Heart disease has long been framed as a man’s problem in India. The data tells a different story. Ischemic heart disease is rising faster among Indian women than men, with mortality from the condition climbing sharply over the past two decades. Coronary artery disease is now a leading cause of death for women too, yet it remains under-recognized, underdiagnosed, and undertreated compared to men with the same condition.
Why Women Are Missed
Much of this gap starts with symptoms. The textbook heart attack, crushing chest pain radiating down the left arm, is drawn largely from studies on male patients. Women are more likely to experience subtler warning signs: fatigue, nausea, breathlessness, jaw or back pain, or discomfort easily mistaken for indigestion or anxiety. These symptoms are often dismissed, by patients and sometimes by doctors, delaying diagnosis at the exact moment speed matters most.
Women also face conditions that don’t always show up on a standard angiogram. Microvascular dysfunction, where the tiny blood vessels of the heart are affected rather than the major arteries, is far more common in women and can cause real, dangerous chest pain even when the main coronary arteries look clear. Spontaneous coronary artery dissection, a tear in an artery wall, also disproportionately affects women, often those who are younger and otherwise healthy.
The Cost of Being Overlooked
The consequences of this diagnostic gap are measurable. Studies consistently show women experience worse outcomes after a cardiac event than men, including higher rates of complications and death following a heart attack. Part of this comes down to timing: women are less likely to receive timely intervention, in part because their symptoms weren’t recognized as cardiac in the first place.
Risk factors are shifting too. Rates of obesity, diabetes, tobacco use, and elevated blood pressure have all climbed faster among Indian women in recent years than among men, narrowing what was once a protective gap. Menopause adds another layer, as the decline in estrogen removes a natural cardiovascular safeguard many women don’t realize they had.
Closing the Gap
The fix starts with awareness on both sides of the stethoscope. Cardiologists are increasingly calling for sex-specific risk assessment tools rather than applying male-derived diagnostic criteria by default. For women, it means treating unusual fatigue or breathlessness as worth investigating rather than explaining away.
Heart disease in women isn’t rarer. It’s simply been harder to see.
