``Before a heart attack, men typically get a pain in the chest, break into cold sweat and complain of a feeling of impending doom,'' says Barrett-Connor, in India for the International Conference on Heart Health which concluded last week. `` On the other hand, women may feel no pain at all, or if they do, experience it in an unrelated part of the body like an elbow, a shoulder or the jaw''. They don't usually get cold sweat either, and more often than not, just complain of fatigue, ``which is never associated with cardiovascular ailment because women are generally tiredall the time due to overwork,'' says she.

These atypical symptoms, when coupled with the myth that heart attacks are more common in men, result in the disease remaining undiagnosed in many women. This holds especially true in India where, among the majority, only the ailments of the breadwinner, usually a man, seem to warrant medical attention, says she. This is one reason why, despite the much-acclaimed protective nature of estrogen, Indian women account for 15 per cent of the global burden of heart disease which kills about 15 million each year. This figure closely follows the male burden of 17 per cent in 1977.

``Indian women are at an almost equal risk as men, probably because women are more prone to risk disorders like diabetes and hypertension, both fairly common here,'' she says. A recent study by the Indian Council of Medical Research found age-adjusted hypertension more prevalent in urban women than men, with 284 per 1,000 women being hypertensive as compared to 245 per 1,000 men. However, heartdisease risk among diabetics is the same for women and men, irrespective of age. Other risk factors also remain the same for both sexes: high fat dirt, increased tobacco consumption, reduced physical activity and abdominal adiposity which plays havoc with lipid and cholesterol levels. Still, the world of cardiology continues to remain a man's domain. ``It's amazing how few women-oriented studies related to heart diseases are conducted,'' says Barrett-Connor.