When Ange Foster started to feel unwell after an overseas holiday, she thought her symptoms—breathlessness, fatigue—would go away on their own. They didn’t.
“I was walking from my usual tram stop to my office when I had to sit down to catch my breath,” recalls Ange. “And I thought, this is not normal.”
Having been previously diagnosed with Hashimoto’s Disease (a condition that causes your immune cells to attack your thyroid gland) and Fibromyalgia (a condition that causes pain and extreme fatigue), Ange knew how important it was to listen to her body and take its cues seriously.
After describing her symptoms to her GP, Ange was taken to the emergency department at her local hospital.
“They told me that they were admitting me as a cardiac patient and that I was in heart failure. I said, ‘What are you talking about? Why? My heart’s fine.’”
Within 48 hours however, Ange was diagnosed with severe dilated cardiomyopathy, a condition that makes it harder for the heart to pump blood to the rest of the body.
She was 38, and like many Australians, totally unaware of the prevalence of heart disease affecting women in this country and all over the world.
Read more: Types of heart disease and their symptoms
What is heart disease?
Heart disease is a type of cardiovascular disease, like stroke or blood vessel disease. It refers to several conditions affecting the heart’s structure and function, including:
- arrhythmias
- coronary heart disease
- heart failure
- valve disease.
There are many causes of heart disease. You can be born with heart disease, or have a higher chance of developing it because of your genetics or lifestyle.
Some heart conditions, like cardiomyopathy, can have several causes, including thyroid conditions like Hashimoto’s Disease.
Fortunately, in many cases your risk of heart disease can be significantly reduced by making healthy lifestyle choices.
Heart disease in women
According to the Heart Foundation, cardiovascular disease is the leading cause of death for women globally.
Australia is no exception. In this country alone, coronary heart disease claims the lives of 20 women each day. That’s more than twice as many women in Australia who lose their lives to breast cancer.
Despite the numbers, heart disease and its risks to women continue to evade the national consciousness.
“I’d never heard about how significant heart disease is for women,” says Ange. “It shook me to my core. I think we’re conditioned to think about women’s health as being about breasts, menstrual cycles, pap smears, endometriosis… things that impact women. But as women, we have all the other organs as well.”
While it’s true that heart disease affects men in huge numbers as well, the misconception that it doesn’t (or will rarely) affect women can contribute to women going undiagnosed and undertreated.
Associate Professor Monique Watts is a cardiologist and heart failure specialist, and founder of the Women’s Heart Clinic at Melbourne’s Alfred Hospital. Correcting the narrative around women and heart disease is something she strives for every day.
“If everybody thinks that heart disease is more likely to affect a man and that it’s more of a problem for a man, women will go undiagnosed and undertreated, and sadly as a result they will have worse outcomes,” says Dr Watts. “Unfortunately, this is what we see globally, and right here in Australia. I see women who are completely shocked when they find out that they have heart disease. It’s one of the biggest barriers to women getting proper care: they don’t see themselves at risk of heart disease.”
Speaking about her decision to open the Women’s Heart Clinic, Dr Watts says: “I saw a real gap in care that to me was unacceptable. This was a gap that I could address, a problem that I could work to fix.”
Signs women may be at higher risk of heart disease
It is possible to find out your risk of heart disease. For women, there are specific signs to look out for.
“There are female-specific risk potentiators that women need to know about so that they know they can go and get help, go and get their risk assessed and see what can be done to minimise their risk [of heart disease],” says Dr Watts.
“Early menopause is a risk factor for heart disease, for instance. If you undergo menopause before 45, your risk of heart disease is higher. The earlier the menopause, the higher the risk of heart disease. So if a woman goes through menopause at 40 then she can say, ‘I know I’m at risk of heart disease because of this fact.’ And she can go to her GP and ask for a heart health check.”
Pregnancy complications – such as gestational diabetes, hypertension in pregnancy, preeclampsia, or delivering small babies or premature infants (before 34 weeks) – are another early indicator of being at higher risk of heart disease.
Read more: Women and heart disease
How to reduce your risk of heart disease
Fortunately, it is possible to significantly reduce your risk of heart disease. In Australia, 80% of cardiovascular related events are preventable.
“Heart disease is the biggest killer of Australians,” says Dr Watts. “And so much – not all of it, but so much of it – is preventable. And you can do that by looking after yourself with a healthy diet, healthy amount of exercise and avoiding smoking.”
Asking your doctor for a heart health check is one more thing that you can do to keep on top of your heart health.
“When you’re addressing your preventative health, whether it be skin checks, pap smears, mammograms or bowel cancer screening, have heart disease on the preventative health checklist,” says Dr Watts.
“It’s never too early to start looking after your heart. The early stages of many risk factors for heart disease – such as high blood pressure, high cholesterol and even diabetes – can have no symptoms. This means that despite feeling completely healthy, you may have treatable conditions that are doing your heart damage. This is the other challenge with younger people and preventing heart disease: they feel completely fine until they’re not. Heart disease often goes undetected until very late in the disease process.”
