Coronary heart disease (CHD) is the leading cause of death of Australian women and kills around 11,000 women a year. Any successful prevention campaign would need to address key gendered issues in relation to heart disease, including the perception that it is a male disease and that breast cancer is of more concern for women.
- Women are not aware that CHD is the leading cause of death – a 2008 Heart Foundation National Newspoll Survey found that 70 per cent of women did not know that coronary heart disease is the leading cause of death of Australian women. The majority of women believed that breast cancer is the leading cause of death for women even though heart disease is responsible for more than four times the number of Australian women’s deaths than breast cancer.
- Women are not aware of key risk factors – the same Newspoll survey found that while women recognised that smoking and obesity are key risk factors, few women recognised that high blood pressure, high cholesterol and diabetes were leading risk factors for heart disease. Women may also not be aware that diabetes is a greater risk factor for women than men and that the risk of heart disease significantly rises after menopause.
- Women and health professionals may not be aware of sex and gender differences in the symptoms of heart disease and heart attack – which is crucial to prevention and which are likely to be related to anatomical differences (for example women have smaller coronary artery lumens) and psychosocial differences (for example depressed patients report more episodes of angina and more intense angina pain, and women have significantly higher rates of depression than men). Differences which may lead to inadequate treatment and which may be partly responsible for women being more likely to die after myocardial infarction (heart attack) than men, include:
- around 70 per cent of women initially present with angina (compared to 30 per cent of men, who present more often with myocardial infarction) and women are more likely to first present with atypical angina that makes diagnosis difficult;
- during an infarction, chest pain is the most common symptom but women experience more nausea, vomiting, neck and back pain than men; and
- women are more likely to suffer ‘silent’ infarction (without symptoms).
Both sex and gender are significant determinants of health, and health outcomes are the result of a complex interaction between the two and the broader social determinants outlined in the next section.