Did you know that according to studies published in the Journal of the American College of Cardiology, the prevalence of coronary artery disease in Indian women ranges from 3% to 13% depending on the age group and has increased by almost 300% over the past two decades and the prevalence of heart failure in women in India more than doubled from 1.1% in 2000 to 2.6% in 2015? The mean age of heart attack in Indian women is 59 years, which is much lower than the average age of heart attack in women in developed countries. Hence, it is imperative to talk about heart health through the lens of gender inequities in India.
A new study of diabetes prevalence in middle-aged women in India by Harvard T.H. Chan School of Public Health finds that 254 of the country’s 640 districts have a very high (greater than 10%) level of the disease, and 130 have a moderately high level (8.7–10.6%). Furthermore, a report on causes of death by the Registrar General of India also reported cardiovascular diseases (CVD) as the most important cause of death in women.
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USV | Her Health: Cardiovascular Wellness and Inclusive Diabetes Care for Indian Women
To mark the occasion of International Women’s Day on March 8, 2024, The Economic Times, in collaboration with USV, presented a special episode featuring Dr. Sarita Rao, Senior Interventional Cardiologist and Director of Cath Lab at Apollo Hospital Indore, Dr. Shehla Shaikh, Consultant Endocrinologist at Saifee Hospital and Reliance Hospital Mumbai, and Dr. Anupama Dubey, MD, FIDM (Fellowship in Diabetes Management), FIDFM, Consulting Diabetologist & Podiatrist at Maharshi Diabetes and Foot Care Centre, Indore. Together, they participated in a webinar titled ‘Winning the Battle Against Diabetes and Heart Disease in Women’, engaging in a discussion with Miloni Bhatt, Editor – Digital Broadcast, EconomicTimes.com. In this sixth episode of the ongoing USV series, the doctors emphasised the importance of prioritising women’s health and addressing the rising prevalence of coronary artery disease, heart failure, and diabetes among Indian women. They provided valuable insights into risk factors, early screenings, lifestyle modifications, and holistic approaches to combat these diseases in women.
The prevalence of diabetes and heart disease is on the rise in India, with a notable increase among women, making them a significant health concern.
It is against this backdrop that The Economic Times, in collaboration with USV, brings a special episode on International Women’s Day, on March 8. The 2024 theme for International Women’s Day is “Inspire Inclusion” with one of the action areas being “helping women and girls make informed decisions about their health”.
Deep diving into the heart health and diabetes landscape through a gender lens, Dr. Sarita Rao, Senior interventional cardiologist, Director of Cath Lab Apollo Hospital Indore, Dr. Shehla Shaikh, Consultant Endocrinologist, Saifee Hospital and Reliance Hospital, Mumbai, Dr. Anupama Dubey, MD, FIDM (Fellowship in Diabetes Management), FIDFM, Consulting Diabetologist & Podiatrist, Maharshi Diabetes and Foot care centre, Indore, joined the webinar titled ‘Winning the Battle Against Diabetes and Heart Disease in Women’, a special episode from the USV, in a conversation with Miloni Bhatt, Editor – Digital Broadcast, EconomicTimes.com. The doctors shared insights into the high-risk factors and dissected their significance and also stressed the necessity of early screenings and medical interventions, lifestyle modifications, and a holistic approach to march towards cardiac wellness and diabetes management.
Why heart health and women: Signs, symptoms, and unique risk factors
According to the Global Burden of Disease Study, heart disease is the leading cause of death among women in India, accounting for almost 18% of all female deaths. Shockingly, the mortality rate due to heart disease among Indian women is higher than that of breast cancer and other cancers combined. Addressing the rising concern of heart disease affecting young females, Dr. Rao shared that today, with the unfortunate increase in young deaths, it’s not just impacting men, but women as well. “Women are unique in that they have different risk factors. For example, women experience events like pregnancy and menopause, which are exclusive to their gender,” said Dr. Rao. These events contribute to hormonal fluctuations, which in turn influence cardiovascular health. Additionally, factors like the use of birth control pills and autoimmune diseases further impact women’s heart health. “Some traditional risk factors are unique to women. One such unique aspect is hormonal changes, often occurring during pregnancy and leading to fluctuations. Early menopause is also becoming more common nowadays. These hormonal changes impact cardiovascular health. Additionally, women often use birth control pills, which can increase the risk of thrombosis. Autoimmune diseases are another common occurrence among women, further linked to cardiovascular health,” elaborated Dr. Rao.
“Furthermore, traditional risk factors such as diabetes are also prevalent in women, especially exacerbated by stress and depression during pregnancy and postpartum phases,” added Dr. Rao. Conditions such as peripartum cardiomyopathy during pregnancy also affect heart health.
