I have seen women look at me incredulously when I tell them they have just survived a heart attack. I can see that it wasn’t on their radar. Many women assume heart disease is something men suffer. But, while on average men may have their heart attacks earlier than women, heart disease is the leading cause of death and disability in both women and men. As a cardiologist, this means it is not uncommon for me to see women patients in their 40s and 50s.
While we are yet to learn the full circumstances of what happened to Senator Kimberley Kitching, her sad and sudden death at the age of 52 from a suspected heart attack should nevertheless be a prompt for righting misconceptions in how we think of heart disease. It’s not a man’s disease. And it’s not just an individual problem.
Heart attacks often manifest differently in women. Women are more likely to have atypical symptoms – breathlessness, fatigue, discomfort as opposed to pain, and less likely to have the stereotypic crushing chest pain. Women with a heart attack are more likely to present late, less likely to get the necessary investigations, such as a coronary angiogram, to diagnose and treat their heart disease, and less likely to start on preventative treatments. They subsequently have poorer outcomes – women have double the odds of being dead a year after their heart attack.
The causes of heart disease are changing in our society, smoking rates have fallen, but cardiometabolic health has worsened. The lifestyles normalised by society make us more prone to diabetes, high blood pressure, overweight, and inactivity, which all drive heart disease.
High blood pressure is the leading modifiable cause of heart disease in the world. Studies show about half of people with high blood pressure are unaware and among those who know they have high blood pressure about half again are undertreated. Comparative statistics show Australia is behind on blood pressure control to our usual counterparts, such as Canada and Britain.
For women, the additional risk factors of pregnancy-related diabetes and hypertension, the stresses, and challenges of being everything to everyone in work and family, and rising cardiovascular risk factors are some of the reasons why I would not be surprised to see heart disease a growing future threat for women.
In the 2019 Australian Institute for Health and Welfare report, it was with disappointment that I saw that the only group in Australia in which smoking rates had gone up was in young women. We know initiating smoking early is a maker of poor cardiovascular health.
But we can’t keep on saying that the many people working and living around us with heart disease have it because they made bad choices. We know diet and physical activity is important to prevent cancer as well as heart disease, but when people get cancer, we don’t say they made bad choices! Heart disease can happen to you. We need to make changes such that living a cardiovascular healthy life is not about a choice. Cardiovascular disease is a public health issue if it is affecting so many people.
In 2019, the government introduced public funding of heart health checks, but consumers tell me they don’t know about it and GPs tell me the level of the Medicare rebate makes it not worth their while. There has been a steady decline in people doing heart health checks across the pandemic. We need to understand why.
Additional tests to assess cardiovascular risk such as the calcium score are not publicly funded. And studies have shown that less than half of people living with heart disease are on prevention treatments. We should have better systems to identify those who are undertreated and get them on treatment.
My colleague Dr Sarah Zaman, a new appointment at The University of Sydney’s Westmead Applied Research Centre researching women with heart disease, is among a generation of earlier career women cardiologists that want to make a difference. Women cardiologists make up only about 15 per cent of our profession. I am hopeful that these women can be part of the solution to help address this big misconception among women that they are not going to get heart disease.
I hope the sudden and tragic deaths of Kimberley Kitching as well as cricketer Shane Warne – also at age 52 – can lead our society to take more responsibility for preventing cardiovascular disease. It should be more than a health department problem, it’s a whole of government, community, and industry problem. It takes life away prematurely and takes from healthy people, their quality of life – their productivity and capacity to care for their families. We need to fix it.
Clara Chow is professor of medicine and the academic director of the Westmead Applied Research Centre, University of Sydney, and a cardiologist at Westmead Hospital.
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