LADIES, TAKE IT TO HEART
Cardiac disease is no longer just a male problem in India. As the gender gap closes on heart attacks and younger women start to show symptoms, here’s how to keep on ticking
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, to be sure. Pagare, 38 then, remembers feeling shocked when Dr Prafulla Kerkar of KEM Hospital told her she was displaying 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?
The 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, rates of cardiac issues among men and women rapidly become similar.
HEART AND HORMONES
So, what does oestrogen do?
Heart attacks occur when 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 stabilises this lining. But hormonal protection is only one favourable factor. Other lifestyle factors increase risks of heart attacks in women.” Dr Abhishek Wadkar, cardiologist at Mumbai’s Nanavati hospital has sobering news for those Not Just The West: For Indians, a heart attack can come 10 years earlier than for someone in the West.
Not Just The Men: The gender gap is closing on cardiac diseases.
Not Just A Minority: 272 Indians per 1 lakh die of heart diseases a year
Not Just Old People: Women in their 30s now experience cardiac blockages.
Not Just A Textbook Warning: Rather than chest pain, it can be stomach or neck pain, nausea or breathlessness.
Have a family history of heart trouble, be it a male or female relative
Are diabetic or pre-diabetic. Test positive for hypothyroism Have a history of miscarriages Use oral contraceptive pills
Have a sedentary lifestyle, regardless of your daily chores
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 national ‘Report on Medical Certification of cause of Death – 2013’ shows that 26.8 % people in India died of heart attacks.
NO GENDER BIAS
Although 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 is “quite noticeable,” 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 says.
Among the young, stress is a major driver of early onset cardiac ailments. “City women, have to deal with household stress plus workplace stress,” he points out. “Working women also tend to eat at odd hours, which may not be healthy.”
It’s not just working women or smokers. “A lot of my patients are housewives,” says Dr Bhabha Das, senior cardiac surgeon at Delhi’s Indraprastha Apollo hospital. “Maybe it is also a lack of time to exercise.”
Shobha Rani Goel, 45, started having a weird pain on her left side and the chest on Raksha Bandhan. She put it down to gastric problems owing to festive food. Two days later, the pain was back, and worse.
“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 surgery 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 minding her clothing shop downstairs.
“We also found that she had been a diabetic,” says Dr Mathur. “Early onset of diabetes is a contributing factor.”
BEAT MARSHALLED
Hypothyroism – a condition in which the thyroid gland does not produce enough thyroid hormone – is another factor. Women form 80 % of people with this condition. Other factors are family history, obesity, hypertension, a history of miscarriages and even 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.
Specialists agree that a lifestyle change works best. Dr Wadkar suggests a healthy diet, concrete steps to reduce stress, no smoking and reduced alcohol intake.
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.
“Stress is inevitable, but I keep myself calm through yoga and meditation. I also make sure to go to my cardiologist for annual follow-ups.”
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