“Now, when discussing signs and symptoms in women, it’s important to note that they may present differently than men. What is typical for a man may not be typical for a woman; their symptoms manifest differently. For instance, women are less likely to complain of traditional chest pain; instead, they may experience breathing difficulties, fatigue, or tiredness. They may also report a general feeling of unwellness, along with symptoms like nausea, dizziness, or acidity. Additionally, approximately 50% of women experience pain, but it’s not typically left-sided. They may describe jaw pain, shoulder pain, back pain, central chest pain, or pain on both sides,” said Dr. Rao.
Dr. Rao cautioned against dismissing them as “mere tiredness or household stress” as these could overlook potentially serious health issues. Hence, it’s crucial to take these symptoms seriously and seek medical attention promptly.
Hormonal imbalance in women
Dr. Shaikh discussed hormonal imbalance in women, emphasising that hormones are crucial chemical messengers secreted by endocrine glands, such as the thyroid and the ovaries. Symptoms of hormonal imbalance vary widely and may include weight gain, hair thinning or loss, fatigue, constipation, irregular cycles, dry skin, mood swings, and infertility.
There are several symptoms that the patients can exhibit. However, each patient will not exhibit all the symptoms. “We need to have a high index of suspicion but at the same time, we also need to understand that a patient should not be interpreted only according to lab reports. What is happening increasingly is that patients are undergoing a huge amount of tests, and being treated according to the test results; it’s vital to communicate to patients the importance of a holistic approach to health. You cannot just interpret human health by simply looking at hormone numbers in isolation,” stressed Dr. Shaikh.
Moreover, hormonal imbalance can manifest differently at different ages, from PCOD and irregular cycles in young patients to infertility and low libido in middle-aged patients, and cardiovascular disease in postmenopausal women.
An inclusive approach to diabetes care: Women with diabetes at four times higher risk of COPD than men
Furthermore, a 2020 study published in the Journal of Diabetes and Metabolic Disorders on diabetes prevalence in middle-aged women in India stated more than one in 10 women aged 35-49 suffer from the disease. Policymakers are deliberating on the need to adopt a gender-inclusive lens in diabetes care given that women face a ‘silent’ burden owing to a lack of awareness and invisible barriers.
Dr. Dubey highlighted that policymakers are considering a more inclusive approach to diabetes prevention and management, acknowledging the unseen challenges women face due to a lack of awareness.
“It would be quite surprising to know that the risk of COPD in women with diabetes is almost four times higher compared to males. This disparity might be due to hormonal factors, as mentioned by Dr. Rao. Additionally, there is an increased risk of other diabetes-related complications such as cardiovascular diseases, kidney disease (CKD), and neuropathy. Specifically for women, there is an elevated incidence of urinary tract infections (UTIs) due to hyperglycemia, resulting in symptoms like painful urination and burning sensations,” said Dr. Dubey.
Moreover, women with diabetes are more prone to vaginal fungal infections, presenting symptoms like itching, discharge, painful intercourse, and soreness. “Furthermore, there is a frequent correlation between diabetes and polycystic ovarian syndrome (PCOS), characterised by insulin resistance. PCOS can cause diabetes, while diabetes can also contribute to PCOS, leading to irregular periods, acne, depression, and infertility,” said Dr. Dubey, shedding light on the vicious cycle.
Monitoring blood sugar levels varies depending on factors like the type of diabetes and treatment stability. Type 1 diabetic patients may need to check their blood sugars frequently, while stable patients may require less frequent monitoring, typically once or twice a week. Patients on insulin often need more frequent checkups, and continuous glucose monitoring (CGM) is an effective tool, especially for those with fluctuating blood sugar levels.
Stress, the silent killer
A 10-country Deloitte survey conducted between October 2022 and January 2023 revealed that 53% of Indian working women faced higher levels of stress in 2022-23 (FY23) as compared to FY22, higher than their global counterparts. 31% of Indian working women said they felt burnt out. The global average of women feeling burnt out was 28%. On the other hand, the burden of common mental disorders (CMDs), including depression, anxiety, and stress-related disorders is on the rise in India. Women in rural areas form one of the high-risk groups concerning CMDs due to their compromised status of living.
Stressing the impact of stress on heart health, Dr. Rao highlighted the pervasive nature of stress in modern life, affecting people from all backgrounds and ages due to changing lifestyles and urbanisation. Stress can elevate blood pressure and hormonal imbalances, leading to inflammation in blood vessels, particularly in the heart. Unhealthy coping mechanisms such as overeating, substance abuse, and smoking further exacerbate cardiovascular risks. Mental health issues stemming from stress, like depression and anxiety, also pose threats to heart health, as does sleep disruption. Studies show a 21% increased risk of heart attacks with chronic stress. Notably, even doctors in India are experiencing high-stress levels and burnout symptoms.
