If women smoke like men, they will die like men” was created to combat the tobacco industry’s efforts to market to women. In many women, high blood pressure is common. Diabetes is increasingly prevalent when body fat percentage rises (especially when it accumulates in the abdomen). Men typically have a reversal pattern of fat distribution, with women typically having more hip than belly fat (pear-shaped bodies) (apple shaped). When women smoke, stop exercising, gain weight, experience high levels of stress, get diabetes, or become physically sedentary, this distinction is eliminated. Then, women tend to experience heart attacks at a young age.

Polycystic ovary syndrome (PCOS) is associated with a higher risk of vascular disease due to many associated metabolic abnormalities, and may manifest as coronary disease at a young age.


Heart attack symptoms in women aren’t usually the same as in men. Instead of the crushing central chest pain that men experience, there may be a mild ache in the chest. Instead of being in the chest, the discomfort could be in the upper back, neck, lower jaw, arm, or upper abdomen. The sole symptoms can be extreme weariness, total exhaustion, or shortness of breath. Even when blocks are not restricting the veins, women may have chest pain as a result of occasional spasm of the coronary arteries. These aches have nothing to do with effort.

Microvascular disease, a condition that affects the tiny blood arteries that nourish the inner layers of the heart muscle, is more common in women. When compared to the “traditional” symptoms in males, many of these presentations are “atypical,” therefore doctors educated on textbook descriptions derived from male experience may miss the diagnosis. Men’s interest in women’s hearts was limited to Valentine’s Day emojis until lately.

Early follow-up studies showed that coronary angioplasty and stents benefit women less than males, whether as a result of late identification of coronary disease, greater age at presentation being associated with more comorbidities, or as a result of smaller coronary arteries. These discrepancies have been reduced by recent developments in medicated stents and newer anti-clotting drugs. Delay in diagnosis and treatment, however, continue to be issues, particularly in low- and middle-income nations.


Cardiovascular disease, manifesting as compromised blood supply to the heart or brain, is becoming a major challenge to the health of women in India. Several recent studies have indicated high prevalence of coronary risk factors (like hypertension and diabetes) in Indian women, especially in urban areas. Low HDL cholesterol and high triglyceride levels (indicative of the ‘metabolic syndrome’) are common in India and pose a high risk of cardiovascular disease.

The recent National Family Health Survey (NFHS-5) reports that 24 per cent of the Indian women aged between 15 and 49 years are overweight or obese, while 56.7 per cent have abdominal obesity. These portend a high risk of future cardiovascular disease and diabetes. Cultural barriers of a patriarchal society reduce opportunities for regular exercise, even as consumption of unhealthy foods is increasing due to malign market mechanics. It is essential that we create social conditions wherein women can promote and protect their health, even as health systems must gear up to assess and correct cardiovascular risk at various stages of their lives.

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