What’s spiking BP in women in their early 30s and 40s faster than men?

 Source: https://indianexpress.com/article/health-wellness

Women between 30s and 40s often begin transitioning through perimenopause, a phase marked by fluctuating and gradually declining estrogen levels. (Representational)

Lately, I have been seeing a lot of women in their 30s and 40s with complaints of hypertension or high blood pressure. And I noticed that most of them lived in some of Mumbai’s most polluted areas. While the impact of pollution is generally associated with respiratory health, in women it can impact their biology and hormones.

Pollution and Blood Pressure

Research indicates that women may experience more pronounced cardiovascular responses to air pollution than men. Exposure to pollutants like fine particulate matter (PM2.5) and nitrogen dioxide (NO₂) has been linked to steeper blood pressure spikes in women. This is because of two reasons. One, women typically have smaller airways, which may allow pollutants to exert a greater physiological impact and obstruct them further. Second, their hormonal cycles and stress levels heighten their sensitivity to environmental triggers.

Hormonal Shifts and Cardiovascular Risk

Women between 30s and 40s often begin transitioning through perimenopause, a phase marked by fluctuating and gradually declining estrogen levels. Estrogen, known for its protective effects on the cardiovascular system, helps maintain blood vessel flexibility and suppresses inflammation. Pollutants like PM2.5 damage cells and trigger inflammation, which, in the absence of adequate estrogen, can damage walls of blood vessels—a precursor to chronic high blood pressure.

Pollutants of Concern

PM2.5 stands out as the most hazardous. These microscopic particles can penetrate deep into the lungs and even enter the bloodstream, igniting inflammation and damaging blood vessels. Nitrogen dioxide (NO₂) from vehicle exhaust leads to arterial stiffness. Carbon monoxide (CO) interferes with oxygen transport, forcing the heart to work harder, while ozone (O₃)—though less studied—has been shown to exacerbate cardiovascular and respiratory conditions. In urban areas, where traffic, construction, and industrial emissions converge, daily exposure to this toxic mix becomes unavoidable.

Many offices and homes suffer from poor ventilation, leading to constant exposure to indoor air pollutants as well. Combined with chronic stress, irregular routines, and limited physical activity, this creates a high-risk environment for cardiovascular problems.

Urban working women also often deal with long screen hours, shift work and low sun exposure — factors that further disrupt metabolic balance and vitamin D levels, both of which are closely linked to blood pressure regulation.

Taking Control: Prevention and Management

Since hypertension is a silent killer, women must do the following:

• Monitor regularly: Schedule routine check-ups for blood pressure, cholesterol and lipid profiles.

• Stay protected: Use indoor air purifiers and wear N95 masks when pollution levels are high.

• Eat smart: Adopt an anti-inflammatory diet rich in antioxidants, fibre and Omega-3 fatty acids.

• Move daily: Engage in regular physical activity, preferably indoors or in clean-air zones like parks.

• Manage stress: Practise mindfulness techniques such as yoga, breathing exercises, or meditation.

• Track the air: Use air quality index (AQI) apps and avoid outdoor activity during peak pollution hours.

 

Doctors revive heart attack patients in remote TN pockets with a little help from WhatsApp: How a hub and spoke model works

 Source: https://indianexpress.com/article/health-wellness

A study conducted by the Institute of Cardiology at Madras Medical College connected 188 smaller hospitals, which do not have catheter labs for angioplasty procedures, to 18 big hospitals in Tamil Nadu as part of a “hub and spoke” therapy model.

What if a person suffers a heart attack in a remote village and the local health centre doesn’t have a cardiologist or the infrastructure to do an angioplasty — a procedure to remove blood clots from heart arteries? The patient can still live and recover if the centre is connected to a bigger hospital through a chat platform, where specialists can recommend clot-dissolving drugs to local healthcare personnel and buy some time for the patient to get to a bigger hospital for surgical interventions.

A study conducted by the Institute of Cardiology at Madras Medical College connected 188 smaller hospitals, which do not have catheter labs for angioplasty procedures, to 18 big hospitals in Tamil Nadu as part of a “hub and spoke” therapy model. Cardiologists at bigger hospitals read the ECG, patient history and test results, suggested drugs and procedures, all through WhatsApp, improving the odds of patients at smaller centres surviving a heart attack.

What a pilot study shows

The study, which covered 71,000 people over five years, was able to demonstrate that just by providing guidance to the smaller hospitals on WhatsApp, more lives could be saved. Within five years, nearly one in five patients treated for heart attack in the hub hospital came from a spoke hospital, indicating how the linking system improved access. In the second phase of the study done with six hub hospitals, the doctors saw a remarkable increase in the proportion of people who got any intervention from 52.6 per cent in 2019 to 87.1 per cent by 2022.

The findings, which were recently published in the Indian Journal of Medical Research, are significant because they lay the template for broad-basing cardiac care to cover the last mile. With more Indians experiencing heart attacks in their early years, such a public health intervention can make heart care accessible even during emergencies. The data is from the cardiac care policy implemented by the government of Tamil Nadu.

Why this model can reduce deaths from heart attacks

“The sooner a person can undergo a procedure to open up a heart blockage or at least get a medicine that can help in dissolving the clot, the more muscles we end up saving. Sadly, a very small proportion of people receive these timely interventions,” said Dr G Justin Paul, professor at the Madras Medical College who designed the model. He also leads the state government’s heart attack management programme team.

“There are two types of heart attacks. A STEMI (ST-elevation Myocardial Infarction) is a major heart attack where the clot blocks blood flow completely to a part of the heart, resulting in muscles dying. Non-STEMI is referred to as a minor heart attack. Once the heart muscles die, there is no way of reviving them. However, there is now enough evidence to show that giving the clot-dissolving drug immediately and then doing the procedure within 24 hours is also equally effective. While most hospitals may not be able to do the procedure, they can certainly give the drug and then move the patients to the bigger hub hospital,” said Dr Paul.

In fact, the WhatsApp chat platform also helps the smaller centres share transfer protocols and coordinate patient care with the bigger hospitals. “This system of care worked in Tamil Nadu because of the availability of cardiologists in several Government hospitals, even in those that did not have a catheter lab prior to the study. This may not be true for all of India. However, the model may be modified and adopted,” said Dr Paul.

Benefits in numbers

In the first cluster with 12 hub hospitals, including the key Madras Medical College, the proportion of patients undergoing the stenting procedure after getting the clot dissolving medicine streptokinase increased from 9.1 per cent to 33.2 per cent. The proportion of patients able to receive the procedure within hours of heart attack also increased from 5.7 per cent to 9.7 per cent.

“The cost of angioplasty in a private hospital — which can range from Rs 1.5 lakh to Rs 6 lakh — can be a deterrent. But, more importantly, not all hospitals have the facility to conduct the procedure. This is the reason many may not be able to get the procedure within a few hours of the heart attack,” reasoned Dr Paul.

The results from the second cluster were even more impressive. While the proportion of patients undergoing the procedure immediately remained the same, those getting the procedure after having received the medicine increased from 0.9 per cent to 5.3 per cent. The proportion of deaths also reduced from 8.5 per cent to 5.8 per cent.

While the study used the less costly streptokinase that is given as an infusion, newer drugs can also be used. “These one-shot injections are costly at present, but the price may be brought down by governmental action, much in the same way as the stent prices were lowered,” said Dr Paul.