Heart Disease in Women: Why They’re Underdiagnosed, Undertreated, and at Greater Risk

Ischaemic heart disease, a condition in which the heart muscle is deprived of adequate oxygen-rich blood due to narrowed or blocked coronary arteries, is the second leading cause of death in Australia, ranking just below dementia.

While deaths linked to cardiovascular disease have declined significantly over the years, heart-related conditions still account for nearly one in four deaths nationwide. High cholesterol, high blood pressure, unhealthy diet choices, and lack of physical activity remain the major traditional risk factors for both men and women.

However, new findings from the Heart Foundation highlight a concerning gender gap in heart disease care. Women are frequently underdiagnosed and undertreated for heart conditions, reducing their chances of receiving timely, life-saving interventions such as angiograms. As a result, women face a higher risk of in-hospital complications and poorer recovery outcomes compared to men.

Adding to the challenge, women often experience different warning signs of heart disease and heart attacks. Instead of the classic chest pain commonly reported by men, women may notice symptoms such as breathlessness, tightness in the chest, unusual fatigue, or discomfort in the jaw, shoulder, or back.

Risk Factors Unique to Women

Women also face several heart disease risk factors that are specific to female biology and reproductive health. These include premature menopause, where falling oestrogen levels reduce the natural protection the hormone offers to the heart and blood vessels. Early or late onset of menstruation has also been linked to increased cardiovascular risk, although the exact reasons remain unclear.

Pregnancy-related complications such as pre-eclampsia and gestational diabetes can cause lasting damage to blood vessels, even after childbirth. Conditions like endometriosis may increase cardiovascular risk due to chronic inflammation, while polycystic ovary syndrome (PCOS) can raise levels of bad cholesterol and triglycerides, making artery blockages more likely.

Certain risk factors affect both sexes but pose a greater danger to women. For instance, smoking increases cardiovascular risk by around 25% more in women than in men, while diabetes raises the risk by nearly 50%.

Some heart conditions also occur more frequently in women. Spontaneous coronary artery dissection, which commonly affects women in their 40s and 50s, can mimic heart attack symptoms and requires immediate medical attention. The condition occurs when a tear forms in one of the heart’s blood-supplying arteries, disrupting blood flow.

Although chest pain remains the most common heart attack symptom in both men and women, women are more likely to experience additional signs such as nausea, vomiting, dizziness, shortness of breath, and extreme tiredness. Health experts urge anyone experiencing unusual or concerning symptoms to seek urgent medical help and call triple zero (000) without delay.

Gender Bias in Diagnosis and Treatment

Despite having fewer heart attacks overall, women are more likely than men to die from one or develop serious complications such as heart failure or stroke. This disparity is partly due to women being misdiagnosed or discharged without a confirmed heart attack diagnosis. Even when heart disease is correctly identified, women often face delays in receiving appropriate treatment.

Experts say this gap exists because many diagnostic tools fail to account for female-specific risk factors, and healthcare professionals may not be sufficiently trained to recognise the less typical heart attack symptoms women experience. Addressing these gaps could significantly improve heart health outcomes for women across Australia.