Women and heart disease: Why their risk is often underestimated

Men are often considered more vulnerable to heart attacks, but women can face distinct cardiovascular risks. Dr Ashok Seth explains that they may experience symptoms that are mistaken for gas, acidity or fatigue.

In Short

• Women can have heart attack symptoms that are easy to mistake for indigestion
• Diabetes and high blood pressure can carry a stronger heart risk for women
• Exercise-related chest discomfort, breathlessness or pain needs attention

For years, heart disease has been seen largely as a man's health problem. But that assumption can leave women underprepared to recognise their own heart attack symptoms.

In an episode of Doctor vs Internet, Sonal Mehrotra Kapoor spoke with Dr. Ashok Seth, Chairman, Fortis Escorts Heart Institute, Okhla, New Delhi, where he talks about how women can have different presentations of heart disease, and some symptoms may be mistaken for indigestion, gas or simple tiredness.

The American Heart Association notes that conditions such as diabetes and high blood pressure can increase heart attack risk more strongly in women than in men. In India, ischaemic heart disease is the leading cause of death among both men and women, according to WHO data.

Heart disease can present differently in women, making it easier to overlook. A Siemens Healthineers study cites an analysis of more than 1.1 million heart attacks in which 42 per cent of women did not experience chest pain, compared with 31 per cent of men. Instead, some women reported shortness of breath, nausea, dizziness, abdominal discomfort, jaw pain, weakness or unusual fatigue. A systematic review cited in the study similarly found that about one-third of women did not report chest pain even when asked directly.

The consequences can extend beyond recognising symptoms. The study cites a 20-year US analysis that found women with angina were more likely than men to receive a delayed or no diagnosis, even when their symptoms were similar. Awareness is another concern, the proportion of women surveyed by the American Heart Association who knew heart disease was the leading cause of death fell from 65 per cent in 2009 to 44 per cent in 2019, with the decline particularly marked among younger women.

For Indian women, the absence of classic chest pain should not be taken as reassurance. Cardiovascular risk can also be shaped by pregnancy-related complications, hormonal changes and menopause. The study notes that conditions such as pregnancy-related hypertension may influence cardiovascular risk later in life, making a woman's reproductive and medical history relevant when assessing her heart health.

WOMEN’S HEART RISK IS NOT JUST ABOUT CHEST PAIN

A common misconception is that a heart attack always means severe chest pain.

Chest discomfort or pressure remains the most common symptom in women too. But women can also experience breathlessness, nausea, unusual tiredness, or pain in the back, shoulder, arm, neck or jaw.

This is one reason heart attack symptoms in women can sometimes be missed.

Here is the link for the podcast:

HEART ATTACK OR GAS? THE DIFFERENCE MAY BE IN WHEN IT HAPPENS

According to the doctor, the commonest heart-related symptom is discomfort or pressure in the centre of the chest, particularly during exercise, brisk walking or climbing stairs.

The discomfort may travel down the arm or towards the neck and can settle after stopping the activity or sitting down.

But some people experience burning, gas or what feels like gastritis instead.

The doctor says this is where people need to be careful.

Anything that repeatedly comes on with exercise should not simply be dismissed as gas.

That includes breathlessness, chest discomfort and even pain in the back or jaw while walking or exercising.

WHY WOMEN MAY MISS THE WARNING SIGNS

The symptoms of a heart attack can vary from person to person. In women, symptoms such as indigestion, nausea, breathlessness, unusual fatigue and back or jaw pain can occur alongside or without obvious chest pain.

That can make it easier to attribute the problem to acidity, exhaustion or another everyday issue.

The doctor warns that this can lead to a dangerous delay in reaching hospital.

WHY EXERCISE-RELATED DISCOMFORT MATTERS

The doctor says some people continue to assume they have gas even as the symptoms persist. By the time they reach hospital, several hours may have passed and the heart could already have suffered damage.

The doctor estimates that around 15% of heart attacks may be missed because people mistake their symptoms for gas.

That is why the timing of the symptom matters. If discomfort, breathlessness or pain repeatedly appears during brisk walking, climbing stairs or exercise, it needs medical attention.

THE HEART ATTACK SIGNS WOMEN SHOULD KNOW

Chest pressure or discomfort, pain in the arm, back, neck or jaw, shortness of breath, nausea and unusual tiredness can all occur during a heart attack.

Not every episode of gas or chest discomfort is a heart problem. But a new or unusual symptom, particularly one linked to physical activity, should not be casually dismissed.

The bigger message is simple: women should know that heart disease is not only a man's problem, and symptoms that feel like gas can sometimes need a closer look.

- Ends