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MUMBAI: Unlike many Mumbaikars who disliked April for its sizzling temperatures, Mahim resident, 27-year-old Payal (name changed), has happy memories of the summer month as a new bride. That is, until June 2, when the software engineer spent a day nursing “terrible acidity” that worsened with acute chest pain in the middle of the night and turned out to be a heart attack.“She showed changes in her ECG when she was brought in at 2am that pointed to a heart attack,” said cardiologist Dr Kaushal Chhatrapati from Saifee Hospital near Charni Road, who put a stent across her circumflex artery in the early hours of June 3.
Payal’s heart attack shocked her family because, for one, she is just 27, and for another, women are supposed to have ‘protection’ against heart disease/attacks during their childbearing years. The protector is the female hormone estrogen, which keeps blood vessels wide enough for blood flow and reduces inflammation.The culprit in Payal’s case, according to Dr Chhatrapati, was contraceptive pills she was prescribed for polycystic ovary syndrome (PCOS), a hormonal disorder characterised by irregular periods and the presence of cysts on the ovaries. Payal’s father said she struggled for almost a decade with PCOS, and her gynaecologist prescribed the contraceptive pills for seven years.A Denmark study published in ‘The BMJ’ medical journal in Feb found that the most commonly used hormonal contraceptive—the combined estrogen-progestin pill —was associated with double the risk of ischaemic stroke and heart attack. The article extrapolated this to mean “one extra stroke for every 4,760 women using the combined pill for one year, and one extra heart attack for every 10,000 women per year of use.” The study maintained that estrogen-containing products, in particular the vaginal ring and skin patches, were of concern.Gynaecologist Dr Kiran Coelho said strokes are more common than heart attacks due to contraceptive pills. “I have seen 22-year-old and 28-year-old women with PCOS who suffered strokes, but women need the pills to suppress ovulation, which, in turn, reduces the number of cysts in their ovaries,” she said.PCOS is often accompanied by obesity and insulin resistance, leading to dyslipidaemia, a condition in which the patient has high levels of lipids (fats) in the blood that can lead to an increased risk of heart disease. “Urban women have high levels of stress, and there is a higher incidence of childhood obesity than before. These factors increase the risk of PCOS in urban India, where one in every five adolescent girls has the hormonal disorder,” said Dr Coelho.Cardiologist Dr Rajeev Bhagwat from Nanavati Hospital in Vile Parle said that while it’s known that contraceptive pills can increase thrombosis, it’s important for doctors to know the woman’s family history of heart disease before prescribing these pills. “Family history is a very strong cause for heart disease among the young,” he added.
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