Women and CVD: underdone
Professor Helena Teede all articles by this author
A gap exists in the awareness of cardiovascular disease in women.
THERE is no doubt that an urgent focus is needed to reduce cardiovascular disease burden in Australian women.
CVD in women is currently under:
Under-estimated and Under-recognised:
Women underestimate their risk of CVD, falsely believing they are more likely to die of breast cancer than heart disease. Confounding this issue even more is that women are more likely to have atypical symptoms of myocardial infarction (MI), which leads to poor symptom recognition. Whilst the recognition of CVD risk in women is increasing there is still need for greater engagement of health profess-ionals in this area.
For example we know that:
• 26,306 Australian women die of CVD per annum
• More Australian women (26,306) die of CVD than men (23,988)
• 64% of the population believe heart disease was the leading cause of death for men, while only 3% thought women would die of heart disease
• 4% of women think they will die from CVD and 50% do
• 90% of women have one or more risk factors for CVD.1-5
Along with poor recognition a complex set of conditions impact on the differing experience of heart disease in men and women. Women will often take longer to seek help for cardiac symptoms and the consequent delay in treatment, along with less aggressive treatment offered to women, contributes to more negative outcomes.
Fifty per cent of MI in women is unrecognised compared to 33% for men, and 38% of women die in the first year after unrecognised MI compared to 25% of men.6-7 Women younger than 55 are nearly seven times less likely to be hospitalised than men for symptoms of MI.8
Advances in acute treatment of MI – specifically early angiography, angioplasty and stenting – have made the time between the onset of symptoms and receiving medical treatment critical in determining outcomes. In-hospital time-to-treatment and total time-to-treatment is critical. Delays after the initial hour from onset of symptoms increases the risk of death and studies suggest that women delay seeking treatment longer than men.9-10 Women also have poorer outcomes after interventions such as coronary artery bypass grafts and finally younger women with CVD also have a worse prognosis than men of the same age.11
Recent research by The Jean Hailes Foundation for Women’s Health (JHF) found around 30% of young women had unrecognised abnormal blood lipids and poor health screening practices, putting them at increased risk of CVD from an early age.12-13
Unless awareness and interventions occur nothing will be done about what is potentially a lifelong burden of disease.
Under-researched and under-resourced:
Research, education and resources addressing women and CVD are inadequate, for health care providers and the community, contributing to continued misperceptions of risk and inadequate prevention. The majority of participants in clinical trials informing practice are men. Results are then extrapolated to women, who have different contributing factors and psychosocial conditions.
Research is needed to understand why women’s risk perception of CVD is so poor and identify barriers to accurate perception and health care practices such as CVD risk screening and women’s understanding of the symptoms of MI.
Research into improved education and awareness is also needed. One JHF national study found that the most likely source of health information for women was from GPs,13 yet other research suggests that awareness about the specific risks for women among medical practitioners is still low.4 This lack of knowledge along with inadequate resources in relation to women and CVD places a burden on the physical, emotional and financial wellbeing of not only the individual woman, but society as a whole.
What could be done:
Poor CVD risk perception directly impacts on failure by women to practise health- promoting behaviours and to seek help when they need it. Broad-based consistent campaigns to raise awareness of CVD in women have shown some improved knowledge of risk and awareness in countries such as the US, yet such campaigns and dedicated translation projects have not been delivered on a large scale here.
The National Heart Foundation (NHF) and the JHF have worked to increase the recognition of this problem and to focus investment in this area. NHF are to be applauded for the development of their Engaging Women Strategy (www.heartfoundation.org.au) and for commissioning an Australian Institute of Health and Welfare study, ‘Women and heart disease: cardiovascular profile of women in Australia’, published in June.14
In 1997, 30% of Americans were aware the leading cause of death in women was heart disease and through awareness campaigns this had increased to 57% by 2006.15 Campaigns such as these and translation of evidence and knowledge into practical outcomes such as increased training, resources and support for health professionals and effective preventive interventions, will go some way to addressing this significant problem.
The Jean Hailes Foundation for Women’s Health is a national, non-profit health organisation focusing on clinical care, innovative research and practical education opportunities for health professionals and women.
Dr Deeks is a psychologist at the Jean Hailes Foundation for Women’s Health, specialising in menopause and midlife.
Professor Teede is director of research at the Jean Hailes Foundation for Women’s Health; she is also an endocrinologist.
Jean Hailes for Women’s Health is a national, not-for-profit organisation focusing on clinical care, innovative research and practical educational opportunities for health professionals and women. www.jeanhailes.org.au
Australian Institute of Health and Welfare (AIHW) 2004. Heart, stroke and vascular diseases—Australian facts 2004. AIHW Cat. No. CVD 27. Canberra: AIHW and National Heart Foundation of Australia (Cardiovascular Disease Series No. 22). www.aihw.gov.au/publications.
 Pfizer, Health report: Healthy hearts. Pfizer Australia Health Report with the Heart Foundaton, 2005. Issue 13, www.healthreport.com.au.
 Mosca L, Ferris A, Fabunmi R, Robertson RM. Tracking Women’s Awareness of Heart Disease: An American Heart Association National Study Circulation, 2004;109(5), 573-579
 Mosca, L., et al., National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation, 2005. 111(4): p. 499-510.
 Deeks, A., S. Zoungas, and H. Teede, Risk perception in women: a focus on menopause. Menopause, 2008. 15(2): p. 304-9.
 Bello N, Mosca L. Epidemiology of coronary heart disease in women. Progress in Cardiovascular Diseases, 2004, 46(4), 287-295.
 Murabito JM. Women and Cardiovascular Disease: Contributions from the Framingham Heart Study J Am Med Women’s Association; 1995, 50, 35-40.
 Pope JH, Aufderheide TP, Ruthazer R et al. Missed diagnoses of acute cardiac ischemia in the emergencydepartment New Eng Journal Medicine, 2000; 342(16), 1163-1170.
 Kerr D, & Kelly AM. Do differences exist in treatment and outcome for women with STEMI in Australia? Emergency Medicine Australasia, 2004;16, 92.
 Patel H., et al. Symptoms in acute coronary syndromes: Does sex make a difference ? American Heart Journal, 2004; 148, 27-33.