Dr. Rao emphasised proactive strategies to manage stress, including physical activity, relaxation techniques like yoga and meditation, and social engagement. The key is to address stress before it takes a toll on health.
Dr. Shaikh elaborated on the intersection of stress and hormonal fluctuations during pivotal life stages such as puberty, pregnancy, and menopause, and their implications for women’s heart health.
Puberty, pregnancy, menopause: The way women experience hormonal shifts
Dr. Shaikh explained that during puberty, adolescent girls face significant peer pressure and body image issues, leading to health concerns like obesity, insulin resistance, dyslipidemia, hypertension, and even Type-2 diabetes. Early intervention is crucial to prevent long-term cardiovascular risks.
Pregnancy, often considered a “stress test” for the heart, poses its unique challenges. Women who develop gestational hypertension or diabetes during pregnancy face a significantly higher risk of developing diabetes or hypertension later in life. Proper counselling and lifestyle changes during pregnancy can mitigate these risks.
Menopause marks a significant hormonal shift, with estrogen levels decreasing and bringing about mood changes, bone changes, obesity, and metabolic alterations. Despite estrogen’s protective effects on the heart, menopause can increase the risk of cardiovascular disease. Dr. Shaikh emphasised the importance of women prioritising their health and society’s need to shift its mindset towards equal attention and care for female patients. This cultural shift is essential to address the disparities in healthcare attention between male and female patients.
Diabetes and women: Navigating subtle symptoms and high-risk factors
The discussion transitioned to the importance of addressing diabetes, particularly in women, due to its subtle symptoms and potential for complications like heart disease, kidney disease, and mental health disorders. Studies reveal that diabetes prevalence is slightly higher in males, yet over 50% of those with diabetes are unaware of their condition. While most diabetes symptoms in women resemble those in men, some are unique to women, often more severe and challenging to detect.
Dr. Dubey highlighted the long-term impacts of “untreated diabetes”, categorising them into macrovascular and microvascular problems affecting various organs. However, the good news is that these effects can be prevented through regular screening and lifestyle management. There’s an emphasis on women’s increasing awareness and participation in regular check-ups and screenings, indicating a positive shift from past attitudes where women prioritised health less. She underscored the significance of maintaining healthy lifestyle habits such as controlling blood sugar, blood pressure, and cholesterol, along with weight management and avoiding smoking and excessive alcohol consumption. Dr. Dubey also stressed the importance of simple, regular screenings and tests like urinalysis, blood sugar monitoring, ECGs, and Doppler tests, which are cost-effective and can detect early signs of complications, allowing for timely intervention.
Dr. Rao shared that electrocardiograms (ECG) are a fundamental test available in various healthcare settings. Typically, an ECG is conducted when a patient experiences chest pain or difficulty breathing. There isn’t a specific age requirement for ECG screenings, as congenital heart conditions can affect individuals of all ages. Regular health checkups, recommended for individuals above 25 years old, encompass various tests, including ECGs, to detect a range of health issues, from heart conditions to lung disorders. Therefore, it’s advised for everyone above 25 to undergo annual health screenings.
Dr. Shaikh shared that bone health is a crucial aspect often overlooked in women’s health discussions, particularly concerning diabetes. While bone mineral density tests may appear normal in diabetic patients, the condition affects bone microarchitecture, making bones more fragile and prone to fractures. Healing of fractures also takes longer in diabetic individuals. Certain medications used to manage diabetes can further impact bone metabolism, necessitating caution, especially in postmenopausal women. Engaging in resistance exercises, even for just half an hour three times a week, is essential for maintaining muscle and bone health, regardless of age.
Dr. Rao said that women must recognise the importance of prioritising their well-being. Often, women tend to prioritise others over themselves, putting family, children, and elders first. However, just as educating a woman benefits the entire family, a healthy woman ensures the well-being of the household. Women need to understand that it’s acceptable to take time for themselves, dedicating at least one hour daily to their mental and physical health. This involves knowing key health indicators like blood pressure, cholesterol, and sugar levels to manage risks of diabetes, high blood pressure, and dyslipidemia. Additionally, maintaining a balanced diet with smaller portions, getting adequate sleep, avoiding smoking and excessive alcohol consumption, and understanding family medical history are vital. Regular exercise is also essential, with half an hour dedicated to physical activity each day. By prioritising self-care, women safeguard not only their health but also that of their families.
