Heart disease and not breast cancer is the bigger killer of women in India today. "Women have a tenfold greater risk of death from coronary arterial disease as compared to breast cancer," says Dr Vivek Gupta, senior cardiologist at Delhi's Indraprastha Apollo hospital.

"Research now says that a heart attack or a stroke is more likely to be fatal in women. When women have a heart attack, the amount of heart muscle destroyed is likely to be greater, and they are more likely to go into shock, have heart failure and die," Gupta asserts. He adds that for women, the rate of mortality within one year after a heart attack is 44 per cent, as compared to 27 per cent for men.

Researchers have started focusing on women and heart disease only in the last decade. Dr Sanjeev Sharma, cardiologist at Delhi's National Heart Institute, says that most women don't take the early symptoms of heart trouble seriously - like heartburn, recurrent digestive problems or nervousness.

Although there is a definite increase in more women coming out to report heart problems, doctors believe the issue is more complicated. "Life expectancy among women has increased. But after menopause, women lose the protection of estrogen (female hormone) against heart disease," says Professor Anita Saxena from the department of cardiology, All India Institute of Medical Sciences (AIIMS).

"From 1960 onwards life expectancy for both men and women in India has increased by 20 years, coming up to an average of 61 years," says Gupta. Simultaneously, coronary arterial disease has increased by seven per cent in urban India and by two per cent in rural India for both men and women.

The most disturbing news about women and heart disease is that it is also affecting younger (35-45 age group) women. Professor A Sampat Kumar, also from AIIMS, attributes this to stress and lifestyle changes. Many young working women today have to perform both at work and at home. The dual pressures play havoc with their hearts. "Stress plays a major role in the deposition of cholesterol in coronary arteries. The safety blanket of female hormones is not enough for women as young as 40 or 45," explains Gupta.

More and more urban women are also leading what Gupta calls "pressure cooker" lifestyles. They eat wrong (more junk food and frequent meal skipping), don't exercise, sleep less and are constantly worrying about work or tasks they have to finish. "They are living in a pressure cooker, and unfortunately the whistle often blows in the form of a heart problem."

There has also been a substantial increase in women smokers in the cities, observe doctors. These women run a high risk of death from heart disease or a stroke. The increasing incidence of diabetes and obesity among women has also made them more prone to heart attacks. Diabetic women have three to seven times more risk of developing heart disease. Recent research is also pointing a finger at the long-term use of birth control pills in increasing such risk among women.

So far, women enjoyed an advantage: of being susceptible to heart problems almost 10 years later compared to men. But once they start smoking, become diabetic or reach premature menopause, they are as vulnerable as men, believes Gupta. Genetically, while Indians are more predisposed to cholesterol deposition compared to people in other countries, Indian women are more likely to get the more dangerous multi-vessel disease.

New research is also connecting heart problems to behavioral patterns and social conditioning. Women are accustomed to not paying attention to their own health needs. They are the caregivers who tend to postpone their appointment with the doctor to fulfill other family duties.

With some precautions, women can regain their advantageous position in the healthy heart race. How? One, through a diet that has five or more servings of fruits or vegetables daily and is low on cholesterol and saturated fats. Two, by walking at least for an hour a week; and three, by quitting smoking.

The benefits of walking have been reinforced by a study published in the journal of the American Medical Association in 2001. It said that walking, even at a moderate pace reduced the risk of heart disease among nearly 40,000 women, including those who smoked, were overweight and had high cholesterol.