One misconception I hear almost daily is that heart disease doesn’t happen to women. Well, it does!
Cardiovascular disease is among the leading causes of death for women worldwide, and India is no exception. Yet many women still believe they are protected, especially before menopause. That assumption can delay prevention, diagnosis, and delay lifesaving treatment.
For years, estrogen was thought to offer meaningful protection against coronary artery disease during the reproductive years. Hormones do influence risk, but the advantage is not absolute, and it is shrinking. Metabolic health, stress, lack of sleep, improper nutrition, and inactivity increasingly outweigh biological protection.
After menopause, risk rises further. Cholesterol patterns worsen, blood pressure climbs, and body fat tends to shift toward the abdomen. Ironically, this is also the phase when many women deprioritise check-ups. This is exactly when screening matters the most.
What is worrying is that we are also seeing heart disease in younger women, sometimes in their 20s and 30s. The reasons are complex, but several are common in Indian settings:
- Chronic stress and emotional load from juggling multiple roles
- Sedentary routines, long work hours, and inactivity
- Unhealthy dietary habits with irregular meals, ultra-processed foods
- Smoking and vaping, especially in some urban groups
- Metabolic conditions such as diabetes, hypertension, and PCOS
- Sleep deprivation and persistent fatigue being normalised
Risk patterns differ across India. In some rural communities, physical activity is higher but tobacco exposure can be significant. In many urban settings, inactivity, stress, pollution exposure, and metabolic disease are major drivers.
The popular image of a heart attack is severe chest pain radiating to the left arm. Women can have that, but many present with subtler or atypical symptoms, such as:
- Upper abdominal pain or burning (often mistaken for acidity)
- Discomfort in the shoulders, back, or jaw
- Sweating with mild chest heaviness
- Unusual breathlessness
- Sudden, unexplained fatigue or weakness
The intensity of pain must not the benchmark. Persistence should be and if symptoms do not settle within 10-15 minutes, seek treatment. The most dangerous delay often happens at home, when symptoms are dismissed as gas, stress, or just tiredness. Do not assume. Get it checked.
Heart disease in women is not only about blocked arteries. We see many women with heart failure, where the heart muscle weakens or stiffens. Women also have arrhythmias, which are rhythm disturbances. Palpitations are common and can feel like racing, fluttering, or skipped beats. They are frequently blamed on anxiety, but medical triggers like anaemia, thyroid disorders, and hormonal or metabolic conditions can contribute.
A routine ECG may miss intermittent rhythm episodes. Even a 24-hour Holter monitor can be normal if the episode does not occur during that window. Longer monitoring with external loop recorders, and in select cases implantable loop recorders that track rhythm for years, can uncover hidden arrhythmias.
Once diagnosed, many rhythm disorders are highly treatable, including with catheter ablation or device therapy. This is where timely specialist assessment makes a real difference.
There is also a serious, often unspoken issue: Sudden cardiac death due to electrical disorders of the heart. If there is a family history of sudden collapse, unexplained death before 50, recurrent fainting, or seizure-like episodes without clear cause, patients must be evaluated. Some electrical conditions can run in families, and early detection can be lifesaving.
One of the hardest challenges is not medical. It is cultural.
Women often postpone treatment because they prioritise everyone else. They manage children’s schedules, family health needs, and household logistics, but minimise their own symptoms. Even when advanced therapies are recommended, many hesitate due to finances, family reluctance, or the belief that “I will manage.”
Lifestyle is central to women’s heart health. Smoking is a major and growing risk factor, and when combined with oral contraceptives in certain profiles, risk can rise further. Chronic stress can elevate blood pressure and worsen rhythm instability. Poor sleep disrupts metabolic and hormonal balance. Inactivity reduces cardiovascular resilience.
Diabetes deserves special emphasis. In women, diabetes is a powerful accelerator of heart disease and can blunt warning symptoms. Central obesity, especially abdominal fat even in women who do not appear overweight, increases risk for diabetes, hypertension, and abnormal lipids. Post-pregnancy weight retention and a sedentary routine can compound this.
Preventive checks should not start at 40 by default anymore. For many women, especially with family history or metabolic risk factors, screening should begin by 25 to 30.
At the very minimum, blood pressure, blood sugar (fasting and/or HbA1c), lipid profile, ECG, and echocardiogram must be periodically assessed.
Equally important are the daily basics: Exercise and physical activity, good sleep, avoid tobacco, reduce alcohol intake and ensure diet includes minimally processed foods with adequate protein and fibre.
And I give one prescription that is often overlooked: Schedule time for yourself. Even 30 minutes a day of walking, stretching, dancing, reading, or quiet reflection is not indulgence. It is stress management. It is preventive cardiology.
As Women’s Day approaches, I would tell women to go in for timely health checks. Take symptoms seriously. I would like to tell their families to support decisions that improve long-term quality of life, not only emergency survival.
Finally, to women, especially mothers and caregivers: Your health is not secondary. A healthy woman sustains a healthy family. Your heart deserves the same attention you so generously give to everyone else.
This article is authored by Dr Vanita Arora, senior consultant & clinical lead, electrophysiology, cardiac sciences, Indraprastha Apollo Hospitals, Delhi.
