A woman’s heart may be deep in feeling, but anatomically it is smaller than a man’s. Its walls are thinner and its blood vessels finer, even when body size is matched. Functionally, women have a faster heart rate and a higher ejection fraction (the proportion of blood pumped per beat), but their overall cardiac output—the total volume of blood pumped per minute—remains lower than in men.
Female hearts are not simply scaled-down versions of male hearts; differences in wall thickness and chamber proportions mean many features do not reduce proportionally with body size. Women’s hearts also show greater contractility, and sex hormones shape their response to stress and regulate calcium, producing distinct rhythm patterns and metabolism. These differences influence how men and women experience, present, and are diagnosed with heart disease. In India, men show a higher prevalence of heart disease, particularly ischaemic heart disease (IHD), and are affected at younger ages. In women—especially post-menopause—heart disease carries higher mortality rates and worse outcomes after cardiovascular events.
Most common conditions: For both sexes, these are IHD, valvular heart disease, and congenital heart disease. IHD, also known as coronary artery disease, occurs when cholesterol builds up in the coronary arteries. Severe obstruction deprives the heart muscle of oxygen, causing angina (chest pain). A rupture and a blood clot results in a heart attack. Valvular heart disease arises when one or more of the heart’s four valves do not function properly, either because of birth defects or childhood infections.
Heart attacks in women: Half of the women have atypical symptoms. Instead of the classic chest pain, they may experience excessive sweating, palpitations, nausea, vomiting, epigastric discomfort, backache, breathlessness, or extreme fatigue.
The risk of misdiagnosis: Women’s symptoms are frequently mistaken for gastritis or psychological symptoms. Greater vigilance is crucial: tests like ECG and echocardiography and treadmill tests should be done to catch early signs.
Cardiac arrest vs heart attack: The first is the condition where heart stops functioning totally. Heart attack occurs when the coronary artery is totally obstructed and causes decreased blood supply to the cardiac muscle. Heart attack can lead to cardiac arrest.
A time of increased vulnerability: Women become increasingly vulnerable to heart disease after 40-45 years, especially post-menopause. Women with diabetes and uncontrolled hypertension are prone to heart problems at a younger age. With menopause and the resultant lowering of oestrogen, women become more prone to heart problems than men.
The oestrogen connection: Oestrogen is beneficial for metabolism and increases good cholesterol. It also dilates the coronary blood vessels, improving the circulation to the heart. So women in their reproductive years are protected from heart problems because of oestrogen. But this shield is lost if they have diabetes and hypertension.
Differences in recovery: When treated early, women recover as well as men. But if treatment is delayed, outcomes become relatively poor. Smaller vessel size and more advanced disease at presentation also makes cardiac procedures like coronary angioplasty or bypass surgery less successful.
The menopause connect: As oestrogen levels come down, cholesterol levels go up. Those with high blood pressure and onset of secondary diabetes are at increased risk of heart problems. Reduced oestrogen and increased cholesterol level causes blood vessels to stiffen further, putting the heart at greater risk.
Effect of birth control pills: Use of these, especially in post-menopausal women, has yielded conflicting results. If you use these long term, they can cause an increase in clotting tendencies and cause blood clotting in the limb vessels, which can go to the lungs and cause pulmonary embolism. But contraceptive pills with low oestrogen and progesterone have been shown to have fewer detrimental effects.
Hormone replacement therapy: HRT initiated early after menopause, that is within the first two years, can benefit patients with definitive indication of heart problems. Women aged 60 and above are found to have more cardiovascular complications with HRT.
Pregnancy and heart health: Most women do not exhibit heightened heart problems during pregnancy. But those who have valvular or congenital heart disease can have complications because of the increase in volume of the heart and other physiological changes during pregnancy. Those who have narrowed valves can develop signs of heart failure in the second trimester. They should have regular evaluations to catch early complications.
Peripartum cardiomyopathy: This is a variant of heart myocardium, which is seen during the later stages of pregnancy (about 28 weeks) and up to six months post-delivery. This occurs when the heart muscle becomes weak, decreasing the heart’s pumping ability to pump. It can cause signs of heart failure or arrhythmia (irregular heart beat). Women who fall pregnant very early (before 20) or late are at greater risk.
As women age: Women over 65 can have increased cardiac risk because most of them tend to develop diabetes, hypertension or have high levels of bad cholesterol.
The Indian scenario: Indians develop heart disease about 10 years earlier than western populations—between 40–60 for men and 50–60 for women. High levels of lipoprotein, early onset of diabetes and hypertension, and dyslipidemia (elevated cholesterol) increase the risk.
Indian women’s unique risks: Hypertension often appears earlier and at lower body weight. Diets high in junk food and trans fats, sedentary jobs and stress raise risks.
Triple threat—diabetes, high blood pressure and thyroid disorders: High blood pressure stiffens blood vessels and reduces blood supply. Diabetes increases cholesterol deposition and vessel thickness, causing stiffening that can lead to early heart attacks. Thyroid disorders elevate blood pressure and add to cardiac risks.
Lifestyle changes are key: Your diet should contain large amount of fresh fruits and vegetables, and nuts and proteins. Reduce intake of carbohydrates. Exercise at least 30 minutes per day for five days a week, or 45 minutes four days a week. Implement these changes as early as possible.
Beyond the heart: A healthy heart is also crucial for a healthy brain. Deterioration of brain function increases risk of strokes. Women with poor cardiac health tend to have a higher incidence of miscarriages or premature deliveries. Other complications during pregnancy include heart failure, arrhythmias and pulmonary embolism (when a blood clot travelling through the bloodstream blocks an artery in the lung).
Heart disease and mental health: Women who have severe anxiety or depression are more prone to heart problems. Heightened levels of stress lead to increased heart rate. Depression can lead women to adopt unhealthy eating and sedentary habits. The risk of hypertension increases correspondingly.
Acute and chronic stress: Increasing levels of stress affect women’s health by increasing the incidence of hypertension and diabetes, which in turn compounds cardiac risks. Meditation, good music and books can help lower stress and reduce heart problems in the long run.
Questions women must ask doctors: Women should inquire about their risk of heart problems, especially those who have a family history of cholesterol, hypertension and diabetes. They must ask when they need to start getting evaluated based on their risk factors.
Links with autoimmune diseases: Autoimmune disorders like lupus and rheumatoid arthritis, besides bringing pain and stiffness, can cause vasculitis (inflammation in blood vessels). This can cause heart attacks and strokes.
The polycystic ovary syndrome connect: Because of impaired glucose tolerance and higher risk of diabetes, PCOS tends to increase cardiac risk. Optimal management of PCOS can prevent heart problems.