Why Women Are Less Likely to Have a Heart Attack, But More Likely to Die of It

Heart issues in women often go undiagnosed because the signs can also be sneaker in women than men.

A hand flying to the chest, intense pressure, and sweating profusely. This is what we are told heart attacks look like – especially in the movies. In the real word, this isn't always the case. More so, if you're a woman.

Former Miss Universe and Bollywood actor Sushmita Sen, 47, recently announced in an Instagram post that she suffered a heart attack. She wrote about how she got timely help, that saved her life.

The news shocked people – but also reignited a crucial conversation around heart health in women. For many women do not get the timely help.

The false notion that young women do not get heart attacks is so pervasive that many go undiagnosed till it's too late. Moreover, signs of heart issues in women can be much sneakier than in men.

FIT spoke to experts to understand what makes women less prone to heart attacks, and when they do get them, what makes them so deadly.

But First, Some Good News...

It is true that estrogen – a group of hormones that helps maintain reproductive health in cisgender women – also helps in maintaining cardiovascular health. It helps reduce the chances of blockages, thrombosis, etc. However, after menopause, when the ovary function subsides and the estrogen levels go down, this protective effect also fades.

"Immunity and protection are different things," says Dr Sanjay Mittal, Director, Clinical and Preventive Cardiology, at Medanta Hospital in Gurugram.

Just because estrogen protects pre-menopausal women against heart attacks to an extent, it doesn't mean they are immune to it.

In fact, heart attacks have been going up in women, particularly in women between the ages of 35 and 54, according to an observational study conducted by researchers at John Hopkins University in the US.

Moreover, this protection is also possibly the reason why heart attacks are more likely to be lethal in women than in men, even though the incidents are rarer.

Explaining this further, Dr Mittal says, "Normally if you have slow-developing blockages in the arteries of the heart, those blockages over a period of time lead to the creation of natural bypasses that act as alternative pathways for blood flow."

"But, when it happens all of a sudden, there is no time to defend and the damage can be far greater. This is why young people having heart attacks in general are more likely to have a fatality when they have a heart attack," he says.

"In the case of women, when the protection by estrogen wanes during menopause, one fine day when you have a pressure surge in the arteries for whatever reason, the layer of the arteries can actually get damaged because of which it suddenly stops the flow."

Dr Sanjay Mittal

Warning Signs Can Be Deceptive in Women

In fact, symptoms of heart issues can be quite deceptive in both men and women.

"Sometimes the symptoms of heart attack resemble that of acidity. People keep taking antacids for a couple of days, and when they don't get better, then they seek treatment. So that leads to unnecessary delay," says Dr Anil Saxena, Executive Director, Cardiac Pacing and Electrophysiology, Fortis Hospital, New Delhi.

Women are more likely to present these vague symptoms that aren't easily linked to the heart, adds Dr Sanjay Mittal.

"They (women) are more likely to present symptoms like nervousness, anxiety, breathlessness, fatigue, sometimes some type of pricking pain – very vague symptoms."

Dr Sanjay Mittal, Director, Clinical and Preventive Cardiology, Heart Institute, Medanta Gurugram

Historically, women have been thought to be more prone to 'nerves', and symptoms like breathlessness, sweating, and feelings of panic are automatically thought to be related to anxiety or stress disorders.

"These are not textbook symptoms of angina which is why they tend to be ignored more frequently. And women are instead taken to a psychologist, a psychiatrist, or even a neurologist," says Dr Mittal.

It isn't just patients either, doctors too often downplay these atypical symptoms of heart issues or don't make the connection in women simply because they are less likely to have them.

"Even when we perform a treadmill test in young women, most of them turn out to be false positives as compared to say, men over 50 years." says Dr Saxena.

"So in young women, when a disease is not very common, a lot of tests are false positive, even when we see a young woman with a positive stress test or TMT, we find that she has no blockage, so the test was false positive."

Dr Anil Saxena, Executive Director, Cardiac Pacing and Electrophysiology, Fortis Hospital, New Delhi

But the catch, Dr Saxena says, is that most of the time the cause of heart attacks in pre-menopausal women is not blockages in arteries which is predominantly seen in men and postmenopausal women.

What Causes Heart Attacks in Women?

When it comes to the root cause, "they are more because of inflammation in the coronary arteries that can lead to angina or heart attack-like symptoms in women," says Dr Saxena.

Other underlying conditions can also contribute to driving up the risk.

• Hormone Imbalance

For instance, Dr Mittal explains, since it's hormones that protects pre-menopausal women against heart attacks, conditions that cause hormone imbalance like PCOS (Polycystic Ovarian Syndrome), PCOD (Polycystic Ovarian Disease), and early menopause can trigger them.

Other conditions that cause hormone imbalance, or require you to take addition hormones, can also increase your risk of heart attacks.

"For instance, Sushmita Sen reportedly has Addison’s disease, a condition for which she would have been on hormone supplements. It could have predisposed her to atherosclerosis – build up of fats in the arteries."

Dr Sanjay Mittal, Director, Clinical and Preventive Cardiology, Heart Institute, Medanta Gurugram

• Biological make-up

"Women’s body size and heart size also tend to be smaller," says Dr Mittal. The walls that divide some of the chambers are thinner, and the veins are finer. This is another reason women’s hearts are likely to get damaged more significantly when they suffer a heart attack.

• Smoking

The experts we spoke to also underscored smoking as a major contributor to raising the risk of heart attacks in young women, more so than in men.

'If Your Body Is Telling You Something, Listen to It'

Man or woman, young or old, "if a person is complaining of discomfort like breathlessness, suffocation, chest pain, or rapid heart rate that increases with movement, and subsides on resting, it should never be ignored because it could be linked to heart issues," says Dr Mittal.

Some other things to keep in mind are,

• Irrespective of your sex, get yourself evaluated if you have a family history of heart conditions.

• Do not smoke or chew tobacco.

• Exercise regularly and eat healthy.

• Manage stress, as high cortisol (hormone released when you're stressed out) levels can also contribute to heart damage in the long run.