Read more: 8 tips to improve your heart health
Living with a heart condition
While most instances of heart disease can’t be cured, many people living with heart disease are able to manage their condition with treatment and lifestyle changes and live well. It’s important to remember that treatments and prognoses will vary depending on the type of heart disease a person has, as well as other health-related factors.
For Ange, adjusting to living with cardiomyopathy was complicated by her pre-existing health conditions.
“I didn’t know what my new normal was,” Ange says about her recovery from her initial hospital admission. “I kept referencing a body and a level of fitness I was never going to get back. I couldn’t even have a shower without being short of breath and having to sit down. It was really scary. Life was tough.”
Over time, with daily medication and the assistance of a cardiac rehabilitation program , Ange slowly regained confidence in her body.
Medibank Heart Health at Home
Eligible* members recovering from a cardiac-related hospital admission may be able to join Medibank Heart Health at Home, a phone-based cardiac rehabilitation program that runs over 6 to 8 weeks from the comfort of your own home. Product, clinical and eligibility criteria apply.
“I started to feel better in my physical health probably about two or three weeks into cardiac rehab,” she says. “I slowly built up my fitness again. Walking down to the post box and back again, that felt big. That was the first stage. Feeling better mentally took a lot longer.”
At the Women’s Heart Clinic, Dr Watts sees many women struggling with the emotional toll of being a woman or a young person with heart disease.
“There seems to be a lot of fear and shame associated with heart disease in women,” says Dr Watts. “I suspect this is related to the perception that heart disease is a man’s disease, or that it’s been brought on by an unhealthy lifestyle, which is not always the case.”
For Ange, feeling isolated in her diagnosis was compounded by the fact that both her and her husband’s families lived in New Zealand. Ange recalls the disconnect she felt then; although her family visited often, and she had a close group of friends around her in Melbourne, “none of them were living with three chronic health conditions.”
“It was very difficult,” Ange confesses. “I wanted to know what my prognosis was. Would I be able to return to work? What’s going to happen to my life? And everything I was reading [about heart disease] then was about older men. All I could think was: I’m a young woman, and none of this relates to me. None of the topics I was looking for were represented until I landed on Supporting Young Hearts.”
The Supporting Young Hearts program is organised by the Heart Foundation, and provides space, connection and support for young people living with a heart condition.
“Finding that was really quite important and transformational as part of my journey,” says Ange. “I finally thought, ‘Oh thank goodness, there are other young people out there like me. I’m not alone.’”
The changing state of heart health care
According to Dr Watts, health care providers need to do more to recognise women as being at risk of heart disease, to help women recognise their own risk, and to empower women to make healthy choices to minimise their risk.
Dr Watts acknowledges her “fabulous male colleagues”, but also points out that the champions of women’s heart health tend to be female cardiologists, which is why she encourages women to enter into the field of cardiology. (In Victoria, only 14% of cardiologists are women.)
“We need to show our junior doctors that we can be women and cardiologists,” says Dr Watts. “And we can have families and be cardiologists. And we can be great cardiologists and women.”
Dr Watts thinks there is still a long way to go to get heart disease on the radar for women in Australia. Slowly though, she says, some things are starting to change.
“At a health care level, there’s more literature now in our medical journals about women’s heart disease,” says Dr Watts. “We are starting bigger databases with female patients so that we can look at the particular types of disease that occurs in women and determine how best to prevent and manage them. Cardiology conferences now have sessions now on women’s cardiology, there’s research being done specifically on women – in the past that didn’t happen.
“Change needs to happen at every level though: a population level, at a health care provider level and at a policymaker level. And, of course, women need to know that they’re at risk so that they can advocate for themselves.”
Looking to the future
Today, Ange is in good health. Cardiomyopathy is a chronic condition though, and she will need to manage it and take daily medication for the rest of her life.
“There are three common themes that come up for me around this,” says Ange. “Will I be able to have children and raise my family? What’s my career going to look like? And how do I put my needs first? Those three topics, I think they’re very common for women.”
Ange remembers how lonely she felt when she was first diagnosed with cardiomyopathy in her 30s. She doesn’t want other women or young people with chronic health conditions to experience the same feelings of isolation and disconnection.
“When I was in that hospital bed, I really just wanted to be able to share my experience so that other people don’t feel like they’re alone like I did,” says Ange. “It's a hard road to travel and it can be really lonely. So that’s what motivates me: to make sure that my experience isn’t in vain, and that someone else that’s in my position can hear my story and know they’re not alone.”
Have you had a heart health check?
A heart health check is a 20-minute appointment with your GP that is designed to detect factors that may be putting the health of your heart at risk.
Heart health checks can also be used to help you make positive changes to your lifestyle habits to lower your risk and help protect against heart disease.
Heart health checks in Australia are covered by Medicare, so if you visit a GP clinic that bulk bills this service, you can get a heart health check for free.