It’s easy to understand why some conditions are considered an issue for a particular gender. While men can develop breast cancer, it’s women who are targeted in pink campaigns due to the significantly higher number of females afflicted by the disease.
Similarly, when we think of heart disease, a common perception is that it is singularly a problem for men.
“Statistically men have a higher incidence of heart disease and cardiovascular events, hence traditionally the focus has been on men rather than women,” says Dr Sonia Davison, endocrinologist at Jean Hailes for Women’s Health.
Yet, while a greater number of men suffer heart disease, statistics tell us that the leading cause of death in Australian women is heart disease. According to the Heart Foundation, each year 36,000 men and 19,000 women are admitted to hospital due to a heart attack. However, there is a slimmer disparity in the figures of death due to heart attack, with the Heart Foundation reporting annual death rates as 4,700 for men and 4,500 for women.
“Women are three times more likely to die of heart disease than breast cancer, but awareness is low,” says Julie Anne Mitchell NSW Heart Foundation Director and national spokesperson on women and heart disease. “Every hour of every day an Australian woman dies of heart disease.”
Women don’t see heart disease as personally relevant, so they are less likely to get checked or act on the signs and symptoms.
Mitchell suggests further investigation is necessary to understand the reasons for gender disparities in heart health, adding that it is “complex”.
“However, social stereotypes where we see men depicted in films and on TV having heart attacks or recovering from heart disease reinforce this perception.”
A contributing factor for women, Mitchell suggests, is that generally women don’t see heart disease as personally relevant, so they are less likely to get checked or act on the signs and symptoms of heart disease when they experience them.
“Women often prioritise the health of others over their own. Even when discharged from hospital after treatment for a heart condition they are less likely to attend cardiac rehabilitation or make the lifestyle changes necessary to keep them out of hospital a second time.”
What causes heart disease?
According to Dr Davison, heart disease increases as we age due to stiffening of the arteries, cholesterol depositing in arteries, an increased prevalence of diabetes and hypertension, smoking, not enough exercise and weight excess.
For women, however, being post-menopausal also increases their risk of heart disease, as well as a family history of cardiovascular disease.
Mitchell notes the most common risk factors affecting women are high cholesterol, high rates of overweight and obesity, and high rates of physical inactivity.
“Research also shows that smoking, poorly controlled diabetes and depression are greater risk factors of heart disease for women than men.”
While much of the warnings around heart disease focus on lifestyle choices and overall health and wellbeing, there is evidence that the risk of heart disease may also increase for those with a lower level of education and less favourable social circumstances.
Research also shows that smoking, poorly controlled diabetes and depression are greater risk factors of heart disease for women than men.
Davison says this is usually due to an increase in other risk factors such as weight excess, smoking and others.
“[Also], some ethnic groups do statistically have a higher risk for heart disease.”
Mitchell says there isn’t a lot of data breaking down the heart disease among particular socio-economic or ethnic groups, but notes that “in general the burden of heart disease often falls hardest on these groups”.
“We do know that in 2009-2010, the coronary heart disease death rate for Indigenous women aged 25 years and over was 1.6 times as high as other women of the same age-group. The age-specific death rate for Indigenous women aged 40-54 was 13 times as high as other women,” says Mitchell.
She further notes that, in 2009-2010, the coronary heart disease death rate for women aged 25 and over in remote and very remote areas was 1.2 times as that for major cities.
“[Coronary heart disease] death rates in women aged 40-54 rose significantly with increasing remoteness, five times higher for women in remote and very remote areas compared with major cities.”
Signs and symptoms
The lack of awareness is something the Heart Foundation has been trying to address. Since 2009, it has run a national women and heart disease campaign.
In June this year, it launches ‘Making the Invisible Visible’, a campaign to draw awareness to heart disease in women, highlighting the invisible nature of the condition with a particular focus on issues that affect younger women, including common risk factors, vascular problems that can emerge in pregnancy, and issues that can arise for women who live with long-term heart conditions.
In general, its target is not only women at risk, but also health professionals and the health system, in order to ensure that the latter two are “more responsive in diagnosing and treating heart disease in women”.
Mitchell believes health professionals can play an important role in ensuring women know the facts, rather than the myths, about heart disease.
Apart from the erroneous belief that heart disease only affects men, Mitchell identifies a second misconception: that the signs and symptoms of heart disease are obvious.
“Symptoms for risk factors such as high blood pressure and high cholesterol are not visible so being tested is the only way a man or woman will really know if they have these conditions or not."
Symptoms for risk factors such as high blood pressure and high cholesterol are not visible so being tested is the only way a man or woman will really know if they have these conditions or not.
According to Mitchell, there are vital things women can do in relation to heart disease, including having a heart health check.
“Knowing your own personal risk is the first step to helping avoid heart disease. So ask for a heart health check next time you visit the doctor.”
Being aware of the warning signs of a heart attack – particularly non-chest pain symptoms, is also crucial.
“Call 000 if you or someone near you thinks they are having a heart attack. Treatment can start over the phone and if it turns out to be indigestion – then as any ambulance driver would tell you – that’s a good thing – better than not take action than live with regret.”
Dr Davison also recommends a visit to the doctor where there is a strong family history of heart disease or any symptoms that may point to heart disease. She also says to check blood pressure, blood glucose and cholesterol.
More generally, women can improve their chances of dealing with potential or actual heart disease early through lifestyle choices.
“Keep healthy,” says Dr Davison. “Avoid smoking, weight or alcohol excess, have a healthy balanced diet, exercise regularly, keep blood pressure and blood sugar/cholesterol under control.”
Image courtesy of Flickr/ Kasia.