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Women and cardiovascular disease: At a social
disadvantage?
Cardiovascular disease (CVD) is the leading health and
economic burden throughout the world, particularly in
industrialised countries. By 2020 CVD will be the most
burdensome public health issue globally (AIHW, 2008a;
World Health Organization, 2009). A sharp increase in
the prevalence of diabetes has led to an increase in
the associated complications of hypertension,
hyperlipidaemia
and atherosclerotic vascular disease (America Heart
Association (AHA) 2004, 2005). For the Australian
population,
cardiovascular diseases as a group contributed to 54%
of all male deaths and 59% of all female deaths
(AIHW,2010a, p. 52). Throughout the lifespan, health
disparities
can contribute to inferior outcomes (Lewis, DiGiacomo,
Currow, & Davidson, 2011).
In the United States, CVD is the leading cause of death in
postmenopausal women and far outweighs death rates
from
all types of cancer combined (AHA, 2002, 2005). Over the
last decade CVD is also the most common cause of death
in
the European Union, accounting for 1 in 7 deaths in
women
(BHF, 2008; BNF, 2000). In 2007 the Australian Institute
of
Health and Wellbeing recorded CVD as the main cause of
death for Australians, with over 78% of the CVD deaths
were of people aged 75 years and over, and more than half
were female (52.7%) (AIHW, 2010a, p. 141).
In Australia more than 26,000 women per year die from
CVD, accounting for 41% of all female deaths (AIHW,
2004).
The proportion of Australian women reporting CVD was
higher than for males in every age group except those 75
years and over. While the age-standardized incidence of
major coronary events fell, both male and female incidence
rates increase with age. Cerebrovascular disease affected
more women than men in Australia in 2005 accounting for
9% of all deaths. Most of these deaths (83%) occurred

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among
those aged 75 years or over (AIHW, 2008a).
The prevalence and costs of coronary heart disease
(CHD) in women is likely to increase due to the ageing
female demographic, and the increasing numbers of
women
affected by obesity, the metabolic syndrome, hypertension,
and diabetes. This paper provides a critical review of the
social issues impacting upon women who have CVD. The
discussion
will also identify areas for future interventions with
a view to improving outcomes for women with CVD.
This paper provides a critical review of the social issues
impacting upon women in Australia.
It also identifies areas for future interventions with a view
to improving outcomes in women
with cardiovascular disease.
The bibliographic databases; CINAHL, MEDLINE,
PsycARTICLES,
were searched for relevant studies using the
search terms women, cardiovascular disease, and
socioeconomic
status. A hand search of reference texts and other
resources held in the university library was also
undertaken.
The references used in this paper were included after
reading
the texts and subsequent discussion by the authors about
the fundamental points intended for this article.
- Women and cardiovascular risk
Cardiovascular risk factors accounts for over 30% of
Australias total burden of death, disease and disability
(AIHW, 2008a). The risk factors associated with CVD can
becategorised into behavioural, biological/medical, and
psychological/ social and include advancing age, family
history, being overweight or obese, physical inactivity,
diabetes,tobacco consumption, chronic renal disease, high
blood pressure, and high cholesterol.
- Social factors impacting upon cardiovascular risk
People with the lowest social and economic status often
have the poorest health (Lewis et al., 2011).
Socioeconomic
status (SES) is strongly associated with risk of disease and
mortality across many conditions in particular CVD. Of
concern is that women are over represented among low
incomeearners and under-represented among higher

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income earners (AIHW, 2010b). Importantly, this disparity

in health status follows a gradient, with overall health
improving with improvements in socioeconomic status
(Marmot, Shipley, &Rose, 1984).
- Cardiovascular risk and geographical isolation
When examining statistics of death rates in Australia the
evidence reveals substantial socioeconomic inequality
(AIHW, 2010a). People outside major cities were more
likely to place themselves at a higher risk of poor health,
and engage in unhealthy behaviours (AIHW, 2010a). They
are likely to smoke, be overweight and drink alcohol
excessively.
- Disparities in treatment and gender
The existing underestimation and poor awareness of CVD
risk among women is well recognised (Mosca, Ferris,
Fabunmi, & Robertson, 2004) and is attributed to cultural
and historical perceptions about CVD as being a mans
disease (Miller & Kollauf, 2002).
The social issues that impact upon women who have CVD
can affect symptom recognition, access to services and
recovery (DiGiacomo et al., 2011; Gholizadeh, Davidson,
Salamonson, & Worrall-Carter, 2010; Kuhn, Page,
Davidson, & Worrall-Carter, 2011). The importance of
prompt access to hospital for diagnosis and treatment of
ACS cannot be underestimated. The highest mortality rate
following acute myocardial function occurs in the first 2 h
after symptom onset, and a reduction in the time between
symptom onset and presentation to hospital can reduce MI
mortality (Then, Rankin, & Fofonoff, 2001). Delay in
treatment is associated with increased disability and
mortality (Lefler & Bondy, 2004). Despite public and
targeted education programs and previous experience of
CHD (Bett, Tonkin, Thompson, & Aroney, 2004; Moser,
McKinley, Dracup, & Chung, 2005),American and
Australian women delay seeking help for cardiac
symptoms (Mosca et al., 2004).
Differences in symptom presentation between women and
men has implications for education of the public and health
care providers regarding the recognition of sex differences
in acute coronary syndrome (ACS) clinical presentation,
and health seeking behaviour and decision
making. This is particularly important for Aboriginal and
Torres Strait Islanders and those living in remote areas.
Mass public education programs to decrease delay have up
until now focussed on the symptoms of MI and the
appropriate response to take (Bett et al., 2004; Moser et al.,

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2005).
Clearly these efforts have been ineffective in decreasing
pre-hospital delay for MI. Primary prevention of CVD and
prompt treatment for those with symptoms of ACS can
only be achieved if women are aware of their CVD risk,
the associated symptoms and the importance of seeking
help
from emergency services. In addition to these factors it is
important to address cultural, social and economic factors
that contribute to health care differentials for women
(Gholizadeh & Davidson, 2008). Health professionals need
to provide individualised information regarding possible
symptoms of ACS, taking into account the patients age,
gender, risk factors, social circumstances, risk factors and
history.
(Gholizadeh, Salamonson, Worrall-Carter, DiGiacomo, &
Davidson, 2009). New tools have been developed which
can help health professionals identify cardiac related
symptoms, (McSweeney, OSullivan, Cody, & Crane,
2004) so that appropriate diagnostic tests (Maseri, 2004)
and treatment can be initiated in a timely manner.
In Australia, the cultural and linguistic diversity of
Australia requires an increased focus on health information
that targets the needs of migrant women (Gholizadeh et al.,
2009). Addressing health literacy needs is an important
consideration in reducing health disparities and improving
population health (Nutbeam, 2000).
Health disparities are evident for women and these factors
contribute to inferior cardiovascular outcomes. Social and
economic health disparities contribute to poorer outcomes
for women and in particular groups, such as Indigenous
women, these health differentials are more pronounced.
Adopting proactive and enabling strategies to increase
awareness of CVD among women and increase accesses to
services is an important factor in improving health
outcomes
for Australian women.