Sunita scheduled her mother’s mammogram, bone density scan, and gynecologist appointment like clockwork. At 58, Amma got regular cancer screenings and kept up with women’s health checkups. Sunita felt proud of being a responsible daughter.
But last Tuesday, Amma collapsed while making dinner. At the emergency room, doctors delivered shocking news: massive heart attack. Three of her main arteries were severely blocked.
“But she just had her annual physical,” Sunita protested. “Everything was fine.”
The cardiologist asked a simple question: “When was her last cholesterol test? Blood pressure check? Heart screening?”
Sunita realized with horror that while Amma got mammograms every year, no one had checked her heart in over five years. The “comprehensive” women’s health visits focused entirely on gynecological and breast health—but completely ignored the number one killer of women: heart disease.
Amma’s story isn’t unique. Across South Asian families, women get regular cancer screenings while their hearts remain completely unchecked. We advocate fiercely for our mothers’ mammograms but never ask about their cholesterol. We make sure wives see gynecologists but ignore chest pain they dismiss as “stress.”
It’s time to change this dangerous pattern before we lose the women we love.
How Heart Disease Presents Differently in Women
Most people picture heart attacks as dramatic chest-clutching episodes affecting men. But women’s heart disease is often a silent killer with completely different warning signs.
Classic symptoms we expect:
- Crushing chest pain
- Pain radiating down left arm
- Sudden collapse
- Obvious distress
How women actually experience heart disease:
Fatigue that won’t go away: Many women feel exhausted for weeks or months before a heart attack. This isn’t normal tiredness—it’s profound fatigue that doesn’t improve with rest.
Nausea and “indigestion”: Women often experience nausea, vomiting, or burning sensations they attribute to stomach problems or food poisoning.
Back, neck, and jaw pain: Heart pain can radiate to unexpected places. Many women think they have muscle strain or dental problems.
Shortness of breath without chest pain: Feeling winded during normal activities, especially if this is new or getting worse.
Dizziness and lightheadedness: Feeling faint or dizzy, especially with minimal exertion.
Why women’s heart disease is different:
- Women’s arteries are smaller and blockages develop differently
- Hormones affect how heart disease develops and presents
- Women are more likely to have “small vessel disease” that standard tests might miss
- Plaque in women’s arteries tends to be more diffuse rather than forming large, obvious blockages
The deadly result: Women’s heart attacks are misdiagnosed 50% more often than men’s. Even when women seek medical care, their symptoms are often attributed to anxiety, menopause, or stress rather than heart disease.
South Asian women face extra challenges:
- Cultural conditioning to endure pain silently
- Tendency to attribute symptoms to family stress or household work
- Lower likelihood of seeking medical care for “vague” symptoms
- Medical bias where doctors don’t expect heart disease in South Asian women
Why Stress, Diabetes, and Menopause Increase Risk
South Asian women face a perfect storm of risk factors that multiply their heart disease risk exponentially.
The stress factor: South Asian women often carry enormous stress loads:
- Managing households and extended families
- Balancing career and family responsibilities
- Financial pressures and economic uncertainty
- Immigration stress for those living abroad
- Cultural expectations to be perfect wives, mothers, and daughters
Chronic stress directly damages the heart by:
- Raising blood pressure and inflammatory markers
- Increasing cortisol levels, which affect cholesterol and blood sugar
- Promoting unhealthy coping behaviors (emotional eating, lack of exercise)
- Disrupting sleep, which affects heart health
Diabetes: The silent destroyer: South Asian women develop diabetes at lower body weights and younger ages than other groups. Diabetes is particularly dangerous for women because:
- It eliminates the natural heart protection that estrogen provides
- Women with diabetes have 3-7 times higher heart attack risk (vs. 2-3 times for men)
- Diabetic women are more likely to have “silent” heart attacks without obvious symptoms
- Diabetes complications progress faster in women
The menopause transition: Menopause dramatically increases heart disease risk in all women, but South Asian women face additional challenges:
Before menopause: Estrogen provides some protection against heart disease by:
- Helping maintain healthy cholesterol levels
- Keeping blood vessels flexible
- Reducing inflammation
After menopause: This protection disappears, and heart disease risk increases rapidly:
- LDL (“bad”) cholesterol often rises
- Blood pressure tends to increase
- Belly fat accumulation increases
- Insulin resistance worsens
Cultural factors during menopause:
- Menopause symptoms are often dismissed or considered shameful
- Women may not discuss symptoms with doctors
- Hot flashes and fatigue may mask heart disease symptoms
- Many women stop exercising due to physical discomfort
The dangerous combination: When stress, diabetes, and menopause combine, heart disease risk doesn’t just add up—it multiplies. A stressed, diabetic, post-menopausal South Asian woman has 5-10 times higher heart attack risk than a young, healthy woman.
Additional risk factors common in South Asian women:
- Polycystic ovary syndrome (PCOS), which increases diabetes and heart disease risk
- Gestational diabetes history, which predicts future heart problems
- High blood pressure during pregnancy (preeclampsia)
- Family history of early heart disease
- Sedentary lifestyle due to household responsibilities
The Basic Tests Women Should Ask For
South Asian women need comprehensive heart screening, not just gynecological care. Here’s exactly what to request:
Essential tests for all women over 35:
Lipid Profile (Cholesterol Panel):
- Total cholesterol, LDL, HDL, and triglycerides
- Should be done every 3-5 years if normal, annually if abnormal
- Cost: Usually $30-50
- What to look for: LDL under 100, HDL over 50, triglycerides under 150
Blood Pressure Screening:
- Should be checked at every medical visit
- Home monitoring is often more accurate than office readings
- Target: Under 120/80 for most women
Blood Sugar Tests:
- Fasting glucose and HbA1c (3-month average)
- Especially important for South Asian women who develop diabetes earlier
- Normal ranges: Fasting glucose under 100, HbA1c under 5.7%
Advanced tests for women with risk factors:
ApoB (Apolipoprotein B):
- More accurate than standard cholesterol tests
- Counts actual number of dangerous cholesterol particles
- Target: Under 90 mg/dL
Lp(a) – Lipoprotein(a):
- Genetic form of cholesterol that’s common in South Asians
- Can’t be changed with diet but important to know
- Concerning level: Over 30 mg/dL
CRP (C-Reactive Protein):
- Measures inflammation in the body
- High levels predict heart disease risk
- Low risk: Under 1.0 mg/L
Comprehensive cardiac testing for high-risk women:
Coronary Calcium Score:
- CT scan showing calcium deposits in heart arteries
- Excellent for risk assessment in women over 50
- Cost: $100-300
- Interpretation: 0 is ideal, over 100 suggests significant plaque
Stress Test (Exercise or Chemical):
- Shows how heart responds to increased demand
- Can detect blockages before symptoms appear
- Recommended for women with multiple risk factors
Echocardiogram:
- Ultrasound of the heart showing structure and function
- Useful if high blood pressure or other heart conditions suspected
When to get these tests:
- Age 35-45: Basic screening (lipids, blood sugar, blood pressure)
- Age 45-55: Add advanced tests if risk factors present
- Over 55: Comprehensive screening including calcium score
- High risk at any age: Full cardiac evaluation
How to request these tests:
- Don’t wait for your doctor to suggest heart screening
- Say: “I’d like comprehensive cardiac risk assessment”
- Bring printed list of tests you want
- Mention family history and South Asian ethnicity
- If denied, ask for the refusal to be documented in your chart
Real Stories from South Asian Families
These true stories show how heart disease affects South Asian women and how early detection can save lives:
Priya’s Story – Age 44:
Priya was the perfect South Asian daughter. She managed her aging parents’ care, worked full-time, and raised two teenagers. For months, she felt exhausted and had occasional nausea, but attributed it to stress from her demanding life.
During her annual gynecological visit, Priya mentioned feeling tired. Her doctor suggested therapy for stress management but didn’t order any cardiac tests. Six months later, Priya had a heart attack while driving her daughter to school.
At the hospital, doctors found severe blockages in multiple arteries. “This didn’t happen overnight,” the cardiologist explained. “Your heart has been crying for help for months, but we weren’t listening to the right signals.”
Lesson: Fatigue and nausea in busy South Asian women aren’t just stress—they need cardiac evaluation.
Kamala’s Story – Age 52:
After her husband’s heart attack, Kamala became obsessive about his health. She monitored his diet, managed his medications, and drove him to every cardiology appointment. But she never thought about her own heart health.
During menopause, Kamala gained weight and developed diabetes. Her adult daughter insisted she get comprehensive screening. The tests revealed dangerously high cholesterol (LDL 189), elevated blood sugar (HbA1c 8.2%), and a calcium score of 245.
With aggressive treatment, Kamala avoided her husband’s fate. “I was so focused on taking care of him that I forgot to take care of myself,” she said.
Lesson: Women who are caregivers often neglect their own health—sometimes with deadly consequences.
Deepika’s Story – Age 38:
Deepika had a strong family history of heart disease but felt protected because she was young and had no symptoms. She got regular mammograms and Pap smears but had never had her cholesterol checked.
During a routine blood donation, screening tests revealed total cholesterol of 267 and triglycerides of 201. Further testing showed Lp(a) of 156—extremely high. Despite her young age and lack of symptoms, Deepika had significant genetic heart disease risk.
With medication and lifestyle changes, Deepika lowered her cardiac risk dramatically. “I’m so grateful they caught this before I had symptoms,” she said.
Lesson: Family history trumps age—young South Asian women with genetic risk need early screening.
Meera’s Story – Age 61:
Meera’s doctor had been treating her high blood pressure for years but never ordered comprehensive cardiac testing. When Meera developed chest discomfort during her daily walk, she mentioned it during a routine visit.
Her doctor ordered a stress test, which showed significant abnormalities. Cardiac catheterization revealed blockages requiring bypass surgery. “If we had done comprehensive testing earlier, we might have prevented this with medications alone,” her surgeon explained.
Lesson: High blood pressure is a major cardiac risk factor that warrants comprehensive heart screening, not just blood pressure management.
Did You Know?
South Asian women are 2-3 times more likely to die from their first heart attack compared to other women, partly because their symptoms are often dismissed as stress, anxiety, or menopause. Additionally, 64% of women who die from heart disease have no previous symptoms—making regular screening absolutely critical for early detection.
Action Steps
Champion the heart health of every woman in your family starting today:
Schedule comprehensive cardiac screening for the women you love: Make appointments this month for your mother, wife, sister, or aunt to get complete heart health evaluation. Don’t accept “gynecological only” checkups. Specifically request: lipid profile, blood sugar tests, blood pressure evaluation, and EKG. If they’re over 50 or have risk factors, push for calcium scoring and advanced cholesterol tests like ApoB and Lp(a).
Create a “women’s heart health” advocacy plan: Become the family advocate for women’s cardiac care. Research cardiologists in your area who understand women’s heart disease. Prepare lists of symptoms that women should never ignore: unexplained fatigue, nausea with exertion, back or jaw pain, and shortness of breath. Share this information in family WhatsApp groups and social circles.
Challenge cultural assumptions about women’s health: Stop accepting “she’s just stressed” or “it’s menopause” as explanations for concerning symptoms. When women in your family complain of fatigue, chest discomfort, or feeling unwell, advocate for cardiac evaluation alongside other tests. Normalize the idea that women’s hearts deserve the same attention as their reproductive health.
Start family conversations about women’s heart disease: Share the statistics: heart disease kills more women than all cancers combined. Discuss how symptoms in women are different from men. Make sure every woman in your family knows the warning signs and feels empowered to seek immediate medical care. Create an environment where women’s health concerns are taken seriously, not dismissed as emotional or stress-related.
Lead by example in prioritizing women’s heart health: If you’re a woman, get your own comprehensive cardiac screening and share your results with family. If you’re a man, make sure the women in your life know their cardiac risk factors just as well as you know yours. Schedule couple’s or family health screenings where everyone gets complete cardiac evaluation together.
Frequently Asked Questions
Q: My doctor says I’m too young for heart disease at 42. Should I insist on cardiac testing? A: Yes, especially as a South Asian woman. We develop heart disease 10-15 years earlier than other ethnic groups. If you have any risk factors (family history, diabetes, high blood pressure, stress), request cardiac screening regardless of age. If your doctor refuses, ask for the refusal to be documented in your medical record and consider seeking a second opinion.
Q: I get regular women’s health checkups. Isn’t that enough for overall health screening? A: No. Traditional “women’s health” visits focus on reproductive and breast health but often completely ignore cardiovascular health—which is actually the leading cause of death in women. You need separate cardiac risk assessment including cholesterol, blood sugar, blood pressure, and potentially advanced testing based on your risk factors.
Q: How do I convince my mother/wife to get heart screening when she says she feels fine? A: Emphasize that heart disease in women is often silent until it’s too late. Share that 64% of women who die from heart attacks had no previous symptoms. Offer to schedule and attend appointments with her. Frame it as “peace of mind” rather than expecting problems. Consider scheduling family screenings where everyone gets tested together, making it a positive, proactive experience rather than focusing on individual risk.
References
- Mehta, L.S., et al. (2016). Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation, 133(9), 916–947.
- McSweeney, J.C., et al. (2016). Women’s early warning symptoms of acute myocardial infarction. Circulation, 108(21), 2619–2623.
- Joshi, P., et al. (2007). The prevalence and correlates of coronary artery disease in South Asians. JACC: Cardiovascular Imaging, 2(2), 76–85.
- Anand, S.S., et al. (2000). Risk factors, atherosclerosis, and cardiovascular disease among Aboriginal people in Canada. The Lancet, 356(9228), 279–284.
- Lichtman, J.H., et al. (2014). Symptom recognition and healthcare experiences of young women with acute myocardial infarction. Circulation: Cardiovascular Quality and Outcomes, 8(2), S31–S38.
- Gulati, M., et al. (2021). 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain. Circulation, 144(22), e368–e454.
- Vaccarino, V., et al. (2016). Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. New England Journal of Medicine, 353(7), 671–682.
If this helped you, please share it with someone you love.
