Cardiovascular disease: the difference between men and women

Published April 2024 | 5 min read
Expert contributor Professor Jason Kovacic, cardiologist and Director and CEO of the Victor Chang Cardiac Research Institute
Words by Karen Burge 

Cardiovascular disease affects one in six Aussies, but the symptoms and risk factors can vary based on gender. Here are the signs to watch for and why heart health checks are so important.

Cardiovascular disease (CVD) is Australia's biggest killer. It takes 118 Australian lives every day and is responsible for one in every four deaths – almost three times as many women die from CVD as they do from breast cancer – according to the Heart Research Institute.

CVD is a broad term for a range of conditions that currently affect one in six Aussies. But bundling men and women together masks some considerable differences between how each gender is impacted.

While men are more likely to develop CVD, global studies show women have a higher death rate after an acute cardiovascular event and a worse prognosis. To better understand how this might impact your heart health, let’s explore some key areas.

Signs of cardiovascular disease: the gender divide

An Australian Institute of Health and Welfare report suggests that while more men than women have heart disease, stroke and vascular disease, "the risk in women is largely under-recognised by the population". And it’s not only women who need to take note of this trend, but health professionals, too.

At the prevention end, GPs play an important role in addressing the gender gap and identifying the cardiovascular disease risks in women, according to Jean Hailes for Women’s Health.  

Academic interventional cardiologist from the University of Sydney and Westmead Hospital, Associate Professor Sarah Zaman, says only 48% of older women with hypertension have adequate blood pressure control, fewer women than men with high cholesterol are prescribed preventative medications like statins [which lower cholesterol], and women are more sedentary than men, with the gap worsening with age. "These are risk factors we could all be targeting in our clinical practice," she says.

There's room for improvement in a hospital setting, too. Research shows women hospitalised with a suspected heart attack are less likely than men to receive some procedures, such as certain treatments for coronary artery disease. The research authors suggest "unconscious gender bias" could be occurring, where healthcare professionals make assumptions about a patient’s symptoms based on whether they're male or female.

Director and CEO of the Victor Chang Cardiac Research Institute, Professor Jason Kovacic, agrees that women admitted to hospitals with serious heart attacks were less likely to receive ideal treatments when compared to men and didn’t do as well after some interventions, like coronary artery bypass graft surgery.

So, why is this happening? The reasons are complicated and multifaceted, Prof Kovacic explains, but there are some significant influences.

Risk factors for cardiovascular disease

There are several traditional risk factors for heart disease that can affect both women and men, and some can have a greater impact for women in particular. The key risk factors for heart disease in both genders are:

• high cholesterol
• high blood pressure
• obesity
• diabetes
• stress and depression
• smoking or vaping
• lack of exercise
• inadequate or excessive sleep (adults should be aiming for 7 to 9 hours)
• age
• poor diet.

New data is also shining a light on the connection between geography and CVD risk in Australia. A recent report from HCF's partner Royal Flying Doctor Service (RFDS) has revealed the rate of CVD among Australians living outside of major cities is a critical issue. Alarmingly, this data shows that people based in remote and very remote areas are 1.4 times more likely to die from heart, stroke and vascular disease than other Australians.

The RFDS has also found that in some of the most remote and isolated places of our country, such as parts of the Northern Territory and Western Australia, people were between four and 10 times more likely to die from ischaemic heart disease than the national average.

The impact of cardiovascular risk factors in women

Age is a significant factor contributing to the impact a heart event might have on the body. "When women get heart disease, they tend to be, on average, 2.5 years older than their male counterparts, who experience a peak of disease between 60 and 65 years of age, and men and women tend to have different underlying risk factors," says Prof Kovacic.

"For example, many women have a higher burden of high blood pressure, while males tend to have a higher burden of high cholesterol. Underlying differences in risk factors probably does contribute to the differences in outcomes and age of onset. But there are probably some system-wide issues also in how we treat women that are not as ideal as they are for men."

An important factor here is the lack of women participating in clinical trials, says Prof Kovacic.

"Clinical trials conducted over the decades have been largely enrolled by men, so most of the therapies we use have been tested, evaluated and proven to work well in large cohorts of males," explains Prof Kovacic. "We haven't had the same quality and quantity of robust clinical trial data testing different therapies – like aspirin, statins, beta-blockers, common therapies that we use – on women."

Today, he adds, there are significant ongoing efforts to address this, including some women-only studies.

Heart disease symptoms in women

There are also important differences in how men and women present during a heart attack, which can impact the ability to receive care.

"Men classically get this crushing chest pain, and while women can have chest pain also, they tend to have much more varied symptoms, such as shortness of breath, pain in the tummy, severe fatigue and back pain," says Prof Kovacic. Other signs can include cold sweats, dizziness, heart palpitations and pain in one or both arms.

Sam Allan, a 50-year-old mother of two, didn’t suspect she was having heart trouble when her lungs began to burn one afternoon two years ago.

"The kids and I had literally just got home from basketball training, and I went around the side of the house to see my husband working in the garden when suddenly my lungs felt like they were on fire," she says. Her symptoms quickly worsened and Sam’s husband drove her to the emergency department of a nearby hospital where she received life-saving treatment and later had surgery to insert two stents.

Sam was lucky that she received quick emergency care. She’d experienced what’s known as a spontaneous coronary artery dissection (SCAD) – a serious condition where an inner layer of a blood vessel in the heart tears. Women in their 40s and 50s are most at risk of SCAD (although it can happen at any age), with the majority having few or none of the typical risk factors for heart disease, like high cholesterol, smoking or diabetes. SCAD is responsible for about one quarter of heart attacks in women under 50 and is the most common cause of heart attack associated with pregnancy.

While much is still unknown about what causes SCAD, possible triggers include fibromuscular dysplasia – a vascular disease thought to affect up to one in 20 women – and broken heart syndrome (or stress cardiomyopathy), which occurs when a person experiences sudden acute stress, extreme emotions or a physical injury that can rapidly weaken the heart’s main pumping chamber.

Have you received a cardiovascular disease diagnosis but want a second opinion? We can connect eligible members to a network of independent, Australia-based medical specialists for a free second opinion on a health condition you’re worried about^*. You’ll have the chance to ask questions so you can confidently make the best decision for your health.

Women and heart health

Additional risks to women include being in the post-menopause phase (after heart-protective oestrogen levels drop) and pregnancy complications, such as preeclampsia or gestational diabetes. A study of more than 10,000 Australian women highlights a lack of clear messaging to those who’ve had a past gestational diabetes diagnosis about their high cardiovascular risk later in life.

Having regular check ups with your GP will go a long way to keep your heart in good health and ensure you have timely access to additional services and support if needed.

Women and men over 45 (or over 30 for Aboriginal or Torres Strait Islander peoples) can see their GP for a comprehensive Heart Health Check, and eligible HCF members^{^} in some states can access a free heart health check at certain times of the year, thanks to our partnership with the Victor Chang Cardiac Research Institute. It’s also essential to be aware of your risk factors and what you can do proactively to reduce your heart disease risk.

Extra help for members

The COACH Program® is a four- to six-month phone-coaching support program provided at no extra cost for eligible members⁺ with heart conditions or diabetes that can help improve your health.