Madam R. Amurtham, 48, a Tamil Singaporean, suffered a heart attack two years ago. A heart bypass operation saved her life.

THE alarm bells had been ringing for Madam R. Amurtham but they just didn’t register. No matter that her symptoms – breathlessness, high blood pressure and cholesterol for a few years – screamed cardiac trouble.

Madam Amurtham ignored all the signs of an impending heart attack, thinking it was a disease that strikes only men, not women.

Two years ago, as the 48-year-old documentation executive was walking up the steep slope of Mount Alvernia Hospital’s driveway to visit a sick friend, she felt a stab of pain in her chest and back. She ignored it and tried to sleep it off that night. But her husband insisted that she see a neighbourhood doctor the next morning.

After an electrocardiogram (ECG), the doctor told her to report to Tan Tock Seng Hospital immediately. Four major blockages were found in her arteries and she was taken to the National Heart Centre Singapore, where she underwent bypass surgery in August 2008.

“I was really surprised when the doctor told me how serious my heart disease was,” says the mother of four.

Cardiologists say she is typical of most women patients. Health Ministry statistics show that the number of women suffering heart attacks is on the rise. In 2006, 1,890 women were admitted to restructured hospitals after suffering heart attacks. The number rose to 2,250 a year later.

As with Indian men, Indian women were disproportionately represented.

They made up 11 per cent of women who suffered a heart attack, compared to Malay women (17 per cent) and Chinese women (72 per cent).

“Women are less likely to believe they’re having a heart attack and more likely to put off seeking treatment,” says Dr Jimmy Lim from the Novena Heart Centre.

What throws them off is that women worldwide generally suffer heart attacks up to 10 years later than men. But when women suffer a heart attack, they are more likely to die from it.

Gleneagles Medical Centre cardiologist Associate Professor Mak Koon Hou, who studied the differences between the incidence and mortality rate of male and female heart attack patients, found that of the 16,320 Singaporeans who suffered heart attacks from 1991 to 1999, about 21 per cent – 3,497 – were women.

For the 20 to 34 age group, the incidence of heart attacks was 10 times higher in men than in women. But the difference narrowed to about two times between 60 and 64 years.

The study also found that women who suffered heart attacks were twice as likely to die as men. Half of the female patients died within 28 days of diagnosis, compared with only 38 per cent of the men.

Overseas studies found the same trend, suggesting that women showed up in the emergency room too late.

Again, cardiologists put this down to many women – sometimes even doctors – not recognising the signs of heart disease. As Dr Lim says: “They may only complain of fatigue or shortness of breath or even nausea or weakness. Women also tend to attribute their symptoms to getting older, being out of shape or to stress, rather than their heart.”

Doctors generally dispense the same advice to male and female patients but with crucial differences.

For one thing, women who don’t smoke often dismiss cigarettes as a risk factor, but constant exposure to others’ tobacco smoke at work or at home increases their risk. Female smokers who use birth control pills also have a higher risk of heart attack and stroke than non-smokers who use them.

High blood cholesterol is as major a risk factor for heart disease in women as it is in men. But studies have shown that low levels of HDL (good) cholesterol seem to have more of an effect in women than men.

Women are also at increased risk of developing high blood pressure if they are obese, have a family history of high blood pressure, are pregnant, take certain types of birth control pills or have reached menopause.

In the light of the results from clinical trials, doctors generally do not advise women to go on hormone replacement therapy (HRT) to reduce the risk of coronary heart disease or stroke.

Studies show that even for women who do not have heart disease, HRT should not be started for the sole purpose of preventing it. In fact, studies done in the United States have shown a slight increase in the risk of heart attacks and strokes in women on HRT.