Cardiovascular disease is the biggest killer of women in Australia. It accounts for more than 40% of all female deaths, which means it kills more Australian women than breast cancer and lung cancer combined. But few women are aware of their risk and many wouldn’t necessarily be able to recognise warning signs.

Part of the difficulty stems from the fact that heart disease is often not obvious and, sometimes, it has no symptoms. High blood pressure (hypertension), for instance, is a major risk factor in cardiovascular disease and can easily go undetected for years. So many women remain unaware that heart disease and stroke are major health issues for them.

Manageable risk factors

Some of the more commonly known modifiable risk factors (things you can change) for cardiovascular disease include smoking, being physically inactive, being overweight, having high cholesterol and high blood pressure, and diabetes.

Most Australian women have at least one risk factor, with many consuming inadequate amounts of fruit and vegetables, and being physically inactive. More than half are overweight or obese, and almost half have high cholesterol.

Women should become aware of their blood pressure, lipids and waist circumference and start to adopt healthy behaviours early. They should also take an active approach by asking their doctor about their risks, rather than waiting for doctors to raise the subject.

Myth busting

A number of myths surrounding cardiovascular disease reinforce inaccurate beliefs and unhelpful behaviours. Many people think cardiovascular disease is a man’s disease, for instance, when it actually affects one in five women compared with one in six men in Australia.

Women have a much lower incidence of heart disease than men of the same age before menopause, but its incidence rapidly increases after menopause.

The death rate from ischaemic heart disease (reduced blood supply to the heart muscle) in women is higher than in men. And warning signs are often different in women than in men, which may lead to missed or inaccurate diagnoses.

Extreme fatigue and shortness of breath are important warning signs of possible heart disease in women and may indicate coronary microvascular dysfunction (a narrowing of the small arteries and blood vessels of the heart that prevents the heart from getting blood).

Other noted symptoms in women may include dizziness, light-headedness or fainting, and upper back pressure.

Gender differences and disparities

The reasons for some of the disparities in levels of understanding and awareness of cardiovascular differences between women and men are related to early research being conducted primarily on the latter, which also means diagnostic tools may not always be as accurate for women as they are for men. And anatomical differences between men and women’s coronary arteries, hormonal effects on the cardiovascular system and body fat distribution may affect gender differences.

Atrial fibrillation (the most common abnormal heart beat) presents a significant risk factor for stroke. This risk factor is higher in women than in men and treatment by anticoagulation (blood thinning medications) is associated with a higher risk of bleeding complications.

Astonishingly, many women receive different health care for cardiovascular disease, atrial fibrillation and stroke. There are also higher rates of misdiagnoses among women and treatment regimes are often less aggressive than their male counterparts.

But there’s not yet enough evidence to determine whether this has any effect on outcomes.

Recognising symptoms

Failure to quickly recognise symptoms and delays in seeking advice and care are among the most common barriers to better cardiovascular health for women. Differences in self-management behaviour (adherence to medication and other lifestyle changes) and access to services, and recovery, may also contribute to poorer outcomes.

Difficulty managing their sometimes multiple conditions likely results from the many roles women play as caregiver, employee and patient, to name just a few. Multiple competing demands may impact on women’s higher rates of psychosocial risk factors including depression, stress associated with work and family, socioeconomic deprivation and adverse life events.

Need for change

The burden of heart disease and stroke in women is set to increase with the ageing population. For improvements in primary prevention, timely diagnosis and clinical management, along with a greater understanding of women’s needs are required from both the community and the government.

Women generally live longer than men, but do so with greater disability, which leads to a loss of independence and more need for support. So longevity becomes an increased social and economic burden to society.

This burden can be significantly reduced through the prevention of heart disease and stroke in the first instance. The time has come to unmask this often silent killer through increased engagement with women, their families, communities, health professionals, organisations, and mass media campaigns.

More information at National Heart Foundation