Mumbai: Heart disease is the leading cause of death among women worldwide, and India is no exception. According to the Indian Heart Association, cardiovascular disease accounts for nearly one in three female deaths in the country.

What is more concerning is that women in India often develop heart disease at a younger age compared to their Western counterparts, and mortality rates remain higher due to late diagnosis and undertreatment.

Subtle, “Atypical” Symptoms in Women

Unlike the male “classic” symptom of crushing chest pain, women often present subtler or atypical symptoms.

“Women with established heart disease tend to have an atypical or subtle symptom response that varies from the male’s ‘classic’ experience of crushing chest pain,” explains Dr Narasimha Pai, Professor and HOD, Interventional Cardiologist, KMC Hospital, Mangalore.

Instead of the well-recognised radiating chest pain, women may report tiredness, shortness of breath, indigestion, nausea, or discomfort in the back, neck, or jaw. These are easily mistaken for acid reflux, stress, or even menopause-related changes, leading to delays in both recognition and treatment.

Gender Bias in Diagnosis and Training

Historically, most cardiovascular research and diagnostic models were designed around men.

“We have built diagnostic and risk assessment tools around the male disease pattern, haven’t we? As a result, women’s symptoms are frequently dismissed as ‘atypical,’ even though they could be typical for women,” says Dr Pai.

This gender bias has led to under-recognition of heart disease in women, contributing to misdiagnosis, late referrals for investigations, and undertreatment.

Why Women Delay Seeking Care

“Although chest pain has been suggested as the most common symptom in both genders, the symptoms that women experience typically occur with other rare symptoms like nausea, indigestion, exhaustion, dizziness, neck or back pain, and shortness of breath,” notes Dr Chirag D, Consultant - Interventional Cardiology, Aster Whitefield Hospital, Bengaluru.

He adds that women often experience symptoms at rest or even during sleep, unlike men, who typically present while physically active. This makes women more likely to dismiss the signs, creating what he calls a “terrifying” risk when heart disease is missed or detected late.

The Indian Context: Higher Burden, Later Age

In India, women generally report heart disease at a later age than men, often compounded by comorbidities such as diabetes and hypertension. Psychosocial factors — from caregiving responsibilities to stress and stigma — also cause women to under-report their symptoms.

“Misdiagnosis, late referral for further investigations, and undertreatment are therefore more frequent in women,” warns Dr Pai.

Bridging the Gender Gap

Cardiologists agree that addressing the gender gap in cardiovascular outcomes requires better awareness, gender-sensitive diagnostic criteria, and early screening. Women must also be encouraged to take their symptoms seriously and seek timely medical attention.

“Heart disease in women is not just a man’s problem in disguise — it has its own face, and it must be recognized for what it is,” concludes Dr Chirag.