S2E4: Why Women’s Heart Disease Gets Missed with Dr. Ambreen Mohamed
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S2 E4
Heart disease has long been framed as a “man’s disease” – but women are being missed, misdiagnosed, and overlooked in ways that can be life-threatening, especially within South Asian communities where cardiovascular risk often develops earlier and more aggressively.
In this episode, Dr. Komal Patil-Sisodia sits down with advanced imaging and preventative cardiologist, Dr. Ambreen Mohamed, to unpack the evolving science of women’s cardiovascular health, the hormonal shifts that impact risk throughout midlife, and why prevention needs to start far earlier than most people realize.
Together, they explore the subtle symptoms women experience that are too often dismissed, the intersection of menopause, PCOS, pregnancy complications, insulin resistance, and heart disease, and why traditional risk calculators frequently fail to capture the realities of South Asian patients. Most importantly, this conversation reframes prevention not as fear-based medicine, but as empowerment: understanding your risk factors early enough to change the trajectory of your health before disease develops.
The Heart of the Matter: Why Women – Especially South Asians – Are Being Overlooked
By Dr. Komal Patil-Sisodia, MD | Eastside Menopause & Metabolism
Three Reasons Women’s Heart Disease is Still Missed or Misinterpreted
1. A historically male-centered model of cardiovascular disease
Much of cardiovascular medicine was built on research that primarily studied men, which shaped the “classic” understanding of heart disease symptoms and presentation. As a result, the field has long centered on dramatic, obstructive disease patterns and textbook symptoms like crushing chest pain or sudden collapse. Women are still too often evaluated against this template, despite having different disease pathways and symptom presentations.
2. Symptoms that don’t always look “cardiac”
In women, cardiovascular disease may present in ways that are more subtle and easily attributed to non-cardiac causes. Common examples include fatigue, dizziness, lightheadedness, shortness of breath with minimal exertion, jaw, neck or shoulder discomfort, reduced exercise tolerance, nausea and/or indigestion. Because these symptoms are nonspecific, they are often attributed to stress, anxiety, or gastrointestinal issues, which can lead to delayed recognition.
As Dr. Ambreen Mohamed emphasizes, by the time many women reach cardiology care, it is often because they already feel something is wrong, even if prior evaluations were “normal.”
3. Under-recognized mechanisms of disease in women
Women are more likely to experience cardiovascular disease driven by mechanisms that are not always detected through standard testing. This includes microvascular coronary disease, endothelial dysfunction, and non-obstructive plaque patterns. These forms of disease may not always appear on routine stress tests or initial evaluations, even when symptoms are present and clinically meaningful. The result is a gap between what patients feel and what conventional testing captures.
The South Asian Risk Profile
South Asian women carry a disproportionately high risk of cardiovascular disease, often at younger ages and with fewer traditional warning signs. This elevated risk is driven by a combination of genetic and metabolic factors that are frequently not included in standard screening.
Key contributors include:
Higher prevalence of elevated lipoprotein(a) (approximately 1 in 4)
Increased ApoB and atherogenic particle burden
Higher rates of insulin resistance, even at normal BMI
Greater visceral fat distribution, which is metabolically active
Dr. Mohamed asserts that this creates a risk profile compounded over time by genetics, lifestyle, and environmental factors.
A System Without Full Visibility
One of the central challenges in cardiovascular prevention is that standard screening tools do not always reflect true underlying risk. Dr. Mohamed highlights a key gap: many individuals with normal LDL cholesterol, normal blood pressure, and normal BMI may still have elevatedcardiovascular risk when deeper markers are considered. This means a “normal” lab report may not fully represent cardiovascular reality.
A Prevention Framework: What Should Actually Be Checked
Dr. Mohamed outlines a practical, structured prevention approach for women, especially those with family history or higher-risk backgrounds.
Core labs and markers to request:
Complete lipid panel (beyond basic cholesterol screening)
ApoB (atherogenic particle burden)
Lipoprotein(a), ideally by age 30
Fasting blood glucose
Hemoglobin A1C
Metabolic and physical risk measures:
Blood pressure (including diastolic values)
Waist circumference, even with normal BMI
Trend-based glucose changes over time
Family and reproductive history considerations:
Family history of premature cardiovascular disease
Gestational diabetes
Gestational hypertension or preeclampsia
Preterm delivery or other pregnancy complications
Dr. Mohamed is clear: prevention begins when you start asking for more complete data – not just routine screening.
Timing Matters: When Screening Becomes Essential
Dr. Mohamed also highlights specific timing considerations. She states that lipoprotein(a) should ideally be checked by age 30. In cases of strong family history of heart disease, screening in one’s 20s is recommended. These thresholds are not arbitrary – they reflect the goal of identifying risk before disease becomes clinically apparent.
Understanding Risk Over Time, Not in Isolation
A central theme in the conversation is that cardiovascular risk is cumulative. Dr. Mohamed emphasizes that single snapshots of data are less informative than longitudinal trends. For example, rising fasting glucose over time can signal developing insulin resistance and “normal” labs can still miss early metabolic change. Additionally, BMI alone does not capture visceral fat risk. Prevention, therefore, is not about one-time testing – it is about pattern recognition.
Hormones, Life Stages, and the Unmasking of Risk
Cardiovascular risk in women changes across life stages, particularly during hormonal transitions. Before menopause, estrogen plays a protective role in vascular function, lipid metabolism, and inflammatory regulation. As estrogen declines during perimenopause and menopause, previously compensated risk factors may emerge, such as rising LDL cholesterol, increased insulin resistance, shifts toward visceral fat accumulation, and greater cardiometabolic instability.
Dr. Mohamed also notes pregnancy as a physiological “stress test,” where complications such as gestational diabetes or hypertension may reveal underlying long-term risk.
Prevention in Practice: What Women Can Start Doing Now
Dr. Mohamed outlines foundational, evidence-based prevention strategies:
Walking after meals to improve glucose regulation
150–300 minutes/week of moderate activity (e.g., walking)
75–150 minutes/week of higher-intensity movement if preferred
Strength training 2–3 times per week
Increasing protein and fiber intake
Reducing refined carbohydrates and added sugars
Prioritizing sleep consistency and stress management
The emphasis is not perfection, but consistency and metabolic stability over time.
Ultimately, Dr. Mohamed’s central message is not one of alarm, but of clarity: Prevention improves when we expand what we are looking at, not when we narrow it.
Dr. Komal Patil-Sisodia is a triple board-certified physician (Internal Medicine, Endocrinology, Obesity Medicine) and Menopause Society Certified Practitioner. She is the founder of Eastside Menopause & Metabolism and host of the Clearly Hormonal podcast.