Sikh Women's Health Initiative

Cardiovascular disease is a leading cause of death around the world and is a particularly significant in South Asian communities, including Punjabi and Sikh women. Despite this, many women in our community may not see themselves as being at high risk for heart disease, even if they have a family history of heart problems. But, men are not the only ones that can be affected by this. It’s important to understand the reality of this risk, and what we can do to protect our health and the health of our loved ones.

The Reality of Heart Disease in Our Community

Heart disease is more common and more dangerous for South Asians, including Punjabis, than for many other groups. The statistics are very eye-opening:

• South Asians develop coronary artery disease (a type of heart disease) about 10 years earlier than the general population.
• We have a 40% higher chance of dying from a heart attack compared to other groups.
• Although South Asians make up about 25% of the world’s population, we have more than 50% of the world’s deaths from heart disease.

For Punjabi women, there can be even more risk factors. These include family history, high cholesterol, diabetes, and the changes of menopause. Unfortunately, because these issues are so common in our families, they might not always be seen as serious. But the truth is, heart disease is a major concern – a woman’s lifetime risk of dying from heart disease is eight times higher than the risk of dying from breast cancer.

Why Are Sikh/Punjabi Women at Higher Risk?

There are many reasons why we might be at a higher risk for heart disease:

1. Diet: The traditional Punjabi diet, which has supported many generations, is high in carbohydrates (like rice, lentils, and chapatis), saturated fats (like ghee and butter), and sugars (like in mithai and sweet lassi). While these foods were perfect for our ancestors who did a lot of physical labor, today, they can cause weight gain, diabetes, high cholesterol, and eventually heart disease, especially when combined with less physical activity.
2. Insulin Resistance: Insulin resistance is a condition where the body’s cells don’t respond properly to insulin, the hormone that lowers blood sugar after eating. This leads to higher blood sugar levels. Many South Asians, including Punjabis, have a genetic predisposition to insulin resistance. This condition is closely related to the development of type 2 diabetes and significantly increases the risk of heart disease. For women, insulin resistance is particularly concerning because it often goes together with other risk factors like obesity and high blood pressure. Additionally, women with polycystic ovarian syndrome (PCOS) are more likely to experience insulin resistance, further increasing their risk of heart disease.
3. Cultural Expectations: Many Punjabi women take on the role of caregivers in their families, often putting their own health last. Regular check-ups and preventive care might not be a priority, especially during the busy years of raising a family. This can mean that risk factors like pre-diabetes or high blood pressure are not caught early when they are most manageable.
4. Lack of Awareness: There is often a lack of awareness about how serious these risk factors can be. For example, many women might not know that going through menopause increases their risk of heart disease, or that the symptoms of a heart attack in women can be different from the classic ones we see in men.
5. Changing Lifestyles: The combination of a traditional Punjabi diet with increasing Western fast foods, which are have unhealthy fats and sugars, has made the problem worse. This change in diet, along with less physical activity, has led to higher rates of obesity and diabetes, which are both major risk factors for heart disease.
6. Immigration and Stress: Many Punjabi and Sikh women are immigrants or come from immigrant families, with stress of adapting to a new country and working hard to survive. This stress, combined with factors like diet changes and limited access to culturally sensitive healthcare, can further increase the risk of heart disease.

What Can We Do to Protect Our Health?

The good news is that there are steps we can take to reduce our risk of heart disease. You can find more information on specific tools in the Cardiovascular Disease and Diabetes Toolkit from SAPHA.

1. Prioritize Regular Health Check-ups: Establish a relationship with a healthcare provider and attend regular appointments. Make sure to get screenings for diabetes, high blood pressure, high cholesterol, and other heart disease risk factors. Also, cholesterol goals can be much stricter for South Asians than for other groups. If there are South Asian healthcare providers in your area, establishing care with them may help with getting care that is ethnicity-specific but also culturally-sensitive and fits with your habits and values.
2. Know Your Family History: Share your family’s history of heart disease, diabetes, and high blood pressure with your doctor. This information is crucial for getting the right care. Make sure to share any history of heart attacks or early death.
3. Exercise Regularly: Aim for at least 30 minutes of moderate exercise, five days a week. This can include activities like brisk walking or cycling, which get your heart rate up and help keep your heart healthy. Slow walking and light yoga are great for your health but these are lighter exercise – this weekly goal is for moderate exercise, which can be achieved if you are (comfortably) a bit more out of breath. You can talk to your doctor to get more personalized advice regarding exercises, especially if you have other problems, such as joint pain. There are many tools online for exercises you can do to tailor this to your personal preferences as well.
4. Eat a Balanced Diet: Try to reduce your intake of unhealthy fats, carbohydrates, and sugars. Add more fruits, vegetables, lean proteins (chicken, fish, and tofu for vegetarians, or small amounts of paneer), and whole grains (atta instead of white flour). If you have a history of high cholesterol or diabetes, it is also helpful to lower the amount of dairy you eat, as we tend to consume large amounts of dairy in Punjabi families.
5. Be Aware of Special Health Concerns: Women with polycystic ovarian syndrome (PCOS) are more likely to have insulin resistance, which increases the risk of diabetes and heart disease. If you have symptoms like irregular periods, severe acne, excessive hair growth, or difficulty getting pregnant, these can be signs to talk to your doctor.
6. Understand the Impact of Menopause: The years around menopause are a time of increased risk for heart disease in women. It’s important to pay extra attention to your heart health during this time and to follow these heart-healthy tips.
7. Reduce Stress: Finding ways to manage stress, whether through exercise, meditation, or spending time with loved ones, can have a big impact.
8. Educate and Advocate: Educate yourself and your family about the risks of heart disease. Encourage other women in your community to take their health seriously and to prioritize regular check-ups and healthy lifestyle choices. Heart disease is not just something that affects the men.

Final Thoughts

Cardiovascular disease is a serious issue for Punjabi and Sikh women, but with awareness and action, we can make a difference. By understanding our risks, especially the role of insulin resistance, and making healthy choices, we can protect our hearts and ensure a healthier future for ourselves and our families. Let’s take this knowledge to heart and start making small changes today for a healthier tomorrow.