Pune: When 38-year-old Mridula (name changed) recently walked into a doctor’s clinic in the city, she did not expect to get a positive stress test indicating cardiac distress. Accompanied by her husband, both educated and from an affluent background, Mridula was advised an angiogram. However, she was hesitant, while her husband blamed the result on her eating habits and left, followed by the patient.This, according to several doctors TOI spoke to, is a not-so-rare reaction when it comes to women’s heart health. Many women patients, they said, tend to ignore symptoms till a serious cardiac event occurs.DrMilind Gadkari, head of the cardiology department at KEM Hospital, Pune, recollected attending to this patient. He told TOI, “In the first two decades of my career, I encountered fewer women patients with heart-related issues. The scenario has changed significantly now, with at least two to three women under 50 visiting the clinic each month, some even in their early thirties.Social bias, particularly in rural areas, further delays timely referrals, leading to misdiagnosis and late detection. Withnon-communicable diseases (NCDs) more common these days, contributing to the development of metabolic syndrome, women are more likely to have microvascular disease. Regular screening —particularly for women over 40 or those with existing health conditions —is a must.”Metabolic syndrome refers to a cluster of conditions like high blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol levels, that together drastically increase the risk of heart disease, stroke, and Type 2 diabetes.On World Health Day, marked by the World Health Organisation (WHO) on April 7, city doctors shone the spotlight on cardiological issues in women, calling for more research and better training of doctors to diagnose the same.Cardiologist Dr Amanpreet Singh Wasir said, “The difference in gender-based cardiac problems also oftenleads to delays in diagnosis and treatment.Research shows that women are also less likely to be prescribed evidence-based therapies such as statins, aspirin, and blood pressure medications at the same rate as men, even when they present with identical risk profiles. Women are underrepresented in most landmark cardiovascular clinical trials, meaning much of the treatment data that guides clinical decisions today was generated primarily from male participants.“To help doctors better diagnose cardiological issues in women,Hridayamrit Foundation (HAF), an NGO founded by Dr Wasir, conducted a special inaugural session on women’s heart health on March 28. Thehybrid event brought together cardiologists and public health experts from India and abroad to discuss the growing burden of cardiovascular disease among women and the need for stronger awareness and early detection.Heart disease remains the leading cause of death among women globally, yet experts at the event noted it is consistently under-recognised and underdiagnosed.”Women develop heart disease differently. It’s not just a smaller version of what men experience,” says Dr Anu Lala, associate professor of cardiology at Mount Sinai, New York, and founding advisor to HAF.“Women are more likely to have microvascular disease (disease in the smaller blood vessels of the heart), which standard angiograms can miss entirely. They also tend to develop heart disease about a decade later than men, often after menopause, which creates a false sense of security during their younger years.While men typically present with the classic symptom of crushing chest pain, women are far more likely to experience atypical symptoms like shortness of breath, nausea, jaw pain, extreme fatigue, or upper back discomfort, which are frequently mistaken for anxiety, acidity, or stress,” Lala added.According to Dr Sujit Sawadatkar, HoD of interventional cardiology at Noble Hospitals and Research Centre, “As clinicians, we must unlearn bias, actively listen, and adopt gender-sensitive diagnostic approaches. Research must prioritise women-specific patterns like microvascular disease, which standard tests may miss. Early screening, especially post-menopause, and equal access to evidence-based therapies are essential. Women’s heart health is not a variation of men’s, it is a distinct clinical reality. Recognising this is not just good medicine; it is a moral responsibility.”Dr Rajendra Patil, consultant (cardiology) at Jupiter Hospital, said, “We need to look at risks specific to women and use tests that are designed for this demographic. Women are not included enough in trials, so we do not know enough about how heart disease affects them. This includes things like microvascular disease, which can be hard to find with tests. If doctors are trained to look for the signs of heart disease in women and if we listen to what women are saying about their symptoms, we can save a lot of lives lost to heart disease.“
