On Thursday, Sushmita Sen, former Miss Universe and Bollywood actor, shocked fans with an announcement that she had recently suffered a heart attack. “I suffered a heart attack a couple of days back…Angioplasty done…stent in place… all is well and I am ready for some life again!!!” Sen, 47, posted on Instagram. Along with an outpouring of support on social media, her health update also had many speculating about the root causes of rising instances of heart attacks, especially among the young and seemingly fit.

Recently, an increasing number of headlines and viral videos have documented people across the country suddenly collapsing during everyday activities. On Tuesday, a 38-year-old man died after he collapsed while playing Badminton in Hyderabad. A 40-year-old man suffered a heart attack during a ‘haldi’ ceremony, and a 19-year-old boy died in Telangana while dancing during a wedding – all suspected cases of cardiac arrests. In recent years, a number of high-profile personalities – from comedian Raju Srivastava to TV actor Sidharth Shukla – have also succumbed to heart attacks, further pushing the grim reality of heart health into the limelight.

A heart attack, or acute myocardial infarction, is a condition where blood flow to the heart is obstructed. It has long been associated with the elderly, and was once considered rare among people under the age of 40 years. However, as the American College of Cardiology noted in 2019, now one in five patients are 40 years of age, or younger. In India, the numbers are staggering. Deaths due to heart attacks rose by 53% between 2014-2019 in the country. According to the World Health Organization (WHO), India accounts for one-fifth of all cardiovascular disease-related deaths, especially among the younger population.

A significant amount of speculation has revolved around the effects of the pandemic on people’s health, with doctors across the world stating that those who were hospitalized with Covid19 were three times more likely to face cardiovascular problems within eight months after hospitalization, reported Business Insider. But while this remains hotly contested, there’s relatively more consensus among experts attempting to pinpoint the reasons for this rise in numbers: it could be closely linked to people’s lifestyle choices.

“The younger generation today are unaware of health risks… which often leads to their problems remaining undiagnosed as they believe that they are in their peak of health and they do not need any medications and diagnosis,” Dr Manish Agarwal, senior consultant and head of interventional cardiology, PSRI Hospital told The Sunday Guardian. Apart from those who might have a genetic predisposition to heart disease, a sedentary lifestyle, along with poor intake of nutritious food, excessive consumption of alcohol and lack of sleep, among others, substantially increase people’s risk of a sudden heart attack.

Lack of exercise can lead to several health issues, including diabetes and obesity – both key risk factors for heart disease. High blood glucose can damage blood vessels in people with diabetes. They are also more likely to have other common risk factors such as high blood pressure or high cholesterol, which increases their chances of suffering a heart attack. Obesity, too, comes with a host of related health problems, including an increase in blood pressure, a spike in bad cholesterol, and could even lead to diabetes.

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Smoking, Diabetes, and High Blood Pressure More Likely to Lead to a Heart Attack in Women Than Men

Among the youth, smoking or vaping has been identified as a leading risk factor that makes them more vulnerable to cardiovascular diseases. In 2020, the WHO along with World Heart Federation and the University of Newcastle Australia released alarming statistics – 1.9 million people die from tobacco-induced heart disease every year, which amounts to one in five deaths due to heart disease. One doesn’t need to smoke a pack to increase their risk of a heart attack; even occasional smoking or exposure to second-hand smoke substantially raises chances of heart disease.

Over the years, a number of studies have also revealed that the youth are under an inordinate amount of stress – one study among Indians said that 74% suffer from stress, while 88% suffer from anxiety post-pandemic. A demanding professional life, relationship trouble, financial issues and poor mental health, all contribute to rising stress levels – a primary cause of heart attacks. The human body’s response to stress is meant to protect it, however, constant tension could cause a buildup of plaque that blocks arteries, while raising cortisol levels which, in turn, increases cholesterol, triglycerides, blood sugar and blood pressure.

Historically, men have been considered to be more prone to heart disease. However, experts have noted that, contrary to popular belief, it is a leading cause of death for both men and women. In Sen’s case, doctors suggest one of the possible causes to be an autoimmune condition called Addison’s disease, which Sen was diagnosed with in 2014. Most autoimmune disorders are known to disproportionately affect women. “Autoimmune conditions, including Addison’s disease, can also affect heart health. Autoimmune diseases are conditions in which the body’s immune system mistakenly attacks its own tissues, including those of the heart. This can lead to inflammation of the heart muscle, known as myocarditis, which can damage the heart and lead to heart failure,” Dr Nishith Chandra, Director Interventional Cardiologist at Fortis Escorts Heart Institute, told The Hindustan Times.

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What You Need to Know About Heart Disease and Heart Attacks in Women

When it comes to diagnosing cardiac illnesses for women, a gender gap in medical knowledge comes into play. Heart attacks are often known to manifest as chest pain, lightheadedness, arm, neck or jaw pain, a sudden feeling of weakness, and irregular heart palpitations. However, in women, the signs are less recognizable. There are still several overlapping symptoms, including nausea, fatigue, pain that usually presents itself in the stomach or back for women. But the key symptom long associated with heart attacks – chest pain – is noticeably absent in most women. As such, heart disease remains under-diagnosed among women. They are also 50% more likely to be misdiagnosed, noted The Guardian.

Further, women’s symptoms have long been dubbed ‘atypical’, which confounds women’s access to adequate and timely treatment, raising concerns over health inequity. “[T]he belief that women having a heart attack will present more often with atypical symptoms carries an undertone that women present in the ‘wrong way’,” Dr Véronique Roger, senior investigator at the National Heart, Lung, and Blood Institute in Maryland, told The Guardian.

Thus, a gender data gap emerges, where women’s underrepresentation in clinical studies and research on cardiovascular disease puts their lives at risk – a fact that has also been noted by a presidential advisory by the American Heart Association. Research on men’s bodies, positioned as “the gold standard,” in Roger’s words, fails to account for sex differences that are of import when attempting to advance heart health, and prompt treatment, for all.