Women+ Heart Health: Why Risk, Symptoms and Access to Care Are Not the Same for Everyone.
Heart disease does not affect all women+ in the same way.
Biology matters. Hormones matter. Pregnancy history matters. Menopause matters.
But so do race, culture, income, where you live, access to healthcare, experiences of discrimination, and whether the health system recognises your risk in the first place.
That is why conversations about women+ and heart health need to go beyond a simple list of symptoms.
Cardiovascular disease remains a major cause of illness and death in Australia, and the burden is not distributed evenly. Women from First Nations communities, culturally and linguistically diverse backgrounds, regional and remote areas, and lower socioeconomic communities may face additional risks or barriers to timely care.
Heart disease in women+ is still under-recognised
Chest pain remains the most common symptom of heart attack in both women and men.
However, women are more likely to also experience symptoms such as shortness of breath, nausea, dizziness, jaw, shoulder or back pain, indigestion and unusual fatigue. Women under 50 are more likely to present with symptoms other than chest pain.
These symptoms can be easier to attribute to something else — stress, anxiety, exhaustion, reflux or musculoskeletal pain.
That matters because delays in recognition can delay treatment.
Women also have some cardiovascular risk factors that are specific to, or more relevant across, different life stages. Pregnancy complications such as pre-eclampsia and gestational diabetes can increase later cardiovascular risk, while risk also rises around and after menopause.
But sex and hormones are only part of the picture.
First Nations women face a significantly higher burden
For Aboriginal and Torres Strait Islander women, cardiovascular disease risk begins earlier and the burden is higher.
The Heart Foundation reports that Aboriginal and Torres Strait Islander women are almost twice as likely as non-Indigenous women to have cardiovascular disease. Cardiovascular events such as heart attack and stroke also tend to occur around 10 to 20 years earlier in First Nations populations.
AIHW data also show that the disparity in cardiovascular disease between First Nations and non-Indigenous Australians is particularly pronounced among females. In 2023–24 and 2024, hospitalisation and death rates from cardiovascular disease were around twice as high among First Nations people overall, with the disparity generally greater among women than men.
These differences should not be reduced to individual behaviour.
They sit within a much bigger context that includes access to culturally safe care, geography, income, historical and ongoing disadvantage, racism, housing, food security and access to preventive healthcare.
Research supported by the Heart Foundation has also highlighted the importance of designing heart health services with Aboriginal women themselves, recognising cultural, spiritual, emotional, social and physical wellbeing rather than relying only on a Western biomedical model.
This is also why cardiovascular risk assessment begins earlier for First Nations people. Aboriginal and Torres Strait Islander people should have cardiovascular risk factors screened from adulthood, with formal cardiovascular risk assessment recommended from age 30.
Ethnicity can influence cardiovascular risk
Cultural and ethnic background can also influence heart disease risk.
The Heart Foundation identifies people of South Asian, Middle Eastern, Māori and Pacific Islander backgrounds among populations with increased cardiovascular risk.
But ethnicity alone does not explain outcomes.
Migration experiences, language barriers, health literacy, access to culturally appropriate services, income, employment conditions and differences in how symptoms are understood or communicated can all affect when someone seeks care and how quickly risk is identified.
This is one reason a “one-size-fits-all” approach to prevention does not work particularly well.
A person’s cardiovascular risk needs to be understood in the context of their whole life not only their blood pressure and cholesterol.
Socioeconomic disadvantage changes heart health too
Where you live and the resources available to you can have a measurable effect on cardiovascular health.
In 2024, the cardiovascular disease death rate for people living in Australia’s most socioeconomically disadvantaged areas was 1.6 times that of people living in the least disadvantaged areas. Among women, the difference was about 1.5 times.
For coronary heart disease specifically, death rates in 2024 were 1.7 times higher in the most disadvantaged areas than in the least disadvantaged areas.
The reasons are complex.
Lower socioeconomic status can affect access to:
regular GP care
preventive screening
affordable medicines
healthy food
safe places to exercise
flexible work arrangements
transport
specialist care
The Heart Foundation also notes that social exclusion and limited access to employment, healthcare and healthy food are linked with risk factors such as high blood pressure and cholesterol.
So telling people simply to “eat better and exercise more” misses much of the real picture.
Heart health is shaped by the conditions people live in.
Geography also matters
People living in regional and remote Australia also experience a higher cardiovascular burden.
AIHW data show that cardiovascular disease death rates in Remote and very remote areas were 1.4 times higher than in major cities in 2024.
For coronary heart disease, the difference can be even more marked for women. In 2023–24, coronary heart disease hospitalisation rates among women in Remote and very remote areas were 1.9 times those of women living in major cities.
Access plays a major role.
Long travel distances, fewer specialists, limited diagnostic services and delays in emergency care can all influence outcomes.
For women+ balancing work, caring responsibilities or financial pressure, these barriers can be even harder to navigate.
The danger of treating every patient as “average”
Most heart health advice is built around population averages.
But an “average” patient does not really exist.
A 48-year-old woman living in inner-city Melbourne, a 38-year-old First Nations woman in a regional community, and a 55-year-old migrant woman with limited English may all have very different cardiovascular risks, barriers and healthcare experiences.
They may also experience symptoms differently, communicate them differently and have different access to follow-up care.
Good cardiovascular care needs to recognise those differences.
It also needs to listen when a patient says something does not feel right.
What should women+ know?
There are some broad principles that apply to everyone.
Know your blood pressure.
Know your cholesterol.
Understand your family history.
Ask about cardiovascular risk if you have had pre-eclampsia, gestational diabetes or other pregnancy complications.
Take changes around menopause seriously.
And know that symptoms such as chest discomfort, shortness of breath, nausea, dizziness, jaw or back pain and unusual fatigue can all be relevant.
But the most important message is this:
Your heart health cannot be separated from the rest of your life.
Your culture, community, income, geography, reproductive history and healthcare experiences all matter.
A more inclusive approach to heart health
At Elgin House, our approach to women+ health is grounded in looking at the whole person.
Heart health is part of that conversation.
For some patients, that may mean recognising menopause or pregnancy history as part of cardiovascular risk.
For others, it may mean acknowledging the impact of cultural background, socioeconomic disadvantage or barriers to accessing care.
A more equitable approach to women+ heart health requires more than awareness.
It requires listening carefully, recognising who is at higher risk, making care more accessible and culturally safe, and understanding that not everyone enters the healthcare system with the same opportunities.
That is how prevention becomes meaningful.
And that is how fewer people get overlooked.
References
Heart Foundation Australia. Cardiovascular disease risk factors and heart attack warning signs in women. Heart Foundation
Heart Foundation Australia. Women and heart health. Heart Foundation
Heart Foundation Australia. Are you at risk of heart disease? Heart Foundation
Australian Institute of Health and Welfare. Heart, stroke and vascular disease: Australian facts. 2026. AIHW
Australian Institute of Health and Welfare. Heart, stroke and vascular disease: First Nations people. 2026. AIHW
Heart Foundation Australia. Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander peoples. Heart Foundation
Heart Foundation Australia. Understanding what keeps Aboriginal women’s hearts strong. Heart Foundation
Australian Institute of Health and Welfare. Coronary heart disease — variation by socioeconomic status and remoteness. AIHW