Heart disease in women rarely arrives with drama. More often, it whispers — through fatigue, breathlessness, disturbed sleep or an unexplained heaviness that’s easy to dismiss. Yet behind these subtle signals lies a growing health concern. As hormonal shifts, chronic stress and modern lifestyles collide, doctors are warning that angina and coronary artery disease are rising steadily among women, often years earlier than expected.
“Oestrogen has a protective effect on blood vessels. As women approach menopause, falling oestrogen levels lead to arterial stiffness, reduced blood flow and increased plaque formation. Even when there was no history of heart disease, the change in transition has substantially increased the risk of angina symptoms,”says Dr E Ravi Shanker, consultant endocrynologist, Apollo Hospitals, Jubilee Hills.
Experts also point out that women’s heart health is being effected by many different factors such as their sedentary lifestyles, inadequate sleep, late pregnancies, and balancing work and home responsibilities. They also explain how unhealthy dieting practices, gaining excessive amounts of weight, smoking, and consuming an excess of processed foods place an additional burden on a woman’s cardiovascular system.
“Women internalise stress far more than we realise. That emotional overload can trigger sudden spikes in blood pressure and heart rate, making stress itself a potent trigger for angina,” explains Dr Narasa Raju Kavalipati, senior consultant cardiologist and director, interventional cardiology, CARE Hospitals, Banjara Hills.
Unlike men, women often don’t experience classic crushing chest pain. Their symptoms may appear as fatigue, breathlessness, nausea, indigestion-like discomfort, jaw pain or a vague heaviness in the shoulders. “In women, angina often announces itself quietly. Because these symptoms don’t fit the textbook picture, treatment has to begin with listening carefully and looking beyond obvious scans. Conditions like microvascular angina or coronary vasospasm are more common in women and may not show up on routine tests,” adds Dr Narasa.
The rising prevalence of angina amongst women between 30 and 40 years of age is alarming doctors. There has been a shift in the risk factor profile to an earlier age due to the combination of obesity, insulin resistance, chronic stress, hormonal imbalances, smoking, long hours of work, and lack of adequate sleep.
“Physiological stress and lifestyle disruption are reshaping cardiovascular disease in women. Conditions like PCOS, untreated hypothyroidism and a history of gestational diabetes significantly raise long-term heart risk through their link with metabolic syndrome,” cautions Dr Ravi Shanker.
Family history is another critical red flag. A parent or sibling with early heart disease — before 55 in men or 65 in women — warrants closer monitoring from a young age. Despite rising risk, women are still less likely to receive timely cardiac care. “Women often reach the hospital later than men. Some symptoms are dismissed as anxiety or acidity. Others delay seeking help because they prioritise family needs or believe heart disease is a ‘man’s problem’. These delays shrink the window for early intervention,” states Dr Narasa.
Awareness, he emphasises, must begin at the primary care level — with doctors actively asking women about fatigue, breathlessness, sleep quality and stress during routine visits. Cardiac rehabilitation, both experts say, is a powerful but underutilised tool for women recovering from angina.
Dr Narasa further highlights, “It restores confidence, improves stamina and reduces future cardiac events. But caregiving duties, work schedules and fear of strenuous exercise often prevent women from enrolling. Even home-based rehab can make a marked difference.”
Lifestyle change, both doctors stress, is not optional. “For women, lifestyle correction is part of the treatment itself. Regular movement, disciplined sleep, stress management and mindful eating directly improve vascular health. Small, consistent changes matter far more than extreme, short-lived efforts,” says Dr Ravi Shanker.
With timely screening, hormonal monitoring and early lifestyle intervention, doctors agree that angina risk in women can be significantly reduced — across every stage of life.
Age-wise prevention is key. Specialists recommend a targeted approach:
1. 20s–30s: Maintain healthy weight, regular exercise, monitor thyroid and hormones
2. 40s: Screen for blood pressure, cholesterol and diabetes; manage stress proactively
3. Perimenopause: Regular cardiac evaluations become crucial
4. Post-menopause: Vigilant heart monitoring and strict lifestyle control are essential