August 23, 2023
Cardiovascular Disease (CVD) is currently the leading cause of death and disability worldwide. CVD which include myocardial infarction most commonly known as heart attack, stroke, peripheral vascular diseases, accounts for around 28% of deaths annually across India. World Health Organization (WHO) and Global Burden of Disease (GBD) Studies have also reported increase in mortality and disability-adjusted life years (DALYs) from Ischemic Heart Disease in India in the last few decades. Studies show that compared to people of European ancestry, CVD affects Indians at least a decade earlier and in their most productive mid-life years. There has been a drastic increase in the prevalence of CVD among the young population and contrary to popular belief prevalence among young women has amplified. It is common knowledge that health-related risk factors such as unhealthy diet, sedentary lifestyle, psychosocial factors, smoking and harmful use of alcohol are paramount in the causation of CVD. In addition to biological differences, socio-economic factors contribute to disparities in cardiovascular health outcomes in women, most of them being modifiable.
Cardiovascular Disease risk factors can be categorized as two – Modifiable and Non-Modifiable. Non Modifiable risk factors are gender; males being more commonly affected than premenopausal women, positive family history, increasing age. On the other hand, modifiable risk factors constitute to obesity, smoking, alcohol intake, increased salt intake, reduced physical activities, lower socioeconomic status, increased screen time and stress. However, a study done by Vaishnava showed an alarmingly high prevalence of such risk factor behaviors in young women, especially of metropolitan cities of India, indicating imminent cardiovascular disabilities. Another study by Kiran Gaur et al proved that Ischemic Heart Disease affected women more than men and this was associated with a greater increase in such modifiable risk factors.
According to National Family Heath Surveys done in the years 2015-2016, 6.8% women were tobacco consumers, 56.2% women were exposed to unclean fuels, 20.6% women were overweight/obese all of whom were affected with Ischemic Heart Disease. In our experience 14-17% of women patients are young working and upper middle class having unhealthy lifestyle, obesity, metabolic syndrome and a confluence of various other non modifiable factors culminating in cardiovascular risk. This risk is paramount as young working population getting affected by such a debilitating comorbid illness leads catastrophic repercussions in the development of the society.
Women had a 25% increased risk for CVD by cigarette smoking compared with men. The combination of smoking with oral contraceptive use has a synergistic effect on the risk of CVD. In accordance with the Framingham Heart Study based in the US, obesity increased the relative risk of CVD by 64% in women as opposed to 46% in men. Higher prevalence of inactivity was noted among women than men in all age adjusted groups based on the NHIS 2011 survey. Women with Type 2 Diabetes Mellitus have higher risk of fatal CVD as compared to men with Type 2 Diabetes Mellitus. The prevalence of diabetes in particular, appears to be higher in Indian women compared to women in other countries; approximately 12% versus the global average of 9% according to the International Diabetes Federation and the Programme for Demographic and Health Surveys.
We can attribute these trends to causes like hormonal changes during pregnancy and menopause that impact a woman’s cardiovascular health. Conditions like diabetes during pregnancy (gestational diabetes), and hypertensive disorders during pregnancy (pre-eclampsia and gestational hypertension) can increase the risk of heart disease. Another reason could be a surge in Estrone- the unhealthy form of Estrogen. Due to such unhealthy lifestyle habits, increased psychosocial stress there is a rise of the levels of estrogen directly produced from fat cells, leading to conditions like PCOS, infertility, dyslipidemia. A previous study showed a higher level of estrogen in the blood was associated with an elevated risk of Coronary Artery Disease in women during their peri- and postmenopausal period.
The incidence of CVD in India is nothing short of an epidemic, the prevalence of the same in women is a silent threat looming amongst us. However, the prevention and early diagnosis can be classified into following levels:
1. On an individual basis, regular check-ups with your health provider are essential. Identification of risk factors especially modifiable risk factors and to come up with tailor-made and individualized solutions along with a health-care professional and by self is beneficial.
2. On an Institutional level, providing ample in-patient and out-patient social work resources, providing appropriate health literacy, coordinated efforts centered on achieving health equity for all women irrespective of socio-economic status, increasing screening test and early treatment programs of those exhibiting high-risk behaviors, advocating women to take charge of their health are absolute necessities.
3. Policy makers can foster community support programs for women’s health, increase health coverage of high-risk women, increase funding of community outreach and telemedicine programs, implement affordability and accessibility to said treatment on a timely